Strategies for preventing caries | Oral Health Foundation

Preventing and managing dental caries in patients can fall under many categories. These are:

• Preventing new caries lesions from appearing

• Preventing existing lesions from advancing further

• Preserving tooth structure with

• Non-operative care at more initial stages

• Conservative operative care at more extensive caries stages

• Managing caries risk factors

• Being alert to changes at both tooth and patient risk levels through periodic monitoring

• Improving health outcome for patients 

Improving the oral health routine and diet

Every patient should be educated in how to care for their teeth and gums.  The dental team should be in charge of helping patients understand what is involved in an effective daily routine. ¹

This includes oral hygiene practices such as toothbrushing with a 1450ppm fluoride toothpaste last thing at night and at one other day during the day.  Patients should also be encouraged to clean in between their teeth interdentally once a day. ¹

For those patients at higher risk of caries, a fluoride mouthwash may be advised.  Patients should be urged to use mouthwash once a day, at any time in between brushes. ¹

Patient groups at high risk of caries, or with previous history of caries should also be advised to reduce the amount and frequency of sugar (carbohydrate) consumption. ¹  This includes limiting sugar consumption to mealtimes and being discouraged from unhealthy snacking.

Another behaviour habit that can help patients at increased risk of caries include chewing sugar free gum with xylitol. This can help promote saliva flow. ²

High fluoride toothpaste

Prescription high fluoride toothpaste is a simple, evidenced-based means for helping prevent dental caries in adolescents and adults. ^{3, 4, 5}  It is particularly advised for patients at risk from multiple caries (coronal and/or root caries). ^{4, 6} 

High fluoride toothpaste is an evidenced-based method of early intervention. ¹

It is a proactive solution for those patients at multiple caries risk ^{4, 5, 6} that have had interrupted care due to lockdown, to help avoid caries deterioration.

Public Health England’s ‘Delivering Better Oral Health’ advises prescription high fluoride toothpaste at 5000ppm for patients over 16 years old at high risk of caries, either at present or in the future. ¹

Learn more about prescribing high fluoride toothpaste here: High fluoride toothpaste on prescription [hyperlink]

High fluoride varnish

Fluoride varnish 2.2% NaF (sodium fluoride) treatments are more often applied to children who are at risk of caries, or who have active caries.  However, many peer reviewed studies show that caries in adults is comparable to that of young people. ⁷

As a result, Delivering Better Oral Health recommends the use of professionally applied topical fluorides for all ages.   Adults with obvious current active caries, dry mouth, those with special needs, or with other caries risk factors, are all advised to undertake twice-yearly fluoride varnish treatment. ¹

Fluoride varnish is one of the best options for increasing the availability of topical fluoride, regardless of the levels of fluoride in the water supply.   There is also high-quality evidence of the caries-preventive effectiveness of fluoride varnish in both permanent and primary dentitions. ¹

Any patient who has been diagnosed with decay over the last 24 months should be considered at increased risk for caries and can be considered for high fluoride varnish treatment. ⁸

Clinicians should be aware that there are many fluoride varnishes on the market that may not be licensed for caries control, although they may have similar formulations. This should be taken into consideration with respect to prescriber’s responsibilities. ¹  Colgate® Duraphat® Varnish is the only medically licensed (Prescription Only Medicine, POM) varnish which has been clinically proven for the prevention of caries. ⁹

Pit and fissure sealants

Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces.  Sealants act to prevent bacteria growth that can lead to dental decay. ³

A sealant is a protective composite coating, which is applied to occlusal surfaces of molars.  The sealant forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the teeth and causing decay. ¹⁰

It is recommended that pit and fissure sealants be applied to moderate or high caries risk children. ³

You can tell patients which teeth are being sealed after you have examined them and checked whether the fissures are deep enough for sealing to help.  Some teeth naturally have deep grooves which will need to be sealed; others have shallow ones which will not need sealing. ¹⁰

Sources

1. Public Health England (2017) ‘Delivering better oral health: an evidence-based toolkit for prevention’, Third Edition, UK.
2. Newton JT, Awojobi O, Nasseripour M, et al. A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries. JDR Clinical & Translational Research. 2020;5(3):214-223. doi:10.1177/2380084419887178
3. Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017 Jul 31;7(7):CD001830. doi: 10.1002/14651858.CD001830.pub5. PMID: 28759120; PMCID: PMC6483295.
4. Colgate-Palmolive (U.K.) Ltd (2020) ‘Summary of Product Characteristics’, Duraphat 5000ppm fluoride toothpaste. Online at https://mhraproducts4853.blob.core.windows.net/docs/993ca2d10345c940c4649fd8c98042f68fe00d51
5. Colgate-Palmolive (U.K.) Ltd (2014) ‘Duraphat® 5000ppm Fluoride Toothpaste’, Package Leaflet: Information for the user, online at https://mhraproducts4853.blob.core.windows.net/docs/f7686217b083fc71959d19152bb6eab6ea5dad82.
6. Colgate-Palmolive (U.K.) Ltd (2020) ‘Summary of Product Characteristics,’ Duraphat 2800ppm fluoride toothpaste. Online at https://mhraproducts4853.blob.core.windows.net/docs/c0e452136f37b21ae14dae330bc55c62b0e931fb
7. Thomson WM. Dental caries experience in older people over time: what can the large cohort studies tell us? Br Dent J. 2004;196(2):89-92.
8. ADA Scientific Panel issues evidence-based clinical recommendations: Patients at elevated risk for developing cavities benefit from applying topical fluoride. American Dental Association website. https://www.ada.org/en/press-room/news-releases/2013-archive/november/ada-scientific-panel-issues-evidence-based-clinical-recommendations. Published November 01, 2013.
9. Colgate-Palmolive (U.K.) Ltd (2020) ‘Colgate® Duraphat® Varnish 50mg/ml Dental Suspension’, online at https://www.colgateprofessional.co.uk/products/products-list/colgate-durphat-varnish-50-toothpaste, accessed October 2020.
10. Oral Health Foundation (2020) ‘Pit and fissure sealants’, online at https://www.dentalhealth.org/pit-and-fissure-sealants, accessed October 2020.