The Ivory Cross regularly receives questions about Gewoon Gaaf. The questions and answers are given a permanent place on this page in the hope that this will be helpful to many professionals who work or want to work according to the Gewoon Gaaf method.

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Question: During the GG course, there is a rather reserved attitude about giving fluoride applications to all children between the ages of 6 and 18. What exactly is wrong with that?

Answer:
First the question why, then the question: what's wrong with it?
The why becomes clear if one roughly divides the caries process into 3 phases.
Phase 1: nothing (visible) happens to the enamel,
Phase 2: the caries process starts, a white spot becomes visible
Stage 3: The white spot progresses to cavity.

Research has shown that fluoride mainly intervenes in phase 3, the progression from white spot to cavity. It also became clear that if you apply fluoride to enamel, as with the local fluoride applications, that fluoride only remains to a significant extent in the enamel of phase 2 when the white spot is visible and in phase 3. Taken together, this indicates that fluoride application on intact enamel ( phase 1) is not effective, but is effective in phases 2 and 3. It has now also been found that not every phase 2 progresses to phase 3. The distinction between a progressing phase 2 caries and a non-progressing phase 2 caries can be established by the appearance of the white spot and/or by following a white spot and carefully recording if it gets bigger. In children, it can be argued that any stage 2 caries occurring is also progressing, unless there is clear evidence that the process has stopped. The latter may have happened as a result of the fluoride applications and/or an improved oral hygiene on the spot, of course with fluoride toothpaste. It may then be considered to discontinue fluoride applications until caries activity is observed again.

What exactly is wrong with it? The problem, of course, is in overtreatment. This can be rejected as a general medical principle, but there are more arguments. The costs and time wasted by the practitioner with which and in which more meaningful treatments could have been performed on the same or a different patient. But there is also a downside if the practitioner and patient think that the patient is protected when this is not the case. Unnoticed, this can influence the intensity with which the practitioner and the patient try to improve self-care behavior. And then we might get caught in the rain.

Another advantage of applying on the basis of caries activity is that the treatment can also be motivated for other ages than 6 to 18 year olds. Caries also occurs before the sixth and after the 18th. Also consider the elderly.

This question was answered by Cor van Loveren, of the Advisory Board of the Ivoren Cross.

Cor van Loveren is happy to ask all oral care professionals a question in return. We look forward to receiving responses to this info@gewoon-gaaf.nl.
The best answer is rewarded.