As dental professionals, we have successfully championed the fight against Early Childhood Caries (ECC). Much research has highlighted how vital 5% sodium fluoride varnish is for protecting our youngest patients. But let me be perfectly candid: when those patients turn 18, we often drop the ball. We fall into a routine of offering a quick 2% rinse — or worse, no fluoride therapy at all — sometimes allowing insurance coverage to dictate our care offerings, assuming adult enamel is somehow invincible.
It isn’t. We need to get back to the gold standard of 5% sodium fluoride varnish for our adult patients. We must stop selling our patients short and start providing the elite, preventative treatment they deserve — a treatment that only we can offer.
The reality of adult decay
Let’s look at the facts. According to the American Dental Association (ADA) and CDC data, over 90% of adults aged 20 and older have a history of dental decay, and a staggering 1 in 4 currently have untreated cavities. The Canadian Dental Association (CDA) and the Canadian Health Measures Survey report similarly alarming figures: 96% of Canadian adults have a history of coronal cavities, with roughly 20% harbouring active, untreated decay.
Adults are keeping their natural teeth longer than ever before. Consequently, we are seeing an explosion of root caries, medication-induced xerostomia, and secondary decay around aging restorations. Enamel exposed to the metabolic byproducts of Streptococcus mutans experiences a dangerous drop in pH, regardless of the patient’s age.
The practice issue: Selling adults short
Currently, too many practices reserve highly effective, slow-release resin-based 5% NaF varnishes for pediatric patients. For adults, we either offer nothing or rely on less effective in-office rinses that lack robust evidence for high-risk patients.
By withholding 5% NaF varnish, we are denying adults the multi-faceted benefits of remineralization and microflora reduction. According to our Code of Ethics, we must practice with the principle of beneficence in mind. Providing evidence-based treatment shouldn’t have an age limit.
Implementing change: The transtheoretical model
Just as we shifted pediatric protocols, we can use the Transtheoretical Model of Change to revolutionize adult care in our practices:
Pre-contemplation & contemplation: We must first acknowledge the gap in our adult preventative care. Clinicians should review their clinical practice guidelines, which explicitly recommend 5% Sodium Fluoride varnish for all age groups at an elevated risk of caries.
Preparation: Stock the operatories and remove the mental barrier that varnish is “just for kids.” Ensure all hygienists and assistants are aligned on application techniques specifically tailored to adults, targeting exposed root surfaces, crown margins, and areas of recession.
Action & maintenance: Allocate the necessary time during adult recare appointments to educate patients. Many adults simply don’t realize their caries risk has evolved with age, medications, or dietary changes.
Transitioning our adult preventative protocols to routinely include 5% sodium fluoride varnish will significantly decrease their caries susceptibility. Let’s lead with science, apply the Transtheoretical Model to break our own clinical bad habits, and elevate our standard of care. It is time we give our adult patients the premium, preventative treatment they truly deserve.
References
- American Dental Association (ADA) Council on Scientific Affairs. (2013). Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. The Journal of the American Dental Association, 144(11), 1279-1291.
- Canadian Dental Association (CDA). (2010). Committee on Clinical and Scientific Affairs: Report On Early Childhood Caries.
- Centers for Disease Control and Prevention (CDC). Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016.
- Health Canada. Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007-2009. (Cites the 96% decay history and 20% untreated decay statistics in Canadian adults).
- Astroth DB, Cross-Poline GN, Stach DJ, Tilliss TSI, Annan SD. (2002). The Transtheoretical Model: An Approach to Behavioural Change. Journal of Dental Hygiene, 76(4):286-95.
About the author
With 25 years of experience in the dental profession, Nora is a lifelong learner. She is passionate about providing exceptional care and making dental care accessible. For 21 years, she has remained dedicated to her clients in private practice, striving to deliver safe, empowering, and comfortable experiences. Education plays a crucial role in her practice. Well-informed patients are empowered to make the best decisions for their oral and overall health. For the last 8 years, practice success and efficiency have been key aspects of her work as a Practice Consultant and Trainer. Nora enjoys finding innovative ways to streamline processes and optimize workflows, ensuring that stakeholders, patients, and the dental team all benefit from a seamless experience. She has had the privilege of visiting many dental practices and providing strategic development and training. She provides tailored plans to implement in-office systems, ultimately enhancing efficiency and productivity. It is a privilege to empower and inspire dental hygienists across the GTA and Canada