High fluoride products: Only for children or also for teens?

Fluoride products have been recommended in the prevention of caries for kids, but they should also be considered for teenagers. There are some reasons why teenagers might be at higher risk of dental caries that the dental team should be aware of and therefore implement strategies to help address this. These include the fact that teenagers often wear fixed orthodontic appliances which makes oral hygiene more difficult and often results in patients experiencing more plaque accumulation around the bands and brackets. Studies have shown that up to 96% of teenagers who wear fixed orthodontic appliances develop white spot lesions. Teenagers tend to be non-compliant with oral hygiene requirements and their dietary habits such as frequent snacking and drinking sugar-laden drinks can promote dental caries. Good oral hygiene practices are essential, consisting of twice-daily brushing and daily interdental cleaning and teenagers may need encouragement to comply with these good oral hygiene practices.

Fluoride products, such as toothpastes, mouthwashes and in-office varnishes not only help to prevent caries, they can also arrest and reverse early caries lesions. This means that non-cavitated lesions can be managed in a non-invasive way without removing tooth structure and placing a restoration. This applies to patients of all ages, and as such they are useful for teenagers with an elevated caries risk.

Dental caries develop when bacteria metabolize sugars and other fermentable carbohydrates in our diets, producing acid that demineralizes the dental hard tissues. When fluoride is present, it is absorbed onto the enamel surface. This inhibits demineralization when an acid attack occurs. The mechanism for remineralization works because the area is supersaturated in relation to fluorhydroxyapatite, which promotes remineralization. Once remineralized, the enamel becomes more resistant to future caries challenges. At high concentrations, topical fluoride can also provide antimicrobial action and help to inhibit cariogenic bacteria in the first place.

High-level prescription fluoride pastes, varnishes and gels are recommended by the American Dental Association as well as dental associations and organizations internationally, and help to provide added protection for individuals at increased risk for dental caries. For in-office treatments, 5% percent sodium fluoride varnish, such as Colgate PreviDent varnish (Colgate Duraphat varnish), can be applied at least every three to six months. High-level prescription fluorides for home use, such as Colgate PreviDent 5000 Booster Plus toothpaste, are used on a daily basis. This 5000 ppm toothpaste has been shown to not only prevent dental caries but to remineralize white spot lesions. Use of 5000 ppm fluoride toothpaste has been shown to be more effective at preventing white spot lesions during orthodontic treatments than regular strength toothpaste.

Ensuring appropriate fluoride products are recommended and oral hygiene practices are instilled and followed in teenage years is important for caries prevention during teenage years and to help ensure future oral health in adult years.