The potential of slow-releasing fluoride devices as a novel mechanism for public oral health intervention
Schmidt, Monica R.
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Slow-releasing fluoride devices (SFD) constitute a novel mechanism for fluoride delivery. They incorporate the finding that sustained release of low fluoride levels in the oral cavity is the most effective mechanism for reducing an individual’s risk for dental caries. The device consists of a small fluoride bead that is bonded to the first maxillary molar for a time period of up to two years. The SFDs demonstrate an ideal public health approach to reduce the prevalence of dental caries, especially in those of low socioeconomic status with high risk for decay. Such intervention would offer great benefits to society considering the unequal distribution of oral disease in which approximately eighty percent of carious lesions occur in only twenty-five percent of individuals. Information such as this emphasizes the need for a more personalized approach to caries prevention that targets those at greatest risk for decay. The objective of this literature review is to examine four different studies that evaluate the efficacy of SFDs and assess their potential to be an innovative and cost-effective anticaries mechanism for public oral health intervention. The first and second studies to be analyzed in this review were both developed by Toumba and Curzon. Study #1 is the only randomized controlled trial to analyze the capability of SFDs to prevent dental caries in high-risk individuals. Baseline intra-oral fluoride measurements were recorded from 174 low socioeconomic status, primary school children with existing oral decay. SFDs were subsequently placed in each participant for a period of two years. A statistically significant lower incidence of new decayed, missing, and filled surfaces was exhibited by the experimental group, indicating great potential for the SFDs. Study #2 analyzed the SFDs rate of retention, ideal fluoride concentration for optimal results, and risk of toxicity in case of ingestion. The prototype devices were successfully retained for the eighteen-month timeframe with no associated risk of toxicity. It was established that the device with 13.3% fluoride exhibited the most promising results of increased intra oral fluoride level with reduced risk for caries development. Studies #3 and 4 executed by Al-Mullahi/Toumba and Abudiak et al. respectively, conducted shorter studies. Each analyzed the remineralization potential of the devices based on bead content and ability to maintain intra-oral concentrations of fluoride, phosphate, and calcium. It was determined that all analyzed SFDs, regardless of content variation, successfully increased dental surface microhardness and reduced the occurrence of carries by up to 76%. Overall, the slow-releasing fluoride devices show vast potential for reducing dental decay, specifically in patients with impaired oral health due to lower socioeconomic status, disability, or genetic susceptibility. Future investigation should include more clinical trials to further establish the efficacy and safety of the devices before they are implemented to the public.
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