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Experts eye nonfluoride caries prevention arsenal

Charged with developing a set of clinical recommendations on nonfluoride caries preventive agents, the ADA and Centers for Disease Control and Prevention hosted an expert panel Aug. 9-11 at Association Headquarters.

Dr. Rethman
Dr. Rethman

The panel, which was chaired by Dr. Michael Rethman of the ADA Council on Scientific Affairs, spent three days addressing whether using nonfluoride preventive agents reduces the incidence, arrests or reverses the progression of caries. The panel discussed such agents as polyol chewing gums, xylitol lozenges, chlorhexidine varnishes, mouthrinses and gels. They are currently developing a report and will solicit feedback from other experts and stakeholders. They  hope to finalize the recommendations for publication by summer 2011.

"This conference was consistent with recent ADA initiatives which focus on the clinical significance of risk assessment, prevention, chemotherapeutics and disease management," said Dr. Dan Meyer, senior vice president, ADA Division of Science/Professional Relations. "Nonfluoride caries preventive agents is an important issue that emphasizes the specific needs of each patient and the variety of options available to dentists and the dental team."

In grading the evidence, panelists used a three-tied grading system—high, moderate and low—when evaluating the studies. Their goal was to develop evidence-based guidelines to help clinicians and their patients choose the best treatment for reversing early dental caries.

Dr. Philippe Hujoel, left, and Dr. Woosung Sohn
Weighing evidence: Dr. Philippe Hujoel, left, and Dr. Woosung Sohn participate in a panel on nonfluoride caries preventive agents.

"Daily clinicians are being asked to treat dental caries at an earlier and earlier stage," said Dr. Mark S. Wolff, a panel member and associate dean for the Pre-doctoral Clinical Education Department of Cariology and Comprehensive Care at the New York University College of Dentistry. "It is clear that fluoride prevents decay but, what is not as clear is what 'other' agents in addition to the ones we already know may be effective."

Other questions the panel considered included who the recommendations were for, the effectiveness of nonfluoride caries preventive agents for root caries and high-risk patients.

"Many of the recommendations that clinicians make to patients daily may have little research to back up the recommendation," Dr. Wolff said. "When we really look at the scientific research, we discover that there is a real shortage of good research in many areas. The greatest surprise was that the ADA was able to assemble such an esteemed panel of experts to dedicate many days to the reading and then the deciphering of the literature."

For more information about the ADA Center for Evidence-Based Dentistry, visit, http://ebd.ada.org.