Sir, we have been using both Duraphat and Profluorid for caries prevention for a few years now and a letter in a recent BDJ issue1 has created a great learning opportunity for clinical supervision within our team and a chance to revisit the evidence supporting our daily practice. We initially started using Profluorid at a time when we could not obtain Duraphat and somehow we never stopped using it. Both products are fluoride varnish preparations releasing an identical amount of fluoride to the dental hard tissues; however, we were not aware of the licence differences between them.

The GMC has published extensive guidance for doctors on prescribing unlicensed preparations.2,3 The MHRA provides guidance on the use of unlicensed medication and medical devices, and it specifically suggests that: 'An unlicensed medicinal product may only be supplied in order to meet the special needs of an individual patient'.4 A number of special care/paediatric patients may not tolerate the texture and flavour of Duraphat but they may be able to accept Profluorid. As clinicians we are able to make the decision that a standard licensed preparation does not meet the patient's needs and therefore, we can justify whether the prescription of a safe alternative is more appropriate. Obviously the patient needs to be informed. Good record keeping and appropriate follow up are also essential.