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This is Going to Hurt Me More Than It Hurts You

Remember when your parents would say ‘this is going to hurt me more than it hurts you’? I think you will agree they were wrong, it always hurt me more. Well this blog is no different, I’m going to burst your bubble about the fluoride you might be using in your office.

If you are applying fluoride treatments for your patients-BRAVO! It is one of the most valuable procedures we can provide. If, however, you are using a one minute application of foam or gel…this might hurt.

In 2013 the ADA Center for Evidence Based Dentistry published a paper on professionally applied fluoride options. The research included fluoride varnish, APF and Sodium fluoride gel and foam and gave us an easy way to make decisions of what is best for our patients.

Weighing the risks and benefits for children under 6, the panel recommends a 5% varnish as the ONLY recommended option. This is partly due to the fact that amount of fluoride placed in the mouth with fluoride varnish is approximately one-tenth that of other professionally-applied products. The panel also concluded, after reviewing the research, that APF gel application does not have a caries prevention benefit in primary teeth.

For patients age 6-18 the panel has two recommendations; fluoride varnish or a 4-minute APF gel delivered in a tray. Four minutes in a tray? I haven’t done that since I was in hygiene school! Another concern I have about using the APF is that the majority of my adolescent patients already have some kind of restorative such as sealants or composites, so they are disqualified from receiving acidulated phosphate fluoride due to possible pitting of the surface.

What about foam? The panel suggests ‘expert opinion against’ use of foam due to lack of evidence that it reduces the incidence of decay. In fact, they go as far as to say there is ‘no benefit’ from foam.

Recap of recommendations for elevated risk patients:

Younger than 6

  • 5% fluoride varnish at least twice a year is the ONLY recommended professionally applied fluoride

  • No benefit from APF gel

6-18 years of age

  • 5% fluoride varnish at least twice a year

  • 4-minute, tray applied APF gel at least twice a year (if no esthetic restorations)

Adult Root Caries

  • 5% fluoride varnish at least twice a year

  • 4-minute, tray applied APF gel at least twice a year (if no esthetic restorations)

There is no evidence foam has a preventive benefit for any group

When you get back to work grab a Sharpie and put a big ‘4’ before the word ‘minute’ on your bottle of fluoride gel. Of course, you can do what I do, ditch the trays for good. My patients and I prefer the quick easy application of FluoroDose varnish. It costs less than a dollar to buy, a minute to apply and the patient can eat and drink immediately.

I use FluoroDose Varnish. It goes on fast and easy with no clumping and it takes less than a minute to apply. My patients love the flavors and the fact it doesn’t stick to their lips or cheeks. FluoroDose just won Dental Advisor Top Fluoride Varnish for the third year in a row.

Reference-ADA Scientific Panel Issues Evidence-Based Clinical Recommendations: Patients at elevated risk for developing cavities benefit from applying topical fluoride November 01, 2013

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