Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review

J Dent. 2022 Oct:125:104273. doi: 10.1016/j.jdent.2022.104273. Epub 2022 Sep 1.


Objective: To assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults.

Data/sources: Two independent researchers searched the English literature published up to 31st Dec 2021 in five databases (PubMed, Scopus, the Cochrane Library, EMBASE, and Web of Science) for clinical trials with a comparison group on professionally applied fluoride therapy for caries prevention or arrest at older adults aged ≥60 years with any follow-up period. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate. The Cochrane guidelines were used for the risk of bias assessment.

Study selection/results: Five hundred and twenty-seven studies were identified, and seven studies were finally included. Five studies were rated as having 'low risk'. The root caries-prevented fraction of 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride (APF) gel were 25-71%, 64%, and 32%, respectively. Meta-analysis indicated a decrease in the number of new root caries by 0.55 (95% CI: 0.32-0.78; p < 0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33% to 49%; p < 0.001) after receiving 38% SDF application at the 24-month follow-up.

Conclusions: According to the findings, 5% NaF varnish and 1.23% APF gel prevented root caries, whereas 38% SDF solution prevented and arrested root caries in older adults. More well-designed clinical trials should be conducted to investigate various methods in caries prevention and arrest in older adults.

Clinical significance: Preventive measures effective in other age groups may not suit older adults, as caries type and associated risk factors vary. To date, no systematic review has evaluated professionally applied fluoride therapy in older adults. Evidence from clinical trials in older adults could aid clinical practice and public health measures. The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42022307025.

Keywords: Caries; Elderly; Older adults; Oral health; Prevention; Silver diamine fluoride.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Acidulated Phosphate Fluoride
  • Aged
  • Cariostatic Agents / therapeutic use
  • Dental Caries* / drug therapy
  • Dental Caries* / prevention & control
  • Fluorides / therapeutic use
  • Fluorides, Topical / therapeutic use
  • Humans
  • Quaternary Ammonium Compounds / therapeutic use
  • Root Caries* / drug therapy
  • Root Caries* / prevention & control
  • Silver Compounds
  • Sodium Fluoride / therapeutic use


  • Acidulated Phosphate Fluoride
  • Cariostatic Agents
  • Fluorides
  • Fluorides, Topical
  • Quaternary Ammonium Compounds
  • Silver Compounds
  • silver diamine fluoride
  • Sodium Fluoride