Skip to main content
NCBI home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1995 Mar 15;152(6):836–846.

Periodic health examination, 1995 update: 2. Prevention of dental caries. The Canadian Task Force on the Periodic Health Examination.

D W Lewis, A I Ismail
PMCID: PMC1337757  PMID: 7697577

Abstract

OBJECTIVE: To make recommendations, based on current evidence, for practising physicians and dentists on interventions for the prevention of dental caries in their patients. OPTIONS: Systemic fluoride administration, professionally administered fluoride, use of fluoride mouth rinses, fissure sealants, oral-hygiene practices, dietary practices, identification of groups at a high risk of dental caries, and early diagnosis and treatment. OUTCOMES: Reduced prevalence of dental caries and fluorosis, longer retention of teeth and lower treatment costs. EVIDENCE: Several MEDLINE searches were conducted for articles published from January 1980 to December 1992, including relevant review articles. VALUES: Relevant clinical findings were evaluated and categorized with the use of the evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination. Recommendations were developed for each method of caries prevention, with reduced incidence of dental caries and improved prevalence of caries-free teeth given high values. BENEFITS, HARMS AND COSTS: The potential benefits of these measures in the long-term are a lower incidence of tooth decay, longer retention of teeth and prevention of fluorosis. The cost saving can be considerable for patients and insurers; however, implementation of some recommendations will be difficult, since the traditional preventive practices of dentists and dental hygienists are not easily changed. RECOMMENDATIONS: There is good evidence that the following manoeuvres are effective in preventing dental caries: use of dentifrices containing fluoride, fluoridation of drinking water, fluoride supplements for patients in areas where there is a low level (0.3 ppm or less) of fluoride in the drinking water, professionally applied topical fluoride and the use of fluoride mouth rinses for patients with very active decay or at a high risk of dental caries and selective use of professionally applied fissure sealants on permanent molar teeth. There is poor evidence that the following manoeuvres are effective in preventing dental caries: professionally applied topical fluoride and the use of fluoride mouth rinses for patients with a low risk of caries, toothbrushing (without a dentifrice containing fluoride) and flossing, cleaning of teeth by a dentist or dental hygienist before topical application of fluoride or at a dental visit and dietary counselling for the general population. There is good evidence to recommend against the use of over-the-counter fluoride mouth rinses by the general population. VALIDATION: These guidelines are compatible with those of the US Preventive Services Task Force. SPONSOR: These guidelines were developed and endorsed by the task force, which is funded by Health Canada. Major funding was provided by the Faculty of Dentistry of the University of Toronto, Toronto and the Faculty of Dentistry of Dalhousie University, Halifax.

Full text

PDF
836

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albert R. J., Cantin R. Y., Cross H. G., Castaldi C. R. Nursing caries in the Inuit children of the Keewatin. J Can Dent Assoc. 1988 Oct;54(10):751–758. [PubMed] [Google Scholar]
  2. Axelsson P., Paulander J., Svärdström G., Tollskog G., Nordensten S. Integrated caries prevention: effect of a needs-related preventive program on dental caries in children. County of Värmland, Sweden: results after 12 years. Caries Res. 1993;27 (Suppl 1):83–94. doi: 10.1159/000261609. [DOI] [PubMed] [Google Scholar]
  3. Banting D. W. Epidemiology of root caries. Gerodontology. 1986 Spring;5(1):5–11. doi: 10.1111/j.1741-2358.1986.tb00377.x. [DOI] [PubMed] [Google Scholar]
  4. Beck J. D., Kohout F., Hunt R. J. Identification of high caries risk adults: attitudes, social factors and diseases. Int Dent J. 1988 Dec;38(4):231–238. [PubMed] [Google Scholar]
  5. Beck J. The epidemiology of root surface caries. J Dent Res. 1990 May;69(5):1216–1221. doi: 10.1177/00220345900690051901. [DOI] [PubMed] [Google Scholar]
  6. Brodeur J. M., Simard P. L., Demers M., Contandriopoulos A. P., Tessier G., Lepage Y., Lachapelle D. Comparative effects of FMR programs in fluoridated and unfluoridated communities. J Can Dent Assoc. 1988 Oct;54(10):761–765. [PubMed] [Google Scholar]
  7. Brunelle J. A., Carlos J. P. Recent trends in dental caries in U.S. children and the effect of water fluoridation. J Dent Res. 1990 Feb;69(Spec No):723–823. doi: 10.1177/00220345900690S141. [DOI] [PubMed] [Google Scholar]
  8. Burt B. A., Eklund S. A., Morgan K. J., Larkin F. E., Guire K. E., Brown L. O., Weintraub J. A. The effects of sugars intake and frequency of ingestion on dental caries increment in a three-year longitudinal study. J Dent Res. 1988 Nov;67(11):1422–1429. doi: 10.1177/00220345880670111201. [DOI] [PubMed] [Google Scholar]
  9. Burt B. A. The future of the caries decline. J Public Health Dent. 1985 Fall;45(4):261–269. doi: 10.1111/j.1752-7325.1985.tb01161.x. [DOI] [PubMed] [Google Scholar]
  10. Clark D. C. Appropriate use of fluorides in the 1990s. J Can Dent Assoc. 1993 Mar;59(3):272–279. [PubMed] [Google Scholar]
  11. Clark D. C. Appropriate uses of fluorides for children: guidelines from the Canadian Workshop on the Evaluation of Current Recommendations Concerning Fluorides. CMAJ. 1993 Dec 15;149(12):1787–1793. [PMC free article] [PubMed] [Google Scholar]
  12. Dawes C. Fluorides: mechanisms of action and recommendations for use. J Can Dent Assoc. 1989 Sep;55(9):721–723. [PubMed] [Google Scholar]
  13. Downer M. C. Concurrent validity of an epidemiological diagnostic system for caries with the histological appearance of extracted teeth as validating criterion. Caries Res. 1975;9(3):231–246. doi: 10.1159/000260160. [DOI] [PubMed] [Google Scholar]
  14. Driscoll W. S. What we know and don't know about dietary fluoride supplements--the research basis. ASDC J Dent Child. 1985 Jul-Aug;52(4):259–264. [PubMed] [Google Scholar]
  15. Elderton R. J., Nuttall N. M. Variation among dentists in planning treatment. Br Dent J. 1983 Apr 9;154(7):201–206. doi: 10.1038/sj.bdj.4805041. [DOI] [PubMed] [Google Scholar]
  16. Glass R. L., Alman J. E., Chauncey H. H. A 10-year longitudinal study of caries incidence rates in a sample of male adults in the USA. Caries Res. 1987;21(4):360–367. doi: 10.1159/000261040. [DOI] [PubMed] [Google Scholar]
  17. Graves R. C., Stamm J. W. Decline of dental caries. What occurred and will it continue? J Can Dent Assoc. 1985 Sep;51(9):693–699. [PubMed] [Google Scholar]
  18. Greene J. C., Louie R., Wycoff S. J. Preventive dentistry. I. Dental caries. JAMA. 1989 Dec 22;262(24):3459–3463. [PubMed] [Google Scholar]
  19. Horowitz H. S., Doyle J. The effect on dental caries of topically applied acidulated phosphate-fluoride: results after three years. J Am Dent Assoc. 1971 Feb;82(2):359–365. doi: 10.14219/jada.archive.1971.0063. [DOI] [PubMed] [Google Scholar]
  20. Hunter P. B. Risk factors in dental caries. Int Dent J. 1988 Dec;38(4):211–217. [PubMed] [Google Scholar]
  21. Ismail A. I., Brodeur J. M., Kavanagh M., Boisclair G., Tessier C., Picotte L. Prevalence of dental caries and dental fluorosis in students, 11-17 years of age, in fluoridated and non-fluoridated cities in Quebec. Caries Res. 1990;24(4):290–297. doi: 10.1159/000261285. [DOI] [PubMed] [Google Scholar]
  22. Jensen M. E., Kohout F. The effect of a fluoridated dentifrice on root and coronal caries in an older adult population. J Am Dent Assoc. 1988 Dec;117(7):829–832. doi: 10.14219/jada.archive.1988.0128. [DOI] [PubMed] [Google Scholar]
  23. Johnsen D. C. Characteristics and backgrounds of children with "nursing caries". Pediatr Dent. 1982 Sep;4(3):218–224. [PubMed] [Google Scholar]
  24. KITE O. W., SHAW J. H., SOGNNAES R. F. The prevention of experimental tooth decay by tube-feeding. J Nutr. 1950 Sep;42(1):89–105. doi: 10.1093/jn/42.1.89. [DOI] [PubMed] [Google Scholar]
  25. Karmiol M., Walsh R. F. Dental caries after radiotherapy of the oral regions. J Am Dent Assoc. 1975 Oct;91(4):838–845. doi: 10.14219/jada.archive.1975.0493. [DOI] [PubMed] [Google Scholar]
  26. Krasse B. Biological factors as indicators of future caries. Int Dent J. 1988 Dec;38(4):219–225. [PubMed] [Google Scholar]
  27. Kroll R. G., Stone J. H. Nocturnal bottle-feeding as a contributory cause of rampant dental caries in the infant and young child. J Dent Child. 1967 Nov;34(6):454–459. [PubMed] [Google Scholar]
  28. Lecompte E. J. Clinical application of topical fluoride products--risks, benefits, and recommendations. J Dent Res. 1987 May;66(5):1066–1071. doi: 10.1177/00220345870660051701. [DOI] [PubMed] [Google Scholar]
  29. Leverett D. H. Effectiveness of mouthrinsing with fluoride solutions in preventing coronal and root caries. J Public Health Dent. 1989;49(5 Spec No):310–316. doi: 10.1111/j.1752-7325.1989.tb02089.x. [DOI] [PubMed] [Google Scholar]
  30. Lewis D. W., Banting D. W. Water fluoridation: current effectiveness and dental fluorosis. Community Dent Oral Epidemiol. 1994 Jun;22(3):153–158. doi: 10.1111/j.1600-0528.1994.tb01833.x. [DOI] [PubMed] [Google Scholar]
  31. Lewis D. W. Epidemiologic trends and dental care issues relevant to future dental hygiene. Probe. 1990 Autumn;24(3):132–137. [PubMed] [Google Scholar]
  32. Locker D., Slade G. D., Leake J. L. Prevalence of and factors associated with root decay in older adults in Canada. J Dent Res. 1989 May;68(5):768–772. doi: 10.1177/00220345890680050301. [DOI] [PubMed] [Google Scholar]
  33. Mejàre I., Gröndahl H. G., Carlstedt K., Grever A. C., Ottosson E. Accuracy at radiography and probing for the diagnosis of proximal caries. Scand J Dent Res. 1985 Apr;93(2):178–184. doi: 10.1111/j.1600-0722.1985.tb01328.x. [DOI] [PubMed] [Google Scholar]
  34. Mellberg J. R. Remineralization. A status report for the American Journal of Dentistry. Part I. Am J Dent. 1988 Feb;1(1):39–43. [PubMed] [Google Scholar]
  35. Mellberg J. R. Remineralization. A status report for the American Journal of Dentistry. Part II. Am J Dent. 1988 Apr;1(2):85–89. [PubMed] [Google Scholar]
  36. Mileman P., Purdell-Lewis D., van der Weele L. Effect of variation in caries diagnosis and degree of caries on treatment decisions by dental teachers using bitewing radiographs. Community Dent Oral Epidemiol. 1983 Dec;11(6):356–362. doi: 10.1111/j.1600-0528.1983.tb01391.x. [DOI] [PubMed] [Google Scholar]
  37. Newbrun E. Effectiveness of water fluoridation. J Public Health Dent. 1989;49(5 Spec No):279–289. doi: 10.1111/j.1752-7325.1989.tb02086.x. [DOI] [PubMed] [Google Scholar]
  38. Newbrun E. Frequent sugar intake--then and now: interpretation of the main results. Scand J Dent Res. 1989 Apr;97(2):103–109. doi: 10.1111/j.1600-0722.1989.tb01437.x. [DOI] [PubMed] [Google Scholar]
  39. Niessen L. C., Weyant R. J. Causes of tooth loss in a veteran population. J Public Health Dent. 1989 Winter;49(1):19–23. doi: 10.1111/j.1752-7325.1989.tb02014.x. [DOI] [PubMed] [Google Scholar]
  40. Nuttall N. M., Elderton R. J. The nature of restorative dental treatment decisions. Br Dent J. 1983 Jun 11;154(11):363–365. doi: 10.1038/sj.bdj.4805093. [DOI] [PubMed] [Google Scholar]
  41. Rafuse J. MDs call for more study before endorsing dentists' new recommendations on fluoride. CMAJ. 1993 Dec 15;149(12):1820–1822. [PMC free article] [PubMed] [Google Scholar]
  42. Ripa L. W. A critique of topical fluoride methods (dentifrices, mouthrinses, operator-, and self-applied gels) in an era of decreased caries and increased fluorosis prevalence. J Public Health Dent. 1991 Winter;51(1):23–41. doi: 10.1111/j.1752-7325.1991.tb02172.x. [DOI] [PubMed] [Google Scholar]
  43. Ripa L. W. Nursing caries: a comprehensive review. Pediatr Dent. 1988 Dec;10(4):268–282. [PubMed] [Google Scholar]
  44. Rugg-Gunn A. J., Hackett A. F., Appleton D. R., Jenkins G. N., Eastoe J. E. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children. Arch Oral Biol. 1984;29(12):983–992. doi: 10.1016/0003-9969(84)90145-6. [DOI] [PubMed] [Google Scholar]
  45. Rytömaa I., Järvinen V., Järvinen J. Variation in caries recording and restorative treatment plan among university teachers. Community Dent Oral Epidemiol. 1979;7(6):335–339. doi: 10.1111/j.1600-0528.1979.tb01243.x. [DOI] [PubMed] [Google Scholar]
  46. Rølla G., Saxegaard E. Critical evaluation of the composition and use of topical fluorides, with emphasis on the role of calcium fluoride in caries inhibition. J Dent Res. 1990 Feb;69(Spec No):780–823. doi: 10.1177/00220345900690S150. [DOI] [PubMed] [Google Scholar]
  47. Seichter U. Root surface caries: a critical literature review. J Am Dent Assoc. 1987 Aug;115(2):305–310. doi: 10.14219/jada.archive.1987.0236. [DOI] [PubMed] [Google Scholar]
  48. Shwartz M., Pliskin J. S., Gröndahl H., Boffa J. The frequency of bitewing radiographs. Oral Surg Oral Med Oral Pathol. 1986 Mar;61(3):300–305. doi: 10.1016/0030-4220(86)90379-8. [DOI] [PubMed] [Google Scholar]
  49. Stamm J. W., Banting D. W., Imrey P. B. Adult root caries survey of two similar communities with contrasting natural water fluoride levels. J Am Dent Assoc. 1990 Feb;120(2):143–149. doi: 10.14219/jada.archive.1990.0031. [DOI] [PubMed] [Google Scholar]
  50. Stephens R. G., Kogon S. L., Jarvis A. M. A study of the reasons for tooth extraction in a Canadian population sample. J Can Dent Assoc. 1991 Jun;57(6):501–504. [PubMed] [Google Scholar]
  51. Stookey G. K. Critical evaluation of the composition and use of topical fluorides. J Dent Res. 1990 Feb;69(Spec No):805–823. doi: 10.1177/00220345900690S154. [DOI] [PubMed] [Google Scholar]
  52. Swift E. J., Jr The effect of sealants on dental caries: a review. J Am Dent Assoc. 1988 May;116(6):700–704. doi: 10.14219/jada.archive.1988.0031. [DOI] [PubMed] [Google Scholar]
  53. Weinstein P., Milgrom P., Melnick S., Beach B., Spadafora A. How effective is oral hygiene instruction? Results after 6 and 24 weeks. J Public Health Dent. 1989 Winter;49(1):32–38. doi: 10.1111/j.1752-7325.1989.tb02017.x. [DOI] [PubMed] [Google Scholar]
  54. Woolf S. H., Battista R. N., Anderson G. M., Logan A. G., Wang E. Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by the Canadian Task Force on the Periodic Health Examination. J Clin Epidemiol. 1990;43(9):891–905. doi: 10.1016/0895-4356(90)90073-x. [DOI] [PubMed] [Google Scholar]
  55. Woolfolk M. W., Faja B. W., Bagramian R. A. Relation of sources of systemic fluoride to prevalence of dental fluorosis. J Public Health Dent. 1989 Spring;49(2):78–82. doi: 10.1111/j.1752-7325.1989.tb02030.x. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES