Efficacy of non-invasive and minimally invasive techniques for the prevention/management of root caries in older adults - A literature review

Purpose

To summarize the effectiveness of non-invasive and minimally invasive root caries preventive interventions in older adults.

Methods

An electronic search was conducted in PubMed up to February 18, 2021. Only randomized controlled trials (RCTs) published in English language with root caries outcomes measured on older adults were included in this review. Studies were eligible if assessing the efficacy of either topical fluoride varnish/gel, chlorhexidine (CHX), atraumatic restorative treatment (ART), or silver diamine fluoride (SDF) to prevent and/or arrest root caries in older adults.

Results

A total of 16 RCTs were included in this review. No significant differences were found between conventional therapy with rotary instruments and ART with hand instruments in survival rates of restorations in four studies. 1% CHX varnish (every 3 months), 5% sodium fluoride (NaF) varnish (every 3 months) and 38% SDF solution applied annually in addition to OHI were more effective preventing new root caries than OHI alone over a period of 3 years (with no differences between the 3 interventions). A 0.2% neutral NaF mouth rinse used daily reduced the incidence of caries among elders in long-term facilities and performed better than 0.12% CHX. The number of new lesions in the 1.2% acidulated phosphate fluoride (APF) gel group was significantly lower than in the placebo rinse group (P < 0.05), however the fluoridated mouth rinse group had more reversed root lesions. 38% SDF solution applied annually in combination with oral health education (OHE) every 6 months was efficacious in arresting and preventing root caries among older adults. The combination of Cervitec™ (1%CHX/1% thymol varnish) and fluoride varnish was successful in arresting exisiting root caries in a group of frail older adults compareed to fluoride varnish alone.

Conclusions

Multiple minimally invasive interventions showed significant improvements in arresting and preventing root carious lesions in older adults compared to control groups, including the use of 0.2% neutral NaF mouth rinse, 1% CHX varnish, Cervitec™, APF gel and annual application of SDF combined with oral health education. However, further studies are needed to confirm these results as few studies could be found for each intervention.