Flouride in a concentrated dental application  has been proven by numerous studies to  help with sensitivity, gingivitis, periodontal disease, decrease cavities, strengthen teeth and bones, and remineralize roots.

One way for many insurance plans to increase profits is to not cover this service on adults and some children even though it has substantiated benefits.  which include but are not limited to decresased sensitiivity decay control, gingivisitis, etc

In our office we treat our patients based on optimum treatment needs and desires and not based on what insurance dictates, as we feel the benefit out weighs the cost. 

  Yes I want to maintain optimum oral health by using dentally applied concentrated fluoride to help with my teeth and gums while acknowledging that my insurance plan might not reimburse me for the costs of this  service.

No, I chose at this time to forgo the use of dentally applied concentrated fluoride for my own personal  reason,  but I reserve the right to change my mind at any future time

please write ( yes) or (no) and then sign