Non fluoride caries-preventive agents: evidence-based clinical recommendations

As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

The authors presented evidence-based clinical recommendations regarding the use of non-fluoride caries-preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of non-fluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries.

Types of Studies Reviewed

A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of non-fluoride caries-preventive agents.

Results of the study were:

The panel included 71 published articles whose authors described 50 randomized controlled trials (RCTs) and 15 nonrandomized studies to assess the efficacy of various non-fluoride caries-preventive agents. (Some clinical studies were published as multiple articles.) Only six of these studies were conducted in the United States. Although most studies were conducted in communities with low levels of fluoride in the water supply, participants often used fluoridated toothpaste, received regular dental care that included in-office fluoride therapies or both.

Thus, the researchers concluded that After conducting a comprehensive review of the literature, the panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults who are at higher risk of experiencing caries. The panel found at least 10 ongoing clinical trials that may in the future provide additional evidence for or against the effectiveness of many of these modalities. Therefore, on the basis of available evidence, the panel recommended sucrose-free chewing gum (containing either xylitol only or polyol combinations) or xylitol lozenges for caries prevention. In addition, the panel found that a 1:1 mixture of chlorhexidine-thymol varnish may be efficacious in the prevention of root caries.

Reference:

Non fluoride caries-preventive agents: Executive summary of evidence-based clinical recommendations by Michael P. Rethman, et al. published in The Journal of the American Dental Association.

https://jada.ada.org/article/S0002-8177(14)62481-8/fulltext