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Nurturing Caries-Free Smiles

Five things to consider when recommending high-concentration fluoride toothpaste.

In the realm of modern preventive dentistry, the judicious use of high-concentration fluoride toothpaste has emerged as a potent tool in the battle against dental caries. However, its effective deployment demands a comprehensive understanding of several critical factors.

In this guide, we navigate through the nuanced landscape of recommending high-concentration fluoride toothpaste, shedding light on key considerations that can significantly impact treatment outcomes and patient satisfaction. From risk assessment to patient education, our insights aim to empower dental professionals with the knowledge needed to make informed decisions that safeguard oral health.

1. Risk assessment

Before suggesting the use of a high-concentration fluoride toothpaste, it is important to conduct a thorough risk assessment to confirm your patient’s dental caries risk. For low-risk patients, an over-the-counter fluoride toothpaste, such as Colgate Total SF, may be sufficient.

Patients with an elevated caries, on the other hand, may benefit from additional protective measures such as high-concentration fluoride toothpaste, fluoride varnish, and/​or sealants.

Use a standardized tool like the American Dental Association’s (ADA) Caries Risk Assessment Form available at:​resources/​research/​science-and-research-institute/​oral-health-topics/​caries-risk-assessment-and-management. You’ll find two versions of the form for the following patient populations:

  • Patients ages 0 to 6
  • Patients older than 6

Guidance for conducting an effective caries risk assessment is also provided. There are a variety of other caries risk assesment forms available including: American Academy of Pediatric Dentistry Caries Risk Assessment Tool, Caries Management By Risk Assessment, CarioGram, and Oral Health Information Suite.

Oral health professionals may use these forms to educate patients and their parents/​caregivers about possible risk factors and strategies for limiting caries risk. The forms can also be used as communication tools with the patient or patient’s parent/​caregiver to highlight potential risk. The forms, however, do not eliminate the need for a dental hygienist’s professional clinical judgment.

2. Age

Consider the patient’s age when recommending a high-concentration fluoride toothpaste, as prescription-strength dentifrices are suitable for adults and children ages 6 and older.

Toothpaste with 5,000 ppm are not generally recommended for use in children younger than age 6 due to the risk of ingestion. Too much fluoride exposure may lead to fluorosis in the developing teeth. Oral health professionals need to consider all sources of fluoride exposure before encouraging the use of a prescription-strength fluoride dentifrice.

In cases where the child is at severe risk of caries and related complications, you may judge that the health benefits outweigh the risk of fluorosis, whose side effects are cosmetic and typically very mild. Parents/​caregivers of patients who are nervous about fluoride can be assured with information regarding fluoride and its safety, including the fact it is a natural substance and its many oral health benefits.

3. Patient education

A high-level fluoride toothpaste is only one part of an effective caries prevention plan. It is also important to educate the patient (and parents/​​guardians) on good oral hygiene practices and the control of other risk factors such as limiting sugar-containing drinks and snacks.

Explain to patients how each factor contributes to their current caries risk and how managing them can help promote better oral health. Make sure that any advice you offer is easy to understand and implement at home.

Colgate Professional’s Patient Education site can help you to illustrate your advice with accessible and visually appealing caries resources. The ADA also offers various brochures in their patient education catalog.

4. Patient compliance

In order to fully benefit from the increased caries protection offered by a high-concentration fluoride toothpaste, patients must use it consistently and they must maintain behavioral changes alongside their treatment. Confirm that your patients understand this, discuss any barriers that may stand in their way, and consider what support and motivation you can offer.

Different age groups require a tailored approach. Young children may benefit from seeing the “sugar bugs” on their teeth via a plaque disclosing tablet while it is more important to discuss oral health risks relevant to teenagers, such as vaping and tobacco use, in this age group. Older adults are also at risk for caries, and their strategies should be tailored to their individual needs and health conditions.

5. Recare intervals

When used as directed, a single bottle of Colgate PreviDent 5000 Booster Plus liquid gel will last approximately 1 month. If patients need to refill the prescription before their next appointment, this presents an opportunity for them to abandon treatment. This is especially true for patients who may find it difficult to collect prescriptions (eg, those with limited mobility or those in residential care). Where possible, you can reduce this risk by providing your patient with sufficient product to last until their next appointment (or a repeat prescription, as appropriate).

It is important to determine whether local pharmacies stock prescription fluoride products. If not, make sure you are prepared to direct your patients to the pharmacies offering these important caries-preventing tools.


As dental professionals, our commitment extends beyond diagnosis and treatment — it encompasses patient education, compliance, and empowerment. By tailoring our approach to each individual’s unique risk profile, age, and circumstances, we can optimize the benefits of high-concentration fluoride toothpaste while minimizing potential drawbacks.

Through thorough risk assessment, patient-centered education, and diligent follow-up, we can help our patients embrace oral hygiene practices that serve as pillars of lasting dental health. In this journey, our guidance becomes a compass, steering patients toward brighter smiles and improved overall well-being.n



From Dimensions in Dental Hygiene. September 2023; 21(8):22.

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