2711 N. Duke Street   Durham, NC 27704


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Duke Oral Health

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DSPD Safety Protocol


We are offering an improved method of decay prevention to our patients. We are using a varnish to apply fluoride to children's teeth. The fluoride varnish has a longer working time than the traditional  fluoride gels or foam applications.  To keep the varnish on the teeth for as long as possible:


** Avoid drinking or eating for ten minutes after placement of the varnish.


** Your child should eat a soft, nonabrasive diet for the rest of the day.


** Teeth should not be flossed and brushed until tomorrow morning, at which time a regular schedule of careful oral hygiene should be resumed.


What is enamel fluorosis?

A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development (while they are growing in the jawbones).  Too much fluoride can result in defects in the tooth enamel.  It is shown as white, yellow or brown splotches, streaks or lines, usually on the front teeth.


Why is enamel fluorosis a concern?

In severe cases of enamel fluorosis, the appearance of the teeth are marred by discolorations or brown markings.  The enamel may be pitted, rough, and hard to clean therefore setting those teeth up for increased risk of decay.  In mild cases of fluorosis the tiny white specks or streaks are often unnoticeable.


How does a child get enamel fluorosis?

By swallowing too much fluoride for the child’s size and weight during the years of tooth development (while they are growing in the jawbones).


This can happen in different ways:


• A child may take more of a fluoride supplement than the optimum amount they need (sometimes pediatricians do not take a thorough fluoride history and over prescribe supplements!).


• The child may take a fluoride supplement when there is already an optimal amount of fluoride in their drinking water.


• Some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.


How can enamel fluorosis be prevented?

Dr. Keels will determine the appropriate fluoride supplementation, if any, that should be given.  Dr. Keels may choose to test the level of fluoride in your child’s source of drinking water. After they know how much fluoride your child receives from his or her water supply, they will decide if there is a need for supplemental fluoride within your child’s diet.


Second, monitor your child’s use of fluoridated tooth paste.  A pea-size amount applied to the toothbrush is plenty for fluoride protection.  Teach your child to SPIT out the toothpaste NOT swallow it, after brushing.  Unless Dr. Keels advises it DO NOT use fluoridated toothpaste until your child is age 3-4.


Should I avoid fluorides all together for my child?

NO! Fluoride prevents tooth decay.  It is an important part of helping your child to have a healthy smile for a lifetime.  Getting enough – but not too much – fluoride can be accomplished with the help of our practice.


Can enamel fluorosis be treated?

Once fluoride is part of the tooth enamel, it can not be taken out.  But the appearance of the teeth affected by the fluorosis can be greatly improved by a variety of treatments that our practice offers from bleaching to white fillings.  If your child suffers from severe fluorosis, our practice will educate you and your child about the various techniques and choose the best procedure to help enhance your child’s smile and their self-confidence.