Methods of topical fluoride application in the arrest of root carious lesions of adults and elderly patients: A Systematic Review with Network Meta-Analysis.

Objective: This systematic review evaluated the most effective strategy for the topical application of fluoride in arresting active root caries lesions in adults and elderly patients.

Methods: Databases were searched to identify randomized controlled trials (RCTs) involving adults or elderly patients who presented carious lesions on the root surface of permanent teeth and were exposed to any strategy for the topical application of fluoride. The outcome considered was the arrest of root carious lesions. The risk of bias assessment was performed with the RoB 2.0 tool. Network (NMA) and pairwise meta-analyses were performed for a follow-up of 6 months.

Results: Thirteen RCTs were included in the review. Three studies (907 teeth) were included in the NMA for a 6-month follow-up. All strategies (Conventional dentifrice - CD, High concentration dentifrice - HCD, Dentifrice with ingredient addition -DIA) showed the highest efficacy for caries lesion arrestment than NAC (non-fluoride dentifrice). On the other hand, no difference was observed between CD vs. HCD and HCD vs. DIA. DIA showed higher efficacy for caries lesion arrestment than CD. Among the 13 RCTs included, two studies present an overall high risk of bias, and the majority (n=11) presented some concerns. The certainty of evidence was graded from low to very low.

Conclusion: Fluoride dentifrices, regardless of formulation, were more effective than non-fluoride controls in arresting active root carious lesions in adults and elderly patients at 6 months. Dentifrices with added active ingredients showed the highest probability of being the most effective strategy. However, these findings should be interpreted cautiously due to the low to very low certainty of evidence.

Clinical Significance: This study reinforces the importance of recommending fluoride-containing dentifrices in clinical practice for managing active root caries lesions, particularly in adults and elderly patients. Dentifrice with ingredient addition (DIA) showed the highest efficacy compared to conventional dentifrice and suggests that the addition of specific ingredients (e.g., arginine, stannous fluoride, xylitol) may enhance the anticaries effect of fluoride.