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Ongoing fluoride supplements shortage

Dentists advised to direct patients to other fluoride sources

The ADA has received calls from members about an ongoing shortage of fluoride supplements in part because of the discontinuation of the products by several manufacturers as well as a limited supply from the remaining companies.

Dentists who call the ADA looking for answers about the shortage are advised to work with their pharmacists so that they can order the supplements as soon as they become available. They are also encouraged to continue helping patients by directing them to other sources of fluoride, such as fluoridated bottled water and fluoride toothpaste and to encourage them to diligently follow good oral hygiene.

Of the remaining distributors, Kirkman Laboratories Inc. and Fluoritab currently have sodium fluoride chewable tablets available.

Kirkman has the tablets available in doses of 0.55 milligrams, 1.1 mg, and 2.2 mg, all in 100- and 1000-count bottles. According to the company's fluoride administrator, Corey Bowey, dentists and pharmacists are encouraged to contact their wholesale suppliers to purchase the products.

On March 2, the American Society of Health-System Pharmacists updated its Web site to reflect the status of all sodium fluoride chewable tablets, including the discontinued products.

Fluoritab confirmed that it also has chewable tablets available in doses of 0.5 mg in 100-count, 1000-count and 5000-count bottles and as well as 1 mg-doses in its 1000-count and 5000-count bottles. The 1 mg, 100-count bottles are on backorder. The company also has the supplements available in a liquid form.

Pharmascience is new to selling fluoride supplements, but according to a customer service representative on March 6, says it hopes to soon have the tablets available for distribution. Dentists with questions about availability are advised to contact company on its toll-free number at 1-866-926-7653.

On Feb. 18, the FDA updated its Class II recall list, which included a voluntary recall of all sodium fluoride chewable tablets from Actavis, which according to ASHSP, has since discontinued the product.

The Ethex Corporation said in a Jan. 28 press release that it had recalled all of its Ethedent Chewable Tablets and the March 2 update from ASHSP announced that the company had discontinued the tablets.

Additionally, Colgate and Pharmics have discontinued making the supplements. Colgate stopped distribution at the end of 2008 and Pharmics stopped production in Fall 2007.

Although the companies did not release specific information, business reasons appear to be related tor the discontinuation of the products.

In terms of dietary fluoride supplements, children should only receive supplemental fluoride tablets or drops as prescribed by their physician or dentist based on the dietary fluoride supplement schedule approved by the ADA, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry. The supplements are not recommended for children under six months of age.

To see the ADA Dietary Fluoride Supplement Schedule, visit the Fluoride Supplements Oral Health Topic.

To visit the American Society of Health-System Pharmacists updated Web site, visit www.ashp.org/shortages and click on the current shortages link.