Topical Fluorides in Caries Prevention and （局部氟化物预防龋齿）.pdf

Topical Fluorides in Caries Prevention and Management: A North American Perspective Ernest Newbrun, D.M.D., Ph.D. Abstract: A review of evidence-based literature indicates incomplete evidence for the efficacy of most measures currently used for caries prevention, with the exception of fluoride varnishes and the use of fluoride-based interventions for patients with hyposalivation. Not all fluoride agents and treatments are equal. Different fluoride compounds, different vehicles, and vastly different concentrations have been used with different frequencies and durations of application. These variables can influence the clinical outcome with respect to caries prevention and management. The efficacy of topical fluoride in caries prevention depends on a) the concentration of fluoride used, b) the frequency and duration of application, and, to a certain extent, c) the specific fluoride compound used. The more concentrated the fluoride and the greater the frequency of application, the greater the caries reduction. Factors besides efficacy, such as practicality, cost, and compliance, influence the clinician’s choice of preventive therapy. For noncavitated smooth surface carious lesions in a moderate caries-risk patient, the appropriate fluoride regimen would be semiannual professional topical application of a fluoride varnish containing 5 percent NaF (22,600 ppm of fluoride). In addition, the patient should use twice or thrice daily for at least one minute a fluoridated dentifrice containing NaF, MFP, or SnF2 (1,000-1,500 ppm of fluoride), and once daily for one minute a fluoride mouthrinse containing .05 percent NaF (230 ppm of fluoride). If the noncavitated carious lesion involves a pit or fissure, the application of an occlusal sealant would be the most a