Fluoride for adults

➡️For coronal caries prevention in adults older than 18:

·   Apply 2.26 % fluoride varnish years at least every three to six months for adults at risk of developing dental caries in a clinical setting.

(Conditional recommendation, low certainty evidence ^5,6)

·  Apply 1.23 % acidulated phosphate fluoride (APF) gel for four minutes at least every three to six months in a clinical setting.

(Conditional recommendation, low certainty evidence^7-9) 

·   Apply home-use 0.09 % fluoride mouthrinse at least weekly.

 (Good practice statement)

· Apply home-use 0.5 % fluoride gel or paste twice daily.

 (Good practice statement)

➡️For root caries prevention in adults:

·   Apply 2.26 % fluoride varnish at least every three to six months in a clinical setting. 

(Conditional recommendation, low certainty evidence^7-9)  

·   Apply 1.23 % acidulated phosphate fluoride (APF) gel for four minutes at least every three to six months in a clinical setting.

 (Good practice statement)

·  Apply home-use 0.09 % fluoride mouthrinse daily.

(Good practice statement)

·  Apply home-use 0.5 % fluoride gel or paste twice daily.

 (Good practice statement)

➡️Remarks: Adults with a history of frequent caries or those with reduced salivary flow should consider application of 2.26% fluoride varnish or 1.23% acidulated phosphate fluoride (APF) gel in a clinical setting or using prescription-strength fluoride products at home, such as 0.5% fluoride gel or paste and 0.09% fluoride mouthrinse. The recommendations for adults are based on expert opinion due to the lack of direct evidence specifically for this age group. Therefore, the panel judged that the benefits of these fluoride applications outweigh the potential for harm. However, these recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

➡️Summary of evidence: Evidence supports the efficacy of fluoride gel in reducing caries in adults with history of caries or high caries risk. Clinical trials have shown that fluoride varnish significantly reduces the incidence of dental caries in adults, particularly those with root caries or high caries risk.^{5, 6} Evidence from studies on children and adolescents suggests a benefit of Acidulated Phosphate Fluoride gel (1.23% APF) application twice per year for four minutes.^7-9 The panel extrapolated these findings to adults in preventing both coronal and root caries. Regarding the use of prescription-strength fluoride products at home, such as 0.5% fluoride gel or paste and 0.09% fluoride mouthrinse; limited studies have demonstrated the effectiveness of these products in high-risk adult populations or adults with exposed root surfaces, but studies in younger populations and expert opinion support their use.

➡️Rationale for the recommendation: Professionally applied fluoride varnish provides a high concentration of fluoride directly to the teeth, enhancing remineralization and inhibiting demineralization, which is especially beneficial for adults with exposed root surfaces.⁴ In addition, professional application of fluoride gel ensures a controlled and concentrated dose of fluoride, which can be particularly beneficial for adults with a history of caries or those undergoing orthodontic treatment. Home-use fluoride products allow for regular, sustained exposure to fluoride, which is crucial for ongoing caries prevention, especially in adults with exposed root surfaces or with higher caries risk due to factors like dry mouth or previous dental work.