As healthcare professionals it is important that we are constantly looking for the best possible care for our patients. This philosophy should guide us while we are treating our patients as well as in the product recommendations we make for at-home use. We rely on research, expertise and the patient’s needs and preferences to do what is best. This is Evidence-Based Dentistry (EBD). The vision of the ADA Center for Evidence-Based Dentistry is to “To lead in the promotion of oral health by disseminating the best available scientific information and helping practitioners implement it into clinical practice.” The ADHA also advocates for evidence-based practice, and "patient-centered outcomes research that focuses on preventive and oral health interventions leading to improved health outcomes, quality care and increased patient satisfaction in all practice settings."
Every practice is different. Our goal should be the same. We should always be doing what is best for our patients while caring for them. Our philosophies should be aligned to do what’s best, while still caring for patients within the office guidelines. EBD isn’t promoting any specific brand. It is meant to provide research-based information on materials, purpose and treatment efficacy. A hierarchy also exists in terms of the strength of the evidence for various types of research, with systematic reviews being the strongest, followed by randomized, controlled clinical trials.
For example, the benefits of fluoride applications as caries preventives has been discussed for years. We know the actual purpose of fluoride is to prevent and manage caries, by preventing/reducing demineralization and promoting remineralization. This has been proven clinically and has been researched for patients in all age groups, application, vehicle, frequency, types and concentration of fluoride. The efficacy of periodic applications of 5% sodium fluoride varnish and twice-daily use of fluoride toothpaste, as well as the efficacy of high-level fluorides when needed, has been thoroughly researched.
Based on the available evidence, topical fluoride varnish application is recommended every 3 to 6 months for patients of all ages who are at increased risk for caries. It is also recommended as a noninvasive treatment for noncavitated carious lesions on coronal surfaces in permanent and primary teeth. Similarly, for home care, brushing with 5,000 ppm once daily (instead of toothpaste) is a recommended preventive treatment for our patients age 6 and over, and also recommended for the noninvasive treatment of root caries. Since our patients vary in their risk for caries and a patient's risk level can change, it’s important to evaluate each patient who comes into the office and at each evaluation to see if there have been any changes in oral health and risk level for oral disease. Let's suppose a patient presents with an increased risk for caries. We can then recommend additional fluoride therapy based on the evidence and evidence-based recommendations. The topical fluoride varnish can give a boost of fluoride, and a high-level prescription fluoride, such as Colgate PreviDent 5000 Booster Plus, will provide increased protection against caries on a daily basis. We should also provide dietary recommendations on reducing sugar intake and snacking.
Fluoride has great benefits, however there’s no reason to provide fluoride varnish to patients no identifiable need or risk. Evaluating every patient, listening to their concerns and reviewing their dental history, together with access to evidence-based recommendations, will allow us to make the best decisions and recommendations for each patient.