Fluoride has been used both systemically and topically to prevent dental caries. One very practical delivery method for high-concentration topical fluoride is toothpaste, which is sold in the United States at different fluoride ion (F-) concentrations, ranging from 850 ppm to 5,000 ppm.1 Unfortunately, accessibility can be an issue for patients. Dental prescriptions are an out-of-pocket expense for the vast majority of patients because they do not have prescription drug insurance; however, this cost could be minimized and the effectiveness of the available toothpastes could be maximized if dental offices were to dispense them directly, customized to the needs of individual patients.
Although the concentration that research has shown to be the most effective, 5,000-ppm fluoride-containing toothpaste, is primarily dispensed through pharmacies,1 there is a lack of knowledge regarding the types of products that are available in their inventories. In order to make appropriate recommendations to patients, dental professionals, and pharmacy companies, a cross-sectional study was conducted that evaluated the distribution and cost of 1.1% sodium fluoride (NaF) toothpastes across pharmacies in the United States, the results of which were published in an online article that can be viewed at insidedentistry.net/go/2020-08-NaF-study.1
Based on data from the US Census Bureau, the surveyed areas were categorized as rural, suburban, or urban. Pharmacies were identified using a stratified random sampling method, and information regarding the name and location of each pharmacy as well as product details, such as brand names and retail costs, were obtained through walk-in and telephone interviews. A total of 192 pharmacies were surveyed in 47 US states and territories, and 360 prescription toothpaste products were being sold at those pharmacies.
According to the results of the study, the average costs of 1.1% NaF toothpastes in the rural, suburban, and urban areas were $19.65, $20.77, and $20.44, respectively. The difference in these costs was not statistically significant. A significant difference was observed between the costs of commercial and generic products, which ranged from $14.71 to $24.35. Similarly, the costs of products varied significantly between different pharmacies (eg, Costco, CVS, Walgreens, Walmart), ranging from $7.99 to $39.00.
Clearly, this study found wide variation in the costs of commercially available 1.1% NaF toothpastes sold at pharmacies. The products most commonly sold were 1.8-oz tubes, which should last 5 to 6 weeks with twice-daily use by one person. Using this metric, theoretically, five to six refills would be required for 6 months of therapy, which is the most common patient recall cycle. This would require multiple pharmacy visits at considerable cost to the patient. Providing prescription toothpaste from the dental office at a reduced price can reduce those patient costs while also saving trips to the pharmacy, particularly during the COVID-19 pandemic when people are being advised to avoid unnecessary travel.
Interestingly, the data revealed that approximately 54% of the surveyed pharmacies stocked no more than one brand of 1.1% NaF toothpaste. This leaves patients with no options from which to choose. In addition, most of the 1.1% NaF toothpaste products sold at pharmacies do not contain abrasives. Oftentimes, patients unknowingly use a prescription toothpaste as an alternative to regular toothpaste, and regular use of a non-abrasive dentifrice might compromise effective plaque control and overall oral health. Because most dental offices do not direct patients to buy from a specific pharmacy, they are challenged to determine whether patients will purchase an abrasive toothpaste or not. Research has indicated that approximately 20% to 30% of medication prescriptions are never filled and that approximately 50% of medications for chronic disease are not taken as prescribed. The situation could be similar for prescription toothpastes.
All of the aforementioned factors could be addressed if 1.1% NaF prescription toothpaste was dispensed at the dental office, customized to the needs of individual patients. In the interest of providing the best possible care to patients, it is the dentist's responsibility to make optimal treatment methods as widely accessible and as accurately utilized as possible.
About the Authors
Jayakumar Jayaraman, BDS, MDS, PhD, is a resident in pediatric dentistry in the Department of Developmental Dentistry at UT Health San Antonio. Kevin J. Donly, DDS, MS, professor and chair of the Department of Developmental Dentistry at UT Health San Antonio, served as corresponding author for this article.
1. Jayaraman J, Donly K. Price and availability of prescription fluoride toothpaste in US pharmacies. Compend Contin Educ Dent. 2020;41(7).