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Get Listerine fluoride for free with Obamacare – maybe

January 30, 2017 By Trish Walraven Leave a Comment

I feel very targeted right now.

It’s because I’m one of the 16% of Americans that everyone is fighting to either “guarantee insurance” for or “force insurance” upon, depending on which side of the aisle you stand.

You see, my family has Obamacare.

It’s not because we can’t afford anything else. It’s because there simply is no other major medical care available for small employers who either aren’t required to offer insurance to their employees or cannot obtain group insurance because of the size of the company. We privately purchase the exact same plan offered on the Marketplace; it’s off the exchange, though, so there are no subsidies.

Here’s the cool (mint?) reason for mentioning this on DentalBuzz. As part of a family that’s enrolled in a plan that was created due to Obamacare, I discovered by accident that there’s a way to get Listerine fluoride rinse for free.

What happened is that I was browsing through the 2017 drug formulary from my insurance company and found something called the ACA Tier. Almost every exchange-eligible plan has a No-Cost Preventive Drug List like this one from Blue Cross Blue Shield of Texas. It states in part:

Your health plan may include certain prescription and over-the-counter (OTC) preventive medicines, as a benefit of membership, at no cost to you when you use a pharmacy or doctor in your health plan’s network. There is no co-pay, deductible or coinsurance, even if your deductible or out-of-pocket maximum has not been met. Coverage for these medicines can vary according to the type of plan you are enrolled in…. Age limits, restrictions and other requirements may apply.”

So I’m going down the list and notice several entries for Listerine:

How can I get my free bottle, that’s what I said to myself when I read this. You want your free bottle too? Not so fast. All ACA-qualified plans are only required to cover fluoride for children under age 6. Which may mean that if you have children enrolled in Obamacare and they’re preschoolers, all you may have to do is to take your child’s bottle of Listerine up to the pharmacy window, present the insurance card, and they’re supposed to zero out the expense for you. I called my insurance company and this is what they stated. You’ll need to check your own benefit booklet first, though, because some plans only cover fluoride in other forms.

As a dental hygienist and mom, though, what’s a little perplexing is trying to figure out the label directions. We’ll go after this bottle of Listerine Smart Rinse, cause it’s cute and tough all at the same time.

Toddler-friendly? Check again.

There is a huge disconnect between the FDA and the ACA, and it shows on this label! The Food and Drug Administration says you shouldn’t give it to children under six without consulting a dentist or doctor, but the Affordable Care Act pays for its use only for children that age.

Anyway, we all realize that healthcare in the United States is a work in progress. In other words, it’s a mess, right? And most of us are very much out of our element when we’re trying to figure out what’s covered and what’s not. Did you know that even most dentists and hygienists are clueless about fluoride benefits and the ACA? The only reason that I know anything myself is because I did a bit of sleuthing, found a lot of the Obamacare plans in each state, read their Preventive Drug lists, and then compiled the research. Sure, this article starts off with a little Listerine click-bait (hah! Social Marketing 101 – make ’em look!) but I do want to offer some important education, too. Here goes.

• What do all ACA-qualified plans have in common with each other? At the very least, every insurance policy must include fluoride supplementation at no cost for children under age 5. Supplements are recommended mostly in areas where the fluoride level in water supplies are inadequate, and age five and below is the time frame when teeth can be protected most by the ingestion of fluoride. The supplements can be in the form of drops, chewable tablets, or as combination vitamins. All fluoride supplements require a prescription, either from a dentist or a physician’s office.

• Many health plans also pay for the in-office topical application of fluoride varnish. This is covered by the medical side of the plan, not the dental benefit, so you should either be savvy with using the medical code (CPT 99188) or leave it in the pediatricians’ sticky hands. Haha, sticky hands. If you’ve ever worked with fluoride varnish, it sticks to evvvverrrrry thing if you’re not careful. But hey, it’s why varnish can give up to six months of cavity protection, too. Some plans cover fluoride varnish applications as an unlimited benefit, however, I found that most plans pay for no more than two applications per calendar year.

• Some of the plans reviewed include prescribed and/or over the counter (OTC) topical fluoride gels, pastes, and rinses, such as the previously mentioned Listerine Fluoride, Act Rinse, Prevident, Fluoridex, Gel-Kam, Clinpro 5000, Phos-Flur, Omni Gel and others. A few of the plans even list brand-name toothpastes, although I wouldn’t count on those getting covered.

Although I reviewed somewhere in the range of 50-100 healthcare plans available, I can’t tell you specifically which fluoride products are covered by, say, Cigna versus Aetna, because they vary so much between states. You’ll have to read your plan, or better yet, call your insurance company. Be sure to share what you discover with your dentist, hygienist, or physician, so they can help your kids get the fluoride prevention that you’ve already pre-paid for.

Because, let’s face it, pre-payment is what preventive healthcare insurance is, anyways. You only “pay an ounce” for prevention, after all, so you should get at least that much back. Especially when a pound – 16 fluid ounces – of Listerine fluoride costs your insurance company only five bucks.

It sure beats the bill for a pound of actual cure.

Trish Walraven, RDH, BS is a dental hygienist from the Dallas/Fort Worth area who cropped out her lovely daughter in this photo because it’s very, very obvious that she’s older than five. She didn’t want the Obamacare Police to have anything on her if she did show up at the pharmacy begging for her “free” bottle of bubble-gum fluoride rinse.

References and resources

United States Census Bureau, Health Insurance Coverage in the United States: 2015 https://www.census.gov/library/publications/2016/demo/p60-257.html

Aetna Health Care Reform Preventive Care Drug List: https://www.aetna.com/content/dam/aetna/pdfs/formulary/2016_HCR_Preventive.pdf

American Academy of Pediatrics – Oral Health Coding Fact Sheet for Primary Care Physicians: https://www.aap.org/en-us/Documents/coding_factsheet_oral_health.pdf

Science-Based Medicine. Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers https://sciencebasedmedicine.org/preventing-tooth-decay-in-kids-fluoride-and-the-role-of-non-dentist-health-care-providers/

Kaiser Family Foundation. Health Insurance Coverage of the Total Population: http://kff.org/other/state-indicator/total-population/?currentTimeframe=0

United Healthcare. Topical Fluoride Treatment Dental Clinical Policy: https://www.unitedhealthcareonline.comTopical%20Fluoride.pdf

Humana Pharmacy Solutions. $0 Preventive Medication Coverage: http://apps.humana.com/marketing/documents.asp?file=2838979

Kaiser Permanente. Preventive Services Flier: http://apps.humana.com/marketing/documents.asp?file=2838979

Candy that really fights cavities

February 18, 2016 By Trish Walraven 13 Comments

Why do you get cavities? It’s not because your teeth are soft. Cavities happen in mouths where the environment is all jacked up. Too much acid, too many germs, an abundance of refined foods, too little saliva. Basically the little ecosystem in your mouth is out of whack.

How do you get it back in balance? You already know some things you can do: eat better, brush and floss better, drink water. Sometimes, though that’s not enough. What do you do between meals? Between brushing?

You change the mouth itself by changing what can grow in there.

One way is with licorice:

No, that doesn’t count, sorry. It has to be real, tar-black, sugarless licorice. Real licorice contains licorice extract (unfortunately, that’s the stuff that makes it taste way worse than Red Vines). The way that licorice fights cavities is by changing the mouth environment so that the germs that cause cavities are inhibited.

These are licorice roots:

Licorice roots have been around ever since the original hunters and gatherers realized they were sweet-ish, quenched thirst, and tasted much better than most of the other twigs and sticks they used to dig around in their gums and teeth. Maybe they realized their teeth hurt less when they chewed on them, too. Licorice roots contain a compound called glycyrrhizin, which has been proven to reduce tooth decay. They’re cheap, natural, and abundant; you can even buy them here at this link on Amazon.com. But a word of caution: glycyrrhizin can be dangerous in excess amounts. Since licorice root is considered a natural herb, there’s no way for the FDA to regulate the dosage, and too much of it can cause heart arrhythmias, increase blood pressure, and reduce potassium levels.

If your response to black licorice and licorice roots are No, and Hell No, respectively, then how in the heck do you think you’re going to get kids to put licorice extract in their mouths?

Enter capitalism at its finest, folks.

When this company contacted me about a year ago, I was excited to ~~eat free candy~~ write a product review about something that may really help my patients prevent cavities. Remember what I was saying about licorice? Cavibloc™ is the proprietary formulation of licorice extract used in Loloz™ that you can read on their ingredient list here:

How this works

I’ve seen enough studies and listened to tons of lectures from smart people who know what they’re talking about to be convinced that the science is very strong behind using licorice extract in this way to prevent dental cavities. Here’s the biggest problem about it, though: it doesn’t work if you don’t use it, duh. Follow the steps below to get started on this great cavity prevention regimen:

1. Overcome your objections. Just so you know, I’ve eaten practically a whole box of the berry flavored pops, given them to my kids and friends of my kids, and they taste good. Really good. No problem on the flavor at all. Also, it will cost about $90/year for three boxes. Those are the big obstacles. Everything after this is easy.

2. Buy your boxes at Amazon.com. Lookie, it even comes with Amazon Prime! Here are your flavor choices (and by the way, these are NOT affiliate links – I’m not making any money off of this, just in case you doubt my sincerity):

Loloz Berry Lollipops

Loloz Orange Lollipops

Loloz Lemon Lollipops

For people who aren’t into the whole “stick hanging out of your mouth” thing, there are candy lozenges, too:

Loloz Berry Candy

Loloz Orange Candy

Loloz Lemon Candy

3. Open up your box when it arrives.

You’ll get 20 suckers per box… but maybe they’ll throw in a few for a bonus, with a note to let you know they didn’t count wrong. Maybe eat one of the extra ones as soon as you get them, to make sure you’re going to like them. Then…

4. Put them in the car. What? Following the recommended regimen is the most important part. It takes about 10 days of consecutive exposure time for licorice extract to disrupt the germs that cause cavities. And not just once per day. Two times per day for ten days. You’ll want to have one sucker in the morning, one in the evening. But how do you remember to have two per day? You and your kids (if you take them to school and/or work) are in your car at least twice per day. Maybe you don’t actually leave the lollipops in the car because they may get icky gooey on hot days. But you know what I mean. Discipline yourself to make sure you’re using them two times per day.

5. Repeat in 4 months. You’ll do this about three times per year for excellent cavity control, plus you get to feel good about eating candy. Whee! Over time, the bad bacteria will start creeping back in, but starting up another 10-day treatment in 3 to 4 months will help balance out the mouth environment once again. People who get cavities easily need licorice root extract. It’s just that simple. If you’ve ever been given a prescription for high fluoride toothpaste, Loloz are for you.

So you may be asking yourself, why no one else is talking about this, why there might not be a lot of Amazon reviews on Loloz, it must not be any good, right? No, that’s not it. The company made a big push a year ago to get the word out, but marketing these days is a tricky thing for new companies. I am confident that the product is spot-on, and I’m here to reinforce again to you that balancing your mouth environment is one of the most important things you can do to prevent cavities. There are other ways to reduce tooth decay, but right now Loloz are your best bet for obtaining a proven, long-term, dose-controlled antimicrobial effect against decay-causing bacteria. And if you’re a dentist or hygienist who is thinking about recommending this to your patients, remember:

COMPLIANCE IS EVERYTHING!

…She says, with a delicious, sugar-free Loloz lollipop in her mouth.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She has a very, very bad sweet tooth and doesn’t take money from companies like Loloz because she’s afraid they would give her a lifetime supply of sugarless candy which would be no fun because, hey, if it’s good for you, the days of living dangerously from sugar highs just go phhhht. gone.

Resources and References:

International Journal of Pharma and Bio Sciences, January 2015. “Assessing the effectiveness of liquorice root extract lollopop in reducing the S. mutans count in saliva in children aged 6-12 yrs – a pilot study.” http://www.ijpbs.net/cms/php/upload/4020_pdf.pdf

European Academy of Pediatric Dentistry, December 2010. “Clinical reduction of S. mutans in pre-school children using a novel liquorice root extract lollipop: a pilot study.” http://www.ncbi.nlm.nih.gov/pubmed/21108917

Medscape, January 2012. “Licorice Root May Cut Cavities, Gum Disease.” http://www.medscape.com/viewarticle/756532

John C. Comisi, DDS, MAGD, April 2013. “Employing a whole-patient approach to the lifelong struggle of caries management.” http://www.dentalaegis.com/id/2013/04/oral-disease-the-battle-for-balance

British Dental Journal, December 2009. “Liquorice Alert.” http://www.nature.com/bdj/journal/v207/n11/full/sj.bdj.2009.1090.html

Toothpaste can do more harm than good

December 30, 2014 By Trish Walraven 71 Comments

The next time a patient innocently asks me, “What’s the best toothpaste to use?” I’m going to unleash a whole Chunky Soup can of “You Want The Truth? You CAN’T HANDLE THE TRUTH!!!” Gosh, that’s such an overused movie quote. Sorry about that, but still.

If you’re a dental professional, isn’t this the most annoying question you get, day after day? Do you even care which toothpaste your patients use?

No. You don’t. Asking a dentist what toothpaste to use is like asking your physician which bar of soap or body scrub you should use to clean your skin. Your dentist and dental hygienist have never seen a tube of toothpaste that singlehandedly improves the health of all patients in their practice, and the reason is simple:

Toothpaste is a cosmetic.

We brush our teeth so that out mouths no longer taste like… mouth. Mouth tastes gross, right? It tastes like putrefied skin. It tastes like tongue cheese. It tastes like Cream of Barf.

On the other hand, toothpaste has been exquisitely designed to bring you a brisk rush of York Peppermint Patty, or Triple Cinnamon Heaven, or whatever flavor that drives those tubes off of the shelves in the confusing dental aisle of your local supermarket or drugstore.

Toothpaste definitely tastes better than Cream of Barf. And that’s why you use it. Not because it’s good for you. You use toothpaste because it tastes good, and because it makes you accept your mouth as part of your face again.

From a marketing perspective, all of the other things that are in your toothpaste are in there to give it additional perceived value. So let’s deconstruct these ingredients, shall we?

1. Fluoride.

This was probably the first additive to toothpaste that brought it under the jurisdiction of the Food & Drug Administration and made toothpaste part drug, part cosmetic. Over time, a fluoride toothpaste can improve the strength of teeth, but the fluoride itself does nothing to make teeth cleaner. Some people are scared of fluoride so they don’t use it. Their choice. Professionally speaking, I know that the benefits of a fluoride additive far outweigh the risks.

2. Foam.

Sodium Lauryl Sulfate is soap. Soap has a creamy, thick texture that American tongues especially like and equate to the feeling of cleanliness. There’s not enough surfactant, though, in toothpaste foam to break up the goo that grows on your teeth. If these bubbles scrubbed, you’d better believe that they would also scrub your delicate gum tissues into a bloody pulp.

3. Abrasive particles.

Most toothpastes use hydrated silica as the grit that polishes teeth. You’re probably most familiar with it as the clear beady stuff in the “Do Not Eat” packets. Depending on the size and shape of the particles, silica is the whitening ingredient in most whitening toothpastes. But whitening toothpaste cannot get your teeth any whiter than a professional dental polishing, because it only cleans the surface. Two weeks to a whiter smile? How about 30 minutes with your hygienist? It’s much more efficient and less harsh.

4. Desensitizers.

Teeth that are sensitive to hot, cold, sweets, or a combination can benefit from the addition of potassium nitrate or stannous fluoride to a toothpaste. This is more of a palliative treatment, when the pain is the problem. Good old Time will usually make teeth feel better, too, unless the pain is coming from a cavity. Yeah, I’m talking to you, the person who is trying to heal the hole in their tooth with Sensodyne.

5. Tartar control.

It burns! It burns! If your toothpaste has a particular biting flavor, it might contain tetrasodium pyrophosphate, an ingredient that is supposed to keep calcium phosphate salts (tartar, or calculus) from fossilizing on the back of your lower front teeth. A little tartar on your teeth doesn’t harm you unless it gets really thick and you can no longer keep it clean. One problem with tartar control toothpastes is that in order for the active ingredient to work, it has to be dissolved in a stronger detergent than usual, which can affect people that are sensitive to a high pH.

6. Triclosan.

This antimicrobial is supposed to reduce infections between the gum and tooth. However, if you just keep the germs off of your teeth in the first place it’s pretty much a waste of an extra ingredient. Its safety has been questioned but, like fluoride, the bulk of the scientific research easily demonstrates that the addition of triclosan in toothpaste does much more good than harm.

Why toothpaste can be bad for you.

Let’s just say it’s not the toothpaste’s fault. It’s yours. The toothpaste is just the co-dependent enabler. You’re the one with the problem.

Remember, toothpaste is a cosmetic, first and foremost. It doesn’t clean your teeth by itself. Just in case you think I’m making this up I’ve included clinical studies in the references at the end of this article that show how ineffective toothpaste really is.

• You’re using too much.

Don’t be so suggestible! Toothpaste ads show you how to use up the tube more quickly. Just use 1/3 as much, the size of a pea. It will still taste good, I promise! And too much foam can make you lose track of where your teeth actually are located.

• You’re not taking enough time.

At least two minutes. Any less and you’re missing spots. Just ’cause it tastes better doesn’t mean you did a good job.

• You’re not paying attention.

I’ve seen people brush the same four spots for two minutes and miss the other 60% of their mouth. The toothbrush needs to touch every crevice of every tooth, not just where it lands when you go into autopilot and start thinking about what you’re going to wear that day. It’s the toothbrush friction that cleans your teeth, not the cleaning product. Plaque is a growth, like the pink or grey mildew that grows around the edges of your shower. You’ve gotta rub it off to get it off. No tooth cleaning liquid, paste, creme, gel, or powder is going to make as much of a difference as your attention to detail will.

The solution.

Use what you like. It’s that simple. If it tastes good and feels clean to you, you’ll use it more often, brush longer, feel better, be healthier.

You can use baking soda, or coconut oil, or your favorite toothpaste, or even just plain water. The key is to have a good technique and to brush often. A music video makes this demonstration a little more fun than your usual lecture at the dental office, although, in my opinion you really still need to feel what it is like to MASH THE BRISTLES OF A SOFT TOOTHBRUSH INTO YOUR GUMS:

A little more serious video from my pal Dr. Mark Burhenne where he demonstrates how to be careful with your toothbrush bristles:

Final word.

♬ It’s all about that Bass, ’bout that Bass, no bubbles. ♬ Heh, dentistry in-joke there.

Seriously, though, the bottom line is that your paste will mask brushing technique issues, so don’t put so much faith in the power of toothpaste.

Also you may have heard that some toothpastes contain decorative plastic that can get swallowed. Yeah, that was a DentalBuzz report I wrote that went viral earlier this year. And while I can’t claim total victory on that front, at least the company in question has promised that the plastic will no longer be added to their toothpaste lines very soon due to the overwhelming amount of letters, emails, and phone calls that they received as a result of people reading that article and making a difference.

But now I’m tired of talking about toothpaste.

Next topic?

I’m bringing pyorrhea back.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She brushes her teeth every morning and night with a major-label toothpaste because she likes the way it makes her mouth taste but at lunch you never know. Sometimes it will be with a dry toothbrush, or dipped in her leftover coffee, one time she even brushed with a starlight peppermint out of desperation.

Resources:

PubMed.Gov: Role of dentifrice in plaque removal: a clinical trial.

PubMed.Gov: Clinical studies to determine the effectiveness of a whitening toothpaste at reducing stain

PubMed.Gov: Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes.

Vicky Flint RDH: The Truth about Toothpaste

DearDoctor.com: Toothpaste-What’s in it?

Trisha O’Hehir RDH: Dry Brushing -The Toothpaste Secret

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*dentist not included (with clear aligners)

September 26, 2014 By Trish Walraven 147 Comments

This post is from the time when SmileDirectClub first began its marketing campaign, from the standpoint of a general dentist’s practice, and the feelings of whether or not online-ordered cosmetic aligners would be taking away market share for dentists. The reviews are posted below the article, from those who have used the product or who have questions about it.

If you’re not an orthodontist, but you straighten teeth in your dental practice, I’ve got a fistfight just waiting for you. Where? Thankfully someone else went through the trouble of making this cute little scroll-ey infographic, so I’ll just post it here and save myself the trouble, and the punches.

SmileCareClub Wants to Disrupt Dentists- Crowdfunding Insider (no longer available)

(sorry, looks like the infographic wasn’t sanctioned by Smile Care Club… anyways, here’s another link on IndieGogo)

A full set of dental aligners, just like the Invisalign® ones, for a third of the cost or less, can you simply order them online? With no visit to a dental office? Heck, why not? I mean, all you have to do is worm two pieces of putty together and then squish them onto your teeth for an impression, mail them to the lab, upload a few photos from your smartphone, and wait for your trays to magically appear at your doorstep.

What is it with blue boxes? Is blue, like, a confident color or something? See how the SmileCareClub box compares to an aligner box from our office:

And then there’s the involvement of the aligner-providing dentist. The ClinCheck inclusion is a facade, a joke? You mean to tell me that the lab could do all of this via 3D imaging and just cut the middleman dentists out of the deal?

Not completely. You’ve got interproximal reductions that still need to be managed in some cases, and the SmileDirectClub is looking for ~~suckers~~ Endorsed Local Providers to saw those big fat teeth into submission. And who the heck knows whatever happened to attachments? I personally had Invisalign attachments placed a decade ago, and cannot imagine what my results would have been without them.

Orthodontists are probably chuckling to themselves. They saw this coming with all of the cosmetic tooth straightening programs being marketed to general dentists over the last decade.

It makes the whole teeth whitening mall kiosk issue seem petty, now, doesn’t it?

SmileCareClub doesn’t appear to have a single dentist on its management team, but they employ a few, I guess, to keep it legal, I guess. It’s really hard to tell. This aligner system is also sold on the Sharper Image website, in case you want to forward a link to any patients who look at you sideways and curse under their breath when you tell them what their in-office aligner treatment is going to cost. Sharper Image– that’s legit, right? Maybe you didn’t realize that the original Sharper Image went bankrupt. Interestingly, the brand name was bought by the same VCs that, guess what?- own SmileDirectClub.

Orthodontists, are you feeling disrupted yet?

I didn’t think so.

A blogger since 1997, Trish Walraven, RDH, BSDH is a practicing dental hygienist and marketing manager for an indie dental software development company. Her mission with DentalBuzz is to offer a fresh podium of discourse for those involved in dentistry and to expose fun in our professional lives.

Update: SmileCare Club is now called SmileDirectClub, which you can see at SmileDirectClub.com. The cost is $1500, and if you Buy Today!, they’ll include GloScience gel (interestingly enough, here’s what DentalBuzz had to say about GloScience in 2011).

Aug 2016 Update: Invisalign has announced that they are building aligners for Smile Direct Club. See the notice in the comments below. The similarity of the boxes now makes sense!

2017 Update: Invisalign now owns a 19% interest in SmileDirectClub. But that kind of backing will cost you $350 more, which now brings the cost of aligner therapy to $1850.

September 2019 Update:

Smile Direct Club just had their IPO, and now the founders are billionaires. It’s all about disruption of the status quo, apparently, because if you can afford $80/month instead of $150/month (the cost to see a real orthodontist) you should Do Orthodontics Yourself. Smile Direct Club have no more than 250 dentists that “check” the cases. That’s one dentist per 3000 patients (750,000 people served so far)! Bottom Line? If you think of teeth as ornaments, not functional body parts, then that’s on you if they rot out or you can’t chew with them afterwards. Story here: https://www.bloomberg.com/news/articles/2019-09-13/smiledirectclub-s-ipo-creates-a-pair-of-30-year-old-billionaires

Phocal fluoride disks

April 25, 2014 By Trish Walraven 2 Comments

What in the phôc is Phocal? The name is oh-so-clever, the way it changes up the F-sound, pinpoints the precision of its delivery mechanism, adds in a little calcium and acid/base interplay there. Plus, the little disks sorta kinda look like contact lenses. Phocal – the latest in fluoride therapy.

Phocal disks were brought to market last year, but I just discovered them a few days ago at Hygienetown, one of my favorite online dental hangouts, where they were met with a vague sort of shrug and a huh? Which got me to wondering, why in the world aren’t these things getting more press, more attention, more rave reviews?

Of course! It’s because they haven’t been DentalBuzzed yet.

The few articles that I’ve read about Phocal so far are as exciting as your average WHAT’S NEW IN DENTISTRY dreck. DentalBuzz is here to change that, to present to you all the facts about Phocal Therapy in an entertaining, yet insightful package designed to bring the maximum exposure possible to a product that will sink or swim on its own merit in the end.

Problem #1: Incipient interproximal lesions

If you’re not in dentistry you probably don’t know what these are. Let’s just call them future “Cha-Ching!” You know when dentists take radiographic images inside your mouth with x-rays? They’re looking for cavities between your teeth, where sugar and decaying bacteria ferment into acids that dissolve the surface of enamel into a mass of tiny swiss-cheese chalky goo.

When an interproximal lesion has gone too far, expect your dentist to drill it, fill it, and bill it (sorry for such a stale joke!). But Phocal disks promise to change all that. These cute little frisbees are designed to be inserted between your teeth (interproximal) before they’ve decayed, at the first sign of a beginning (incipient) cavity, to minimize the damage done to your teeth, as well as to your bank account.

Problem #2: Isocaps

Even many dentists have forgotten what an isocap is, so that’s why I’m going to explain them to you and why a Phocal disk inhibits their formation. Essentially an isocap is a bubble created between two flat surfaces that prevents liquids from wicking into it. Isocaps have to do with capillary action and surface tension.

Most fluoride delivery systems rely on a liquid to get the tooth-strengthening bits to soak deep into dental structure. If you’ve got a bunch of isocap bubbles between your teeth you can see how there’s no way that you’ll get a liquid-based fluoride to wick into the space where it may be needed most.

The Solution: Jam Some Stuff Between Your Teeth

If you can’t penetrate an isocap, well then, just obliterate it, take it out of existence, displace it. Whatever it takes, just put something ELSE there. Fluoride has been proven in many studies to increase the remineralization of a tooth that has begun to weaken, which is why fluoride is the active ingredient in the Phocal disks.

I’d explain how this whole process works, the options available, and even the studies that show how Ah-May-Zing this new fluoride therapy is except that someone at Collident paid a production company to make this perky animated video that does the job for me pretty well. Yes, you DO have three minutes to watch it. And there’s no voice-over, so feel free to turn off your sound before you click the arrow to start it up.

The Obstacles: Price, Chair Time and FDA Approval

What…you were expecting that these disk are THE answer to cavities between our teeth, forever and ever, end of discussion? If they were perfect we’d all have them in our mouths right now. For one thing, they’re not cheap: a box of 20 Phocal disks cost the dentist around $125 – that’s over $6 for each insertion. And because they are “technique sensitive” (read: only an experienced professional can place them) you’ve also got to deal with the dental office overhead fees. As far as the FDA approval goes, as of the time of this publication it appears that the Food and Drug Administration says that the Phocal Disc is unapproved, stating “this drug has not been found by the FDA to be safe and effective, and this labeling has not been approved by the FDA.”

Does this mean, then, that Phocal disks are doomed to obscurity and demise? Not necessarily. Dentists have no problem purchasing a box from the usual channels, but they may not be aware that this therapy exists in the first place, because there are all these flashy things in dentistry that many dentists prefer to spend their time learning about besides prevention. Besides, there’s more money to be made by fixing decayed teeth versus trying to preserve demineralized ones. That’s why the 5th dentist never recommends sugarless gum to his patients who chew gum (!). Cavities keep dentists profitable.

Which is why it’s now YOUR job to ask for Phocal disk therapy the next time your dentist wants to “watch” a spot between your teeth. And that is because watching is a very, very unhealthy type of voyeurism in the dental world.

References:
University of Michigan: Capillary Action around Dental Structures
National Library of Medicine: http://dailymed.nlm.nih.gov/dailymed/Phocalfluoride