Use of topical fluoride by patients receiving cancer therapy.
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The purpose of this study was to compare the effectiveness of toothbrushing followed by fluoride rinsing, fluoride gel brushing, or fluoride gel dentifrice brushing alone in controlling the demineralization that often follows orthodontic treatment. Seventy-eight consecutive adolescent patients undergoing orthodontic care were divided into 3 groups: group 1 (control) used a low-potency, high-frequency fluoride rinse; group 2 used a high-potency, high-frequency fluoride brush-on gel; and group 3 used a high-potency, high-frequency fluoride gel dentifrice. When pretreatment levels of demineralization were subtracted from posttreatment values, both gel groups displayed a significant difference (P < .05) in smooth surface demineralization sites when compared to controls. Reversal of white-spot lesions occurred in 15% of sites that exhibited pathology as a result of the fluoride and preventive regimen. These results indicate that a daily use of a 5000-ppm fluoride gel along with toothbrushing with a fluoride paste or brushing twice daily with a 5000-ppm fluoride dentifrice alone provides greater protection beyond that of tooth-brushing with a fluoride paste (1000 ppm) and rinsing with a 0.05% sodium fluoride rinse.
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The literature on the risks of dental fluorosis and the benefits from the use of fluoride dentifrices, mouthrinses and self-applied gels has been briefly reviewed. While there are several studies that have investigated the impact of dentifrices on the development of dental fluorosis, results are mixed. Although there is far less research investigating the relationship between the use of mouthrinses and dental fluorosis, the available evidence generally fails to identify this technology as one of the major causes of dental fluorosis. Although there is little direct evidence to suggest that the use of self-applied fluoride gels contributes to the development of dental fluorosis, ingestion of fluoride from these systems is of genuine concern and their use by preschool age children is not recommended.
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The twice yearly application to children's teeth of acidulated phosphate fluoride (APF) gel in dental trays preceded by a professionally rendered 'dental prophylaxis' has become the standard and most commonly used dental chairside procedure for prevention of dental caries. This study was a randomized, 3-year, community-based clinical trial of professionally applied APF gel involving the use and non-use of a prior dental prophylaxis and annual and biannual APF applications for children in age groups 6-7 (n = 176) and 10-11 (n = 153) years initially, who are likely at high risk of future dental caries. The 3-year results of this study show no significant effect on dental caries reduction of either a prior prophylaxis or annual versus biannual APF gel applications. A significant reduction in the frequency of provision of these dental services, limited to high caries risk patients only, is recommended.