Clinical application of topical fluoride products--risks, benefits, and recommendations

This portion of the symposium discusses the various methods of professionally applying high-concentration topical fluoride products and their risks and benefits. Numerous recent investigations in this area of research are reviewed and discussed. Data from these research investigations point to the need for care when high-potency F products are used, especially in young children. Oral-retained F doses following four-minute topical application procedures ranged from 10 to 31 mg when no suction devices or patient expectoration was utilized. Following the use of suctioning devices, oral-retained F doses ranged from 6 to 12 mg, a clinically unacceptable level. Following the use of suctioning devices plus patient expectoration, the oral-retained F doses were reduced to from 2 to 7.5 mg, depending on type of F product and application system. The following recommendation for topical application of high-potency F products are made: (1) No more than 2 g of gel per tray or approximately 40% of tray capacity should be dispensed. Even more conservative amounts should be considered for small children. (2) Because patients may have the need to swallow during a four-minute topical application procedure, the use of a saliva ejector during the procedure is recommended. (3) Following the four-minute application procedure, the patient should be instructed to expectorate thoroughly for from 30 sec to one min, regardless of whether high-speed suction is utilized. Expectoration is probably the single most effective way of reducing orally retained fluoride. (4) When utilizing custom individually fitted trays for patients requiring daily or weekly application of a high-F-concentration product, utilize only 5 to 10 drops of product per tray.