Topical fluoride: JADA to run new recommendations
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Posted June 21, 2006 |
By Jennifer Garvin An evidence-based approach is the fuel for the ADA Council on Scientific Affairs new clinical recommendations for professionally applied topical fluoride.
The recommendations will appear in the August issue of The Journal of the American Dental Association.
The new evidence-based clinical recommendations represent a different approach than has been used in the past. This process involves analyzing and weighing the scientific data to support each specific recommendation. For example, the chart in the August JADA classifies the strength of each recommendation, leaving it up to the dentist to make a decision based on the practitioner's clinical expertise and the patient's preferences.
"This is unique to the evidence-based process and provides very important information that a dentist can use when making decisions about patient treatments," said Dr. Dan Meyer, associate executive director, ADA Division of Science.
Future council recommendations also will be developed through an evidence-based approach, said Dr. Amid I. Ismail, CSA chair.
"The process for developing clinical recommendation relies on the best available evidence; opinions and analysis of dental experts in the field of fluoride research; and commentaries and suggestions from dentists and dental organizations," Dr. Ismail said. "The EBD approach will be used by the ADA to provide dentists with synthesis of the best available evidence."
The CSA stresses that experts are still very important in this process, as they still critically analyze all of the scientific evidence. They also determine how the current state of the science should impact the practice of dentistry.
The recommendations in JADA appear as part of a CSA report, which includes how the recommendations were developed and summarizes the scientific evidence for the effectiveness of topical fluoride in preventing caries.
Also included in the August JADA is an executive summary of the clinical recommendations, a four-page removable insert, "Evidence-Based Clinical Recommendations: Professionally Applied Topical Fluoride," that the ADA hopes will serve as a tool for members to help them apply evidence-based principles into their clinical decisions.
Both the report and the executive summary contain a summary chart of the recommendations and are intended to serve as a resource for dentists on how to best utilize professionally applied topical fluoride. The executive summary will be a quick-reference resource that dentists can post in their offices.
The new recommendations classify the evidence in six categories and provide the practitioner with four classifications of the strength of each recommendation.
The recommendations are the result of the ADA's October 2005 topical fluoride workshop that gathered an expert panel to evaluate all of the relevant and existing scientific evidence for professionally applied topical fluoride applications. Julie Frantsve-Hawley, Ph.D., served as the ADA staff coordinator for the project.
"The panel relied on systematic reviews and randomized controlled trials and used its expertise to extrapolate the results when studies were not available," said Dr. Jeffrey Hutter, who served as panel chair. "The panel has identified the strength and basis for its recommendations so that dentists can make informed decisions when discussing the recommendations with their patients."
The group reviewed all methods of professionally applied topical fluoride including gel, foam and varnish and determined that topical fluoride should be used as a caries-preventive method for at-risk patients of all ages. The recommendations state that patients should be evaluated according to their caries risk status: low-caries risk, moderate-caries risk and high-caries risk; and treatment recommendations are stratified by age groups: under the age of 6, between the ages of 6 and 18, or over 18.
The CSA offers these recommendations as a resource with the "understanding that the dentist, knowing the patient's health history and vulnerability to oral disease," is still the best person to decide which treatment to use.
After they were developed, the recommendations were submitted for review to scientists with expertise in fluoride and caries, ADA agencies and 46 outside organizations—including the Centers for Disease Control and Prevention, the Cochrane Oral Health Group and the Academy of General Dentistry—representing academia, professional organizations, industry and third-party payers before being approved by the CSA.
"In response to previous directives by the ADA's House of Delegates, the comprehensive review process appeared to exceed all expectations," Dr. Meyer said. "It was a huge undertaking, but the expert panel and staff rolled up their sleeves immediately and went to work, sifting through a vast array of published, but at times, conflicting information. Some studies were more clinically relevant and reliable than other previously published information. It was very gratifying to see the group of skilled professionals work so well to provide a very sound scientific basis for oral health care in order to not only address the needs of the practicing dentists, but more importantly, the patients they serve."
Other publications can provide additional information on specific therapeutic doses and recommendations related to general and oral health care. The ADA Guide to Dental Therapeutics is a useful adjunct to the evidence-based clinical recommendations and provides dosage and prescribing information; adverse effects, precautions and contraindications.
Members of the expert panel are listed in JADA. To see the recommendations online, visit www.ada.org/goto/ebd. For more information, call the ADA toll-free number at Ext. 2878.
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