Use of fluoride

Clinical questions

In primary SD patients, does the use of a topical fluoride compared with no topical fluoride reduce the incidence, arrest, or reverse coronal or root caries? In primary SD patients, is one topical fluoride agent more effective than another in reducing the incidence, or to arrest or reverse, coronal or root caries?

Recommendation

Topical fluoride should be used in SD patients with dry mouth. No information was available to answer the second question. Strength of recommendation: strong

Salivary stimulation

Clinical questions

In primary SD patients, does salivary stimulation compared with not stimulating saliva flow reduce the incidence, arrest, or reverse coronal or root caries?

Recommendation

While no studies to date link improved salivary function in SS patients to caries prevention, it is generally understood in the oral health community that increasing saliva may contribute to decreased caries incidence. Based on its expert opinion, the TRG recommends that SD patients with dry mouth increase saliva through gustatory, masticatory stimulation, and pharmaceutical agents; for example, sugar-free lozenges and/or chewing gum, xylitol, mannitol, and the prescription medications pilocarpine and cevimeline. Strength of recommendation: weak

Antimicrobials

Clinical questions

In primary SD patients, does the use of antimicrobial agents compared with placebo reduce the incidence, arrest, or reverse coronal or root caries?

Recommendation

Chlorhexidine administered by varnish, gel, or rinse may be considered in SD patients with dry mouth and a high root caries rate. Strength of recommendation: weak

Nonfluoride remineralizing agents

Clinical questions

In primary SD patients, does the use of nonfluoride remineralization agents compared with placebo reduce the incidence, arrest, or reverse coronal or root caries? In primary SD patients, does the use of nonfluoride remineralization agents compared with the use of fluoride reduce the incidence, arrest, or reverse coronal or root caries?

Recommendation

Nonfluoride remineralizing agents may be considered as an adjunct therapy in SD patients with dry mouth and a high root caries rate. Insufficient information was available to answer the second question. Strength of recommendation: moderate