In the last 30 years a number of community- and individual-level strategies for preventing caries, notably water fluoridation and fluoridated toothpastes, have been highly successful. In light of fluoridation's success, a number of interventions have arisen for primary prevention of dental caries in individual at-risk patient groups. Regretably, these interventions have existed for some time and are still inadequate to resolve the caries pandemic in disparity populations. These existing interventions include: application of acidulated phosphate fluoride gel (APF), fluoride varnish, chlorhexidine varnishes and gels (not available in the United States), pit and fissure sealants, and the use of dentrifices and other products containing antimicrobials (e.g., triclosin and sanguinaria), noncariogenic sweeteners (e.g., xylitol), or agents to promote remineralization (e.g., Enamelon toothpaste). Fluoride reservoir systems, developed for post radiation cancer patients, successfully controlled caries but were never brought to market.
A number of the key processes controlling biofilm formation provide targets for application of novel preventive or remedial technologies (Table 1). Given the increasing use of relatively invasive medical and surgical procedures, the material properties of medical devices have received much attention, as have strategies to target antimicrobials to prevent device-related infections. Dental plaque and oral hygiene would appear to be obvious therapeutic targets for the application of novel anti-infective strategies.
Prospects include: (i) materials or surface coatings that prevent bacterial adhesion, (ii) surfaces that phase change upon command, and (iii) passive or active controlled release of anti-infective agents.