Beyond the Surface: A Deep Dive into Use of Fluoridated vs Non-fluoridated Remineralizing Agents on Permanent Teeth: A Systematic Review

Objectives: Dental caries, characterized by white spot lesions (WSLs), impact approximately 49% of the population and can progress to irreversible damage if untreated. Fluoridated remineralizing agents have traditionally been the standard treatment due to their efficacy in surface remineralization. However, concerns over fluoride toxicity, including risks of dental and skeletal fluorosis, have spurred interest in non-fluoridated alternatives. This systematic review evaluates the remineralizing potential of fluoridated versus non-fluoridated agents for early enamel carious lesions in permanent teeth, focusing on clinical outcomes and patient safety. Methods: Adhering to PRISMA guidelines, randomized clinical trials were identified through comprehensive searches in databases such as Medline, Cochrane, Web of Science and Scopus. Inclusion criteria targeted interventions for WSLs in permanent teeth, assessing their effectiveness using DIAGNOdent scores. Studies involving diverse patient demographics, lesion severities and fluoride exposure risks were emphasized. Results: Six randomized clinical trials met the inclusion criteria. Both fluoridated and non-fluoridated agents demonstrated significant efficacy in remineralization. Fluoridated agents excelled in surface lesion repair, while non-fluoridated options, such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), showed superior performance in subsurface lesion remineralization, addressing fluoride-related safety concerns. However, variability in study methodologies and short-term follow-up limited comprehensive conclusions. Conclusion: Fluoridated agents remain effective for surface remineralization, but non-fluoridated alternatives offer promising solutions for deeper lesion repair and fluoride-free treatments. Long-term, standardized studies are needed to establish sustainable outcomes, enhance cost-effectiveness and guide patient-centric treatment protocols. These findings underscore the need for integrating remineralization strategies into preventive dentistry, balancing clinical efficacy with patient safety and preferences.