Are there any approaches to caries prevention and therapy for the elderly?
This summary is based on the article published in Advances in Dental Research: Approaches to Caries Prevention and Therapy in the Elderly (September 2013)
Context
The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries.
Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population.
Purpose of the Article
This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.
Key Messages
- There are few data available to allow for evidence-based advice on strategies for personal oral health care.
- Fluoride is an effective agent in helping to prevent caries in the older person, with evidence that an increased concentration of fluoride and/or use of multiple methods of fluoride delivery is of increasing benefit.
- There is very limited evidence for the use of calcium phosphate preparations as an adjunct to a fluoride-containing toothpaste in this population, and that which is available comes from high-risk populations with xerostomia. The evidence that is available suggests significant clinical benefit.
- The use of chlorhexidine as a varnish or rinse, again as an adjunct to a fluoride-containing toothpaste, also appears to have some clinical benefit in high-risk populations.
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This article is dangerous. Not only does it mislead with the impression that fluoride is approved for high-risk adult use, it says there is evidence it does so. The truth of the matter is that there are no well controlled studies of fluoride in community dwelling adults which show a significant treatment effect. Hence, there are no fluoride products which are specifically approved for high risk adults.
By contrast, the authors need simply examine what has been approved by the drug approval authorities in Europe and Canada to see what works safely and effectively in preventing caries in high risk adults. The only such treatment achieving this distinction is Prevora (100mg/ml chlorhexidine).
Prevora’s controlled studies are available in Gerodontology (2000) and Acta Odont Scand (2014) and on the website, http://www.partnersinprevention.ca
It is time that the dental community looked to what is approved, not what tradition offers.
Finally, the aging population’s biggest barrier to dentistry is affordability. By targeting painless, truly effective, evidence-based care to this cohort, the dental fraternity just might encourage attendance and compliance.
Time for some fresh thinking folks!
Dr Perry: The benefits of fluoride for caries prevention are taught to first year dental students. The merits of fluoride use are well documented.
According to a joint statement of the FDI and the WHO, “Fluoridation reaches all residents in a community and reduces the risk of tooth decay. It benefits our most vulnerable individuals, including our children, our low and moderate income individuals, and our seniors (Reference). The World Health Organization (WHO) considers access to fluoride to be “part of the basic human right to life” (Reference).
Why wouldn’t fluoride “be approved for high-risk adult use”? They are precisely one of the vulnerable groups who would most benefit from it’s use.
You quote studies on the use of Prevora from a website which is owned by prevora. I am not in a position to comment on the merits of prevora, but i take great offense to your comments that the use of fluoride is “dangerous” and that prevora should replace this lost cost public health measure.
As to your assertion that fluoride is “not approved”, i draw your attention to the Health Canada website which states: “The use of fluoride for the prevention of dental cavities is endorsed by over 90 national and international professional health organizations including Health Canada, the Next link will take you to another Web site Canadian Public Health Association, the Next link will take you to another Web site Canadian Dental Association, the Next link will take you to another Web site Canadian Medical Association, the Next link will take you to another Web site US Food and Drug Administration and the Next link will take you to another Web site World Health Organization.”
I have no financial interest nor conflict of interest in the manufacturing or distribution of any fluoride or fluoridated product, or Prevora.
Do you?
Respectfully,
dr sheryl p .lipton