New Guidelines Support Fluoride Mouthwash for Reducing Tooth Decay in Elderly Long-Term Care Residents

The American Dental Association (ADA) recently announced that applying prescription-strength fluoride directly to the tooth can benefit elderly persons at risk of tooth decay. The recommendation was included in its updated evidence-based clinical guidelines, which were published late last year.

When updating the guidelines, the ADA expert panel sought to answer two clinical questions: (1) In primary and permanent teeth, does the use of a topical fluoride agent reduce the incidence of new lesions in coronal caries, root carries, or both compared with no topical fluoride use? And (2) does the use of prophylaxis before application of topical fluoride reduce the incidence of caries to a greater extent than the application of topical fluoride without prophylaxis? Based on a synthesis of primary evidence collected by a means of de novo systemic review, the ADA recommends the following for people aged 6 years and older at risk of developing dental caries: 2.26% fluoride varnish or 1.23% fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.5% fluoride gel or paste or 0.09% fluoride mouth rinse.

Mouth rinse containing 0.09% fluoride was the only product the ADA recommended specifically for elderly persons living in long-term care facilities. This recommendation was based on the results of 10 randomized and two non-randomized clinical trials that found 0.09% fluoride mouth rinse to be safe and effective on a daily, weekly, or biweekly basis in persons aged 6 years and older. One of these randomized trials was conducted in 369 institutionalized elders. In this trial, the group receiving fluoride rinse had significantly fewer caries and more reversals from carious to sound dental surfaces at the end of a 2-year period than the group receiving a 0.12% chlorhexidine solution rinse.

Despite these evidence-based recommendations, the ADA advised that practitioners consider a patient’s risk of experiencing disease when developing an optimal caries-prevention plan. Potential harm of topical fluoride products may include nausea and vomiting associated with inadvertent product ingestion, which may be more common in older adults with swallowing difficulties.

The ADA’s guidelines were last updated in 2006. The previous guidelines were based primarily on published systematic reviews. The ADA advised that more research on caries prevention is needed in high-risk adults older than 65 years, including those in long-term care facilities, among its recommendations where further clinical research is needed. The full report can be accessed on the American Dental Association website.