The same 86-year-old resident has widespread plaque and multiple root-surface lesions. Which home fluoride regimen should be recommended?

Correct answer: B. Prescription 5000 ppm sodium fluoride toothpaste twice daily

• A. A low-concentration daily rinse is an adjunct for moderate risk. It does not substitute for high-concentration paste, and a rinse is a difficult vehicle for a resident with swallowing or cognitive concerns.
• B. CORRECT. For a high-caries-risk adult, and specifically for ROOT caries, the evidence supports prescription-strength 5000 ppm (1.1% sodium fluoride) toothpaste. High-fluoride dentifrice both prevents new root lesions and increases the likelihood that existing ones arrest in older adults, and the ADA supports its use to arrest or reverse root-surface lesions.
• C. Standard 1450 ppm paste is appropriate for average risk but is insufficient for a patient with active root caries and poor plaque control.
• D. Systemic fluoride supplements are for CHILDREN in non-fluoridated areas during tooth development. They have no role in an 86-year-old.

Note: Both have a defensible case: stannous fluoride adds antibacterial and antisensitivity action, which suits a plaque-heavy patient, but it is available over the counter at only around 1100 to 1450 ppm. The concentration is what drives root-caries arrest, so 5000 ppm sodium fluoride is the better-evidenced answer. Worth raising with the group — this one is genuinely contested.