The aim of this systematic review and network meta-analysis was to summarize the direct and indirect clinical evidence on the effectiveness of professionally applied and self-applied topical fluorides in preventing dental root caries. Controlled clinical trials with any follow-up duration were included. MEDLINE, PubMed, Embase, Scopus, and Cochrane Library were searched. Two reviewers independently carried out the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Fixed effects model and frequentist approach were used in the network meta-analyses. Nine clinical trials involving 4,030 participants were included. Five professionally applied and 7 self-applied topical fluoride agents or combinations were included in the meta-analyses. Compared to control group, 38% silver diamine fluoride solution, 5% sodium fluoride varnish, and 1.2% acidulated phosphate fluoride reduced root caries increment after 2 y (ranging from 0.59 to 0.85 mean decayed or filled root [DF-root]). Fluoride mouth rinse and fluoride toothpaste, used alone or in combination, reduced root caries increment after 1 y (ranging from 0.29 to 1.90 mean DF-root). Among the professionally applied topical fluorides reviewed, an annually applied 38% silver diamine fluoride (SDF) solution combined with oral health education is most likely to be the most effective in preventing dental root caries. Among the reviewed self-applied topical fluoride methods, daily use of a 0.2% sodium fluoride (NaF) mouth rinse is most likely to be the most effective, followed by 1100 ppm to 1500 ppm fluoride toothpaste plus 0.05% NaF mouth rinse, and 1100 ppm to 1500 ppm fluoride toothpaste.

Objectives: The objectives of this review were to identify the factors associated with root caries and to describe their relationship with the presence and extent of root caries. Methods: A search was carried out on the PubMed, Medline, Embase, and Scopus databases for articles published between January 1990 and October 2018. Information was extracted on the factors associated with the presence or extent of decayed or filled root surfaces and/or decayed root surfaces. Factors were sorted into 6 categories: social-demographic background, general health, health behaviors, fluoride exposure, oral health habits, and oral health condition. Results: The quality of the 127 identified relevant papers was assessed, and those of low methodological quality were excluded. Finally, 44 articles reporting on 40 cross-sectional studies were included. The total sample size comprised 78,183 participants from different countries around the world. Positive correlations were detected between root caries and age, gingival recession, and use of tobacco, while negative correlations were found for social position, use of fluoride toothpaste, and oral hygiene status. Mixed findings were reported for association with the number of teeth and dental visit behaviors. Conclusion: This systematic review found a number of factors in different categories to be associated with root caries. People who are older, of lower socioeconomic status, or tobacco users and those with more gingival recession and poorer oral hygiene have higher risk of root caries. Knowledge Transfer Statement: This systematic review found a number of factors associated with root caries, including age, social position, exposure to fluoride, and oral hygiene status. This information helps dental public health workers and clinicians identify the groups at high risk of caries and the factors to act on for more effective prevention and management of root caries (e.g., use fluoride toothpaste and improve oral hygiene).