If the mother is thinking based just on her feeling then it can be incredibly

difficult to sway her opinion on fluoride. So think about how the mother is
approaching the problem. In her mind fluoride is poison so she doesnt
want to risk using it on her children. So if her thinking is solely emotional
she wont be swayed by information and facts. In this emotional state she
will focus on the negatives and deem they outweigh the benefits of
fluoride. Thus even though you will keep an open dialogue trying to sway
her you are best to offer alternative treatments so I would follow this
process:
1. Recognise the problem
a. 4 year old with Incipient lesions
b. Mother dead set again fluoride
i. 4th child so doesnt the see need for fluoride
2. Diet analysis
a. If a high sugar diet or frequent acid attacks provide diet
modification advice.
i. Rinse mouth after an acid attack
ii. Minimise snacking
iii. Reduce overall sugar intake
3. Saliva analysis
a. If problems with saliva address this
i. May require saliva substitutes or sugar free gum
(increase saliva flow)
4. Explain the situation to the mother
a. Provide ADA fluoride sheet for the mother to review in her own
time and ask questions on it at subsequent appointments
5. Teach mother and child good oral hygiene including floss and
interdental brushes
a. Fluoride isnt necessary for remineralisation.
6. Recommend non fluoride remineralisation agents like tooth mouse
or recaldent gum which are CPP-ACP (casein phosphopeptides and
amorphous calcium phosphate)
7. At subsequent appointments:
a. Ask if the mother has any questions about fluoride
i. Recommend fluoride again
b. Monitor lesions to see if there is any remineralisation or
progression.
c. Reiterate OHI
d. Repeat as needed