Dental caries is the most common chronic disease in children and adolescents, but we know that it’s not just young people who are affected. With 9 in 10 American adults ages 20 to 64 years-of-age affected by dental caries, and a prevalence of 96% among older adults, dental caries is clearly a problem that affects all ages. In this article, we discuss the risk factors that dental students should look for and explore the role of fluoride varnish in adult caries prevention and management.
The American Dental Association (ADA) defines dental caries as “a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues.” Left untreated, dental caries can lead to destruction and loss of the tooth structure.
According to the ADA’s Caries Risk Assessment guidance, risk factors for dental caries include:
Insufficient fluoride exposure
Poor oral hygiene
Unhealthy dietary behaviors (e.g., high sugar consumption, frequent snacking).
Special Health Care Needs (e.g., physical disability).
Clinical conditions (e.g., xerostomia)
For individuals up to 14 years-of-age caries experienced in the prior 6 months by the immediate family (mother, caregiver and/or siblings) is also a risk factor
Both the ADA and the International Caries Detection and Assessment System (ICDAS) Foundation offer extensive guidance to help you accurately assess caries risk, classify diagnosed dental caries, and determine the likelihood of progression.
Identifying your patient’s caries risk level will inform your prevention or management plan going forward. Further, frequent monitoring of their risk level will help you to evaluate whether or not your interventions are achieving the desired outcome, allowing you to adjust your approach where necessary.
In 2013, the ADA Council on Scientific Affairs reviewed the available evidence. Based on their review, one of their recommendations was 5% sodium fluoride varnish. Fluoride varnish, such as Colgate® PreviDent® Varnish, is effective for caries prevention in all age groups.
For those at moderate risk of developing caries, the ICDAS Foundation recommends professional application of fluoride varnish twice a year. For those at high risk, they suggest increasing the frequency of application to four times a year.
Fluoride varnish is also recommended to arrest or reverse non-cavitated lesions in both primary and permanent teeth. In their evidence-based clinical guidelines, the ADA recommends that dentists prioritize the use of:
Sealants plus 5% sodium fluoride varnish on occlusal surfaces.
5% NaF varnish on approximal surfaces.
5% NaF varnish or 1.23% APF gel on facial or lingual surfaces.
Preventing, arresting or reversing dental caries has obvious benefits for our adult patients; they can avoid the growing discomfort of caries as the disease progresses, reduce the likelihood of invasive restorative treatments, and preserve their natural smile.
As a method of delivery, fluoride varnishes like Colgate® PreviDent® Varnish strike a very desirable balance between ease-of-use and effectiveness. Meanwhile, patients appreciate that the varnish applies and sets very quickly, has a pleasant taste, and dries to an inconspicuous enamel color.
When we take a pro-active, prevention-led approach to dental caries in adults, everybody wins. We help our adult patients maintain their oral health, which can increase patient satisfaction and our relationship with them. Fluoride varnish is a key way we can achieve this, so consider adding it to your caries management toolkit today.