Caries Management by Risk

Assessment (CAMBRA):




Week 4 Part 1
Fluoride in the Dental Office and by
Prescription
Office-Applied Fluoride Products
Gel (> 5,000 ppm F)
and Fluoride Varnish
Do not require continuing patient
compliance
Forms slowly soluble calcium fluoride-like
deposits in lesions and the plaque
Gives slow release fluoride for several
weeks
Three times a year for high risk patients
Evidence-based Clinical Recommendations:
Professionally Applied Topical Fluoride
The Council on Scientific Affairs, American
Dental Association
May, 2006

Fluoride gel applied for 4 minutes or more is
effective
Fluoride varnish applied every 6 months is effective
Two or more applications of fluoride varnish per
year are effective in high caries risk individuals
Office topical applications no added benefit for low
risk individuals
Protective Factors
Weintraub et al, J Dent Res, 2006. Fluoride
varnish in infants (approx 2 years old at start)
Fluoride Varnish for High Risk of All Ages
White Vanish Varnish 3M ESPE Prev Care
501 Children, 9.1 years old, China, using fluoride
toothpaste
Four groups: a) sealant, b) F varnish 6 mths,
c) Silver Diamine F, d) placebo control (water)
Pit/fissure sites with dentin caries at 24 months
Sealant 1.6 %
NaF varnish 2.4 %
Silver DF 2.2 %
Control 4.6 % - significantly different
J Dent Res 91:753-758, 2012
5000 ppm F vs 1450 ppm F (as NaF) toothpaste
Caries incidence and caries progression
Compliance assessed
Prevented fraction 40%: 5,000 ppm versus 1450 ppm F
Caries still progressed in many, even with high
concentration fluoride
High concentration fluoride products for high
risk patients. Proven effective for root caries.
Clinpro 5000 1.1% NaF Dentifrice
3M ESPE
Contains Tri-calcium phosphate
High concentration fluoride (5,000 ppm
F)toothpaste not available in some countries.
Can use high concentration gel instead.
In Italy, for exmple, you could use Elmex
Gelee, 12,500 ppm F Once a day
Conclusions - Fluoride
The anti-caries effects of fluoride are
primarily topical (surface) in plaque
The systemic benefits of fluoride are
minimal
Therapeutic levels of F can be achieved
from drinking water and fluoride products
Fluoride therapy may not overcome a high
bacterial challenge
Calcium Phosphopeptide:
CPP/ACP

Laboratory studies: Three decades
Clinical Studies: clinical evidence
Representation of a proposed
CPP-ACP complex
Cross et al. 2007 Curr PharmDes,
MI Paste Plus
Has Fluoride

Marketed Also
as Tooth
Mousse
The Caries Balance
Protective Factors
Saliva flow and components
Fluoride, calcium, phosphate:-
remineralization
Antibacterials:- chlorhexidine,
xylitol, new?

No Caries
Caries
Pathological Factors
Acid-producing bacteria
Frequent eating/drinking
of fermentable carbohydrates
Sub-normal saliva flow and
function
Why would we prescribe a 5,000
ppm fluoride toothpaste rather than
a 1,000 ppm or 1450 ppm one?
5,000 ppm F toothpaste has been proven
clinically superior for high caries risk
It is likely that 5000 ppm F will work better
based on laboratory experiments
The 5000 ppm F toothpaste most likely has
antibacterial properties
All of the above
Why would we prescribe a 5,000
ppm fluoride toothpaste rather than
a 1,000 ppm or 1450 ppm one?
5,000 ppm F toothpaste has been proven
clinically superior for high caries risk
It is likely that 5000 ppm F will work better
based on laboratory experiments
The 5000 ppm F toothpaste most likely has
antibacterial properties
All of the above