Non-invasive Treatment of Root Caries in Older Adults

Study Overview
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Brief Summary
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This study aims to test the effectiveness in reducing or arresting root caries lesion in community-dwelling elderly subjects by using high fluoridated toothpaste. A double blinded RCT will be conducted with two arms; 5000 ppm F and 1450 ppm F toothpaste. Dentifrices will be delivered to the participants in a blind format and they will be instructed to brush twice per day. Follow-up will be carries out every 6 months for two years to assess: Root caries incidence. Lesion arresting Changes in salivary flow Microbiology pattern shift Variations in oral health- related quality of life by OHIP-14 Sp

Detailed Description
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Background. Caries of the root surface (root caries) is the most prevalent type of dental caries in older adults with a reportedly worrisome trend to increase, as more teeth are being retained. Dental caries is the leading causes of tooth loss among older adults. Fluoride has been successfully used in preventive programs for root caries. In addition to preventing root caries, fluoride-based therapies may be used to treat lesions. This approach is known as non-invasive treatment. Fluoride seems to arrest and promote remineralization of the lesions. Indeed, recent studies appear to indicate that, higher fluoride concentrations are more effective to prevent and to treat the disease. Dentifrices with high concentrations of fluoride appear to be the most rational approach to prevent and treat root caries. To the chemical effect of fluoride, toothbrushing adds mechanical removal of the dental biofilm. High concentration fluoride varnishes have also been proposed as effective in treating carious lesions. Whether dentifrices, varnishes or the combined use of varnish and fluoridated toothpaste result more effective is a matter of controversy and it needs to be elucidated. Non-invasive treatment avoids the complications inherent to treating frail people in a dental setting, decrease costs and importantly, allows increased coverage, as these therapies may be delivered by non-dentist personnel. Although the appealing idea of non-invasive treatment of root caries in older adults, evidence is still limited and more research appears necessary to both, confirm clinical success and elucidate the mechanisms involved in lesion arrestment. Aim. To determine the effectiveness of non-invasive therapies for root caries and their impact in the quality of life of older adults. Methodology. A double blind randomized controlled trial (RCT) on independently-living older adults aged sixty or more years is proposed. Subjects will undergo clinical and microbiological examination when recruited (baseline) with a six-month follow-up regime until completion of two years. To participate, subjects will have to have at least five teeth with exposed root surfaces and one carious lesion. Sample size was calculated and a sample of two-hundred and eighty-eight older adults is necessary, randomized into two study arms; Group 1: toothpaste 1.450 ppm F- Group 2: toothpaste 5.000 ppm F- Dependent variables. Root caries incidence and activity, cariogenic bacteria and oral health-related quality of life will be assessed upon completion of the study and compared with baseline scores. Expected results. Based on some previous data available, it is expected that a non-invasive therapy for root caries based on low-fluoride concentration will be less effective than high fluoride therapies in inactivating root caries lesions. These results may be used in novel therapeutic programs at the community level, as well as in private practice. Furthermore, these studies will shed light on potential mechanisms associated with non-invasive treatment of root caries, from a microbiology stand point. Since a non-invasive approach decreases costs and increases coverage of dental care for older adults, these results may contribute to increase access to care for the usually vulnerable population of older adults.

Official Title
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Non-invasive Therapy With Fluoridated Toothpastes for Root Caries in Independently-living Older Adults

Conditions
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Root Caries

Intervention / Treatment
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* Drug: Self-administered fluoridated dentifrices


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 60 + years old community-dwelling living in a community with fluoridated water had five or more of their own teeth with ≥ 1 root caries lesion Exclusion Criteria: cognitive impairment alcoholism

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: High Fluoride Toothpaste<br>5,000 ppm fluoridated toothpaste, high concentration. Self-administered fluoridated dentifrices. By the elderly subjects, twice per day Drug (including placebo) | Drug: Self-administered fluoridated dentifrices<br>* Elderly participants will be instructed to self administer toothpastes, twice per day. Toothpastes will be provided.<br>* Other names: Toothbrushing with high and standard fluoride dentifrices;|
| Active Comparator: Standard Fluoride Toothpaste<br>1,450 ppm fluoridated toothpaste, low concentration. Self-administered fluoridated dentifrices. By the elderly subjects, twice per day Drug (including placebo) | Drug: Self-administered fluoridated dentifrices<br>* Elderly participants will be instructed to self administer toothpastes, twice per day. Toothpastes will be provided.<br>* Other names: Toothbrushing with high and standard fluoride dentifrices;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Root Caries Activity | Using Nyvad's criteria for root caries lesions, activity will be assessed by a visual-tactile method. | After 2 years of follow up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oral Health Related Quality of Life, Measured by the Oral Health Impact Profile (OHIP-14 Sp) | The impact on the quality of life of the therapy will be explored using the OHIP-14 Sp, validated by our group. In a scale ranging from 0 to 56 points, with 0-14 being good Oral Health-related quality of life and 15-56 poor Oral Health-related quality of life. | Data registered at 2 years of follow-up | 
| Salivary Flow | Unstimulated Salivary Flow, defined as Normal or Low Important: This outcome measure was originally considered. However, due to logistic issues, we did not assess it and no data is available. | Baseline and 2-year follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fluoride toothpaste, Root caries, Randomized clinical trial