7.1.11 Issue #486 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, CDA RDH
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Topical Fluorides - Preventive Tool, Revenue Enhancer
By Carol Tekavec RDH

The delivery of topical fluorides can be an important service for dental practices to offer their patients. The use of fluorides has evolved over the years from their original introduction in the late 1940s. Originally, fluorides were believed to provide only a reduction in enamel solubility. Now it is known that fluorides can also affect both tooth remineralization and oral bacterial metabolism.

While fluorides are recognized as having helpful caries prevention benefits, a “one-size-fits-all” approach to office delivery is no longer considered appropriate. Instead, topical fluorides should be provided based on a patient’s individual needs, risk factors, and conditions. Low caries risk individuals may not need in-office fluoride application, while high risk patients may benefit from regular professionally provided topicals. In addition, fluorides are no longer considered appropriate only for children.

Based on this information, how might an office go about developing their topical fluoride application protocol?  We can look to the ADA risk levels and recommendations outlined in their publication, Evidence Based Clinical Recommendations: Professionally Applied Topical Fluoride.  According to their guidelines, patients under the age of 6 who have had no incipient or cavitated carious lesions for the last three years, but at least one risk factor for caries are considered at Moderate Risk; while those under age 6 who have had such lesions during the past three years, and have multiple risk factors are considered High Risk. Individuals over age 6 with one or two incipient or cavitated lesions in the past three years and one risk factor are Moderate Risk; while those with 3 or more such lesions in the past three years along with multiple risk factors are High Risk. (The ADA also stresses that the judgment of the dentist must be a deciding factor in the decision to provide fluorides to any patient under any circumstance.)

Example of risk factors for caries under these guidelines include:

  • Poor oral hygiene
  • Familial high caries rate
  • Enamel defects
  • Exposed roots
  • Xerostomia
  • High bacterial load
  • High frequency sugar or other carbohydrate consumption
  • Defective restorations
  • Orthodontic or other appliances
  • Inability to perform adequate oral hygiene

ADA guidelines for moderate risk patients include professionally applied topical fluoride twice per year, with frequencies of two to four times annually for high-risk individuals. The use of over-the-counter fluoride mouth rinses may also be recommended to both categories of patients.

Based on these recommendations, here is a sample office fluoride protocol:

All new patients are evaluated to establish their caries risk category during their first exam at the office. All “recall” patients also receive an evaluation at least once a year. This may be accomplished by an assessment of the dentist, or the dentist and hygienist as a team. The risk category of the patient may then be noted in the patient’s computer record, to be updated at the appropriate intervals. Detailed information concerning the patient’s condition, and education concerning what is being recommended, is offered to the patient or parents. Financial considerations are discussed, to include the likelihood of insurance covering the recommended professional application of fluoride based on age and condition. 

Many (but by no means all) carriers will cover fluorides twice annually if under age 14. Some will cover fluoride application for adults if cervical caries are identified. More frequent application for persons under age 14 or for adults under any circumstance may be denied and will therefore be the patient’s responsibility. Patients need to know in advance why they need the service, accept the office explanations and commit to payment, or problems will arise after the fact. Common fees for topical fluoride may range from $15 to $40. A “check-list” of conditions may be used to facilitate assessment and patient education. An example using layman’s terms is shown:

Conditions that Create a Moderate Risk for Future Decay

  1. Teeth with exposed roots
  2. Deep pits or fissures in the teeth where bacteria can “hide”
  3. Dark spots between the teeth visible on an x-ray
  4. White spots, brown spots, or other discolorations on the teeth

Recommended Treatment

  1. Fluoride varnish professionally applied twice per year
  2. Over-the-counter fluoride mouth rinse once a day
  3. Over-the-counter fluoride toothpaste twice a day

Conditions that Create a High Risk for Future Decay

  1. Visible cavitations (holes) or decay found today
  2. Decayed areas that have been restored during the past three years
  3. Heavy plaque on the teeth
  4. Frequent sugary snacks or drinks
  5. Low saliva flow, caused from medications or other conditions
  6. Any fixed or removable appliance such as braces, “bridges” or teeth replacement

Recommended Treatment

  1. Fluoride varnish professionally applied four times annually
  2. Over-the-counter fluoride mouth rinse once a day
  3. Over-the-counter fluoride toothpaste twice a day

While the use of in-office fluorides is very much at the discretion of each dentist, these evidence-based recommendations can provide a basis for developing a protocol.  Topical fluoride application can be a preventive tool with benefits for patients of all ages, and can provide practice revenue that may not have been previously explored. For example: If an office identifies 200 adults at Moderate Risk and provides two fluoride applications per year at $20, $8000 would be generated. Identifying an additional 100 adults at High Risk and providing four applications of fluoride annually at this fee would generate an additional $8000; adding $16,000 income to the office that year.

Carol Tekavec RDH is the director of Hygiene for McKenzie Management.  Carol can improve your hygiene department in just one day of training “in your office”.  Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

Carol is also a speaker on hygiene efficiency and profitability for McKenzie Management. Interested in having Carol speak to your dental society or study club?  Click here

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