What is the recommended application of fluoride paste after teeth cleaning for preventing dental caries?

Fluoride Application After Teeth Cleaning for Preventing Dental Caries

Fluoride-containing paste used during dental prophylaxis (cleaning) is not an adequate substitute for fluoride gel or varnish in preventing dental caries, especially for high-risk individuals. 1

Effectiveness of Fluoride Paste After Cleaning

• Fluoride paste used during dental prophylaxis typically contains 4,000-20,000 ppm fluoride and might restore the concentration of fluoride in the surface layer of enamel removed by polishing 1
• However, this fluoride paste is not accepted by the FDA or ADA as an efficacious way to prevent dental caries 1
• Professional tooth cleaning solely to prepare teeth for application of a fluoride compound is unnecessary; toothbrushing and flossing appear equally effective in improving the efficacy of high-concentration fluoride compounds 1

Recommended Fluoride Applications for Caries Prevention

For General Population:

• Daily use of fluoride toothpaste (1,000-1,100 ppm fluoride) is the primary recommendation for caries prevention, with brushing twice daily being the standard recommendation 1
• Persons aged >6 years can retain more fluoride in the mouth by either rinsing briefly with a small amount of water or not at all after brushing 1
• The combined use of fluoride toothpaste and fluoridated water offers protection above either used alone 1, 2

For High-Risk Individuals:

• Professionally applied fluoride products should be targeted to persons at high risk for dental caries 1
• Fluoride varnish (2.26% sodium fluoride or 0.1% difluorsilane) applied semiannually is as effective as professionally applied fluoride gel 1
• Fluoride varnish has practical advantages including ease of application, non-offensive taste, and use of smaller amounts of fluoride than required for gel applications 1, 3
• Fluoride gel (1.23% acidulated phosphate fluoride or 0.9% sodium fluoride) applied semiannually has been shown to decrease caries experience by an average of 26% in children residing in non-fluoridated areas 1

Age-Specific Recommendations

For Children Under 6 Years:

• Parents and caregivers should consult a dentist or other healthcare provider before introducing fluoride toothpaste to children aged <2 years 1
• For children aged <6 years, use only a pea-sized amount (approximately 0.25 g) of fluoride toothpaste to reduce risk of enamel fluorosis 1
• Fluoride varnish is preferred for high-risk young children as it has no published evidence of being a risk factor for enamel fluorosis 1

For Children and Adolescents:

• Standard concentration fluoride toothpaste (1,000-1,100 ppm) reduces caries experience by 15-30% 1, 4
• Higher concentration toothpaste (1,500 ppm) may be slightly more efficacious and might benefit persons aged >6 years at high risk for dental caries 1, 4

For Adults:

• Fluoride toothpaste (1,000-1,100 ppm) reduces DMFS increment compared to non-fluoride toothpaste 4
• Teeth remain susceptible to caries throughout life, and topically applied fluorides can be effective in preventing caries in susceptible patients of any age 1, 2

Clinical Application Guidelines

• For high-risk individuals, professionally applied fluoride gel or varnish is recommended after cleaning 3
• Fluoride varnish may be preferred over gel because it is easier to apply, reduces the risk of fluoride over-ingestion, and has greater patient acceptance 3
• Frequency of professional fluoride application depends on caries risk, typically every 6 months 3
• A cleaning or prophylaxis is not necessary before the application of topical fluoride for caries prevention 3

Combinations of Fluoride Modalities

• The effectiveness of combining different fluoride modalities in preventing dental caries is partially additive 1
• The percent reduction in caries from a combination of modalities is higher than from each modality alone, but less than the sum of the percent reductions 1
• The evidence for the combined use of two modalities of fluoride application compared to a single modality is still inconsistent 5

Important Considerations and Cautions

• Know the fluoride concentration in the primary source of drinking water as this affects decisions about other fluoride modalities 1
• For children aged <6 years, supervise toothbrushing to minimize swallowing of toothpaste 1
• In areas where natural fluoride concentration is >2 ppm, children aged <8 years should use alternative sources of drinking water to reduce risk of enamel fluorosis 1