Dynamics of root caries in older adults using high-fluoride toothpaste

To assess changes in the activity pattern of root caries lesions (RCLs) treated with fluoridated dentifrices (1450 vs 5000 ppm F) in community-dwelling older adults.

We used data from a previous randomized controlled clinical trial that evaluated the effectiveness of high-fluoride dentifrices for treating RCLs. A total of 2071 active and inactive RCLs initially detected were followed-up for 2 years. Modified Nyvad's criteria were used to determine activity status and each lesion was categorized into one of eight possible patterns of activity or inactivity at baseline, one year, and two years. Bivariate analyses, Cochrane Q test, and a mixed logistic regression model were conducted to compare RCLs patterns of activity.

Activity of RCLs treated with a 5000 ppm F toothpaste followed two main patterns: a) 64 % of the lesions were active (A) at baseline, became inactive (I) at one year, and remained inactive at two years (A-I-I); b) 30 % of the lesions remained inactive at all time points (I-I-I). In contrast, a mixed pattern of activity was observed for 1450 ppm F, where lesions followed more variable trajectories: only 17.8 % of the lesions followed the A-I-I pattern and 20.4 % remained inactive throughout (I-I-I), while the remaining lesions exhibited fluctuating transitions between activity and inactivity.

The use of 5000 ppm F toothpaste for RCLs in older adults appears to generate consistent and stable inactivation patterns, with a significant proportion of lesions transitioning from active to inactive and maintaining inactivity, unlike 1450 ppm F that exhibited more variability in lesion activity.

The use of 5000 ppm fluoride toothpaste in older adults consistently inactivates root caries lesions (RCLs) and maintains inactivity over two years. Compared to 1450 ppm fluoride, it significantly reduces the likelihood of lesion reactivation, suggesting that higher fluoride concentrations provide more stable and effective long-term management of RCLs.