#21 – Recommends fluoride gel

Stannuous FL gel is no longer applied in the office after a cleaning. The patients can expect a 40% reduction decay by using 5000 PPM FL applied daily. The following chart shows carries reduction by fluoride concentration (study form the 80’s)

One-year carries increment results (visual-tactile exam supplemented with radiograph exam)
Treatment %Reduction
1100 ppm F —
1700 ppm F 11.0%
2200 ppm F 18.6%
2800 ppm F 20.4%

Who needs the FL gel:
1. All children after they are able to spit great prevention (unless parents object!)
2. Kids with decay
3. Adults with decay problem
4. Adults with exposed roots (to prevent root caries)
5. Adults with root sensitivity (to lower hypersensitivity)
6. Clients undergoing radiation therapy
7. Clients in braces
8. Clients with reduced salivary flow
9. Clients with a lot of restorative work

Application directions:
1. Put FL gel on toothbrush and brush thoroughly
2. Spit out no rinse, no eating or drinking for at least 1/2 hour
3. The more applications the better, but bedtime is best

Insurance covers fluoride for children under 19 years on a 6 month basis.

Important facts to know about FL safety:
The lethal dose ranges from 32 64 mgm FJ/kg for adults. For children the minimum dose that could cause toxic signs and symptoms is 5mgm FL/kg.

Fluoride Toxicity:
Signs and symptoms acute FL toxicity include nausea, vomiting, diarrhea, abdominal pain, cramps, a weak pulse, hypotension, and pallor nerve and respiration depression and cardiac irregularities.

Emergency Treatment:
Minor upsets try first to induce vomiting and then give milk or antacids and watch for several hours. Metallic ions (calcium, magnesium, and iron) in these products combine with FL to reduce absorption.

If > 5.0 mgm/kg ingested prompt hospitalization may be required, onset to acute toxicity is very rapid.

This information is important to know, but don’t scare the parent. Simply tell them: “This is a prescription item. If your child swallowed half a bottle they could get sick. Be sure to keep it out of their reach most of the time.

Fluoride
1. In office application does not include rinses
a. Preventive
1′ D1203 – child – all types of applications (also use D1203.3 for low risk fluoride varnish)
2′ D1204 – adult (probably no coverage)
b. 1206 moderate to high cavity risk documented
1′ Adults with visible need (poor hygiene, diet, existing decay, etc.)- add narrative for coverage
2′ Fluoride varnish – 1206 not to desensitize a tooth/quadrant, only a decay control (whole mouth) – covered if moderate to high risk of decay
2. D9910: Desensitizing