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6.6.08 Issue #326 Forward This Newsletter To A Colleague

Angie Stone RDH, BS
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Fluoride - It's Not Just for Kids

Fluoride remains one of the most amazing developments in the dental profession. The general population experienced a sharp decline in dental decay when community water supplies became fluoridated. When some folks balked at what they perceived to be involuntary use of a chemical, some communities removed fluoride from the water source only to see a quick increase in dental caries. As a result, many communities made the decision to place fluoride back in the water supply. So, since 1945, people have been reaping the benefits of fluoridated water.

The main use of fluoride in the past has been to protect teeth during development and eruption, but research has now shown that fluoride helps protect erupted teeth in the battle against tooth decay. Although clinicians preach about the use of fluoridated toothpaste and fluoride rinses, in-office fluoride treatments are often overlooked, especially if patients are over the magical age of 18. The evidence is clear that professional topical fluoride applications provide an additional benefit (beyond fluoridated water and toothpaste) for all adult patients with a moderate to high caries risk.

The following information should be considered when deciding which adult patients would benefit from fluoride:

  • Is the patient taking medications that cause a dry mouth? A decrease in saliva can increase the risk for decay. Fluoride treatments can help reduce the risk of decay in this population.
  • Does the patient have exposed root surfaces? Root surfaces are extremely susceptible to decay and decay can travel quickly through the root. Professional fluoride treatments help make roots stronger and resistant to decay.
  • Has the patient needed a restoration due to decay in the last year? If so, the patient is at risk for decay and delivering a fluoride treatment will reduce this risk.
  • Does the patient have crowns and/or bridges? Fluoride can help protect the margins of these restorations and potentially eliminate decay around the margins.
  • Is the patient wearing bonded brackets or bands? High concentration of fluoride can help keep teeth caries free during orthodontic treatment.
  • Is the patient undergoing or going to be receiving head and neck radiation? Radiation damages salivary glands, which causes an extreme reduction in salivary flow. Saliva is an important component in the fight against tooth decay. Without it, the risk for decay is extreme. This patient will benefit from fluoride treatments.
  • Is the patient experiencing sensitivity? Fluoride can help reduce the pain and discomfort caused by exposed root surfaces. Regular fluoride applications can help eliminate this sensitivity.
  • Does the patient have poor oral hygiene? Plaque on the teeth increases the risk of decay. Fluoride helps fight the decay process caused by high levels of plaque.

When considering these reasons for applying fluoride to adult patients, it becomes easy to see that a high percentage of adults fall into at least one of these categories and would benefit from in-office fluoride treatments.

The question thus becomes what fluoride is the most effective. The American Dental Association report, Evidence-Based Clinical Recommendations: Professionally Applied Topical Fluoride, is a great resource when making this decision. The following information is taken from this report.

  • There is considerable data on caries reduction for professionally applied topical fluoride gel treatments of four minutes or more. In contrast, there is laboratory (but no clinical equivalency) data on the effectiveness of one-minute fluoride gel applications.
  • Two or more applications of fluoride varnish per year are effective in preventing caries in high-risk populations.
  • Fluoride varnish applications take less time, create less patient discomfort and achieve greater patient acceptability than do fluoride gel treatments, especially in preschool-aged children.
  • Moderate-risk patients should receive fluoride varnish or gel applications at six-month intervals.
  • Higher-risk patients should receive fluoride varnish or gel applications at three- to six-month intervals.
  • Application time for fluoride gel and foam should be four minutes. A one-minute fluoride application is not endorsed.
  • Other considerations: Foam commonly is used in dental practice; however, the weight of the clinical evidence of its effectiveness is not as strong as that for fluoride gel and varnish.
Another aspect to consider is that of revenue for the hygiene department. If hygienists make decisions about in-office fluoride treatments based upon patients’ caries risk factors, it is easy to see why more adult patients would be receiving these treatments. This would directly increase hygiene productivity. Let us say that the hygienist sees eight adult patients per day and half of them receive a fluoride treatment at a cost of approximately $25 per treatment. That would be an increase of $100 per day per hygienist. If the hygienist works 16 days per month, that would mean $1600 per month and $19,200 per year. This revenue can come easily by simply assessing the need for adult patients who can benefit from fluoride. It is a win/win situation for both the patient and the office.

Interested in knowing more about how to improve your hygiene department?

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