Professionally Applied Topical Fluoride: Evidence-Based Clinical Recommendations
American Dental Association Council on Scientific Affairs
Abstract: With the dramatic increase in the amount of scientific information available about oral health, an evidence-based approach to oral health care and the practice of dentistry is necessary. There is a need to summarize,critique, and disseminate scientific evidence and to translate the evidence into a practical format that is used easily by dentists. The evidence-based clinical recommendations in this report were developed by an expert panel established by the American Dental Association Council on Scientific Affairs that evaluated the collective body of scientific evidence on the effectiveness of professionallyapplied topical fluoride for caries prevention. The recommendations are intended to assist dentists in clinical decision making. MEDLINE and the Cochrane Library were searched for systematic reviews and clinical studies of professionally applied topical fluoride—including gel, foam, and varnish—through October 2005. Panelists were selected on the basis of their expertise in the relevant subjectmatter. The recommendations are stratified by age groups and caries risk and indicate that periodic fluoride treatments should be considered for both children and adults who are at moderate or high risk of developing caries. Included in the clinical recommendations is a summary table that can be used as a chairside resource. The dentist, knowing the patient’s health history and vulnerability tooral disease, is in the best position to make treatment decisions in the interest of each patient. These clinical recommendations must be balanced with the practitioner’s professional expertise and the individual patient’s preferences. Address reprint requests to the American Dental Association Council on Scientific Affairs, 211 E. Chicago Ave., Chicago, IL 60611. Key words: fluoride, caries, cariesprevention, evidence-based dentistry, clinical recommendations
he American Dental Association (ADA) defines the term “evidence-based dentistry” as follows: “Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence relating to the patient’s oral and medical condition andhistory, with the dentist’s clinical expertise and the patient’s treatment needs and preferences.” In adopting this definition for EBD, the ADA recognizes that treatment recommendations should be determined for each patient by his or her dentist and that patient preferences should be considered in all decisions. Dentists’ experience and other circumstances, such as patients’ characteristics, alsoshould be considered in treatment planning. EBD does not provide a “cookbook” that dentists must follow, nor does it establish a standard of care. Figure 1 lists definitions of terms commonly used in evidencebased dentistry. What are evidence-based clinical recommendations? Evidence-based clinical recommendations are
developed through evaluation of the collective body of evidence on aparticular topic to provide practical applications of scientific information that can assist dentists in clinical decision making. The best available scientific evidence is objectively assessed and used to develop clinical recommendations based on the currently available science. The clinical recommendations are graded according to the strength of the evidence that forms the basis for the recommendation.It is important to note that the grade of the recommendation is not related to the importance of the recommendation, but rather reflects the quality of scientific evidence to support the recommendation. These recommendations are offered with the understanding that the dentist, knowing the patient’s health history and vulnerability to oral disease, is in the best position to make treatment...