Prevention of root caries: a literature review of primary and secondary preventive agents

Spec Care Dentist. May-Jun 2013;33(3):133-40. doi: 10.1111/j.1754-4505.2012.00318.x. Epub 2012 Dec 10.


Purpose: This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly.

Method: Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010.

Results: In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%.

Conclusion: For 1° prevention of root caries the recommended "best choice" is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended "best choice" is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Calcium Phosphates / therapeutic use
  • Cariostatic Agents / therapeutic use*
  • Chlorhexidine / therapeutic use
  • Dental Care for Aged*
  • Fluorides, Topical
  • Humans
  • Middle Aged
  • Pit and Fissure Sealants / therapeutic use
  • Prevalence
  • Primary Prevention
  • Quaternary Ammonium Compounds / therapeutic use
  • Root Caries / epidemiology*
  • Root Caries / prevention & control*
  • Secondary Prevention
  • Silver Compounds
  • Sodium Fluoride / therapeutic use
  • Xylitol / therapeutic use


  • Calcium Phosphates
  • Cariostatic Agents
  • Fluorides, Topical
  • Pit and Fissure Sealants
  • Quaternary Ammonium Compounds
  • Silver Compounds
  • amorphous calcium phosphate
  • Sodium Fluoride
  • silver diamine fluoride
  • Chlorhexidine
  • Xylitol