ANTICAVITY  - sodium fluoride rinse 
Hy-Vee, Inc.

Disclaimer: Most OTC drugs are not reviewed and approved by FDA, however they may be marketed if they comply with applicable regulations and policies. FDA has not evaluated whether this product complies.

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Sealed with printed neckband for your protection

Active ingredient
Sodium fluoride 0.05% (0.02% w/v fluoride ion)

Purpose
Anticavity rinse

Use aids in the prevention of dental cavities

Warning

Keep out of reach of children.  If more than used for rinsing is accidentally swallowed, seek professional assistance or contact a Poison Control Center immediately.

Directions
•adults and children 6 years of age and older: use once a day for brushing your teeth with a toothpaste
•remove cap
•pour 10 milliliters (10 mL mark on inside of cap) do not fill above 10 mL mark
• vigorously swish 10 milliliter of rinse between your teeth for 1 minute and then spit out
•do not swallow the rinse
•do not eat or drink for 30 minutes after rinsing
•instruct children under 12 years of age in good rinsing habits (to minimize swallowing)
•supervise children as necessary until capable of using without supervision
•children under 6 years of age: consult a dentist or doctor

Other information
•store at room temperatue

Inactive ingredients benzyl alcohol, calcium disodium EDTA, cetylpyridinium chloride, disodium EDTA, disodium phosphate, flavor, green 3,
menthol, methyl salicylate, poloxamer 407, polysorbate 20, potassium sorbate, propylene glycol, sodium benzoate, sodium phosphate, sodium saccharin,
sorbitol, water, yellow 5

This product is not manufactured or distributed by Chattem, Inc., distributor of Act Anticavity Fluoride Rinse

DISTRIBUTED BY HY-VEE, INC.
5820 WESTOWN PARKWAY
WEST DES MOINES, IA 50266
SATISFACTION GUARANTEED OR
PURCHASE PRICE REFUNDED
FOR INFORMATION CALL
1-800-289-8343
www.hy-vee.com

Hy-Vee
Compare to the
active ingredient of Act
Anticavity
Fluoride Rinse
Mint
•Alcohol Free
•Strong cavity protection
•Helps strengthen teeth
•Freshens breath
IMPORTANT: read directions for proper use
18 FL OZ (532 mL)
image of principal display panel

ANTICAVITY 
sodium fluoride rinse
Product Information
Product TypeHUMAN OTC DRUGItem Code (Source)NDC:42507-231
Route of AdministrationORALDEA Schedule    
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Sodium fluoride (FLUORIDE ION) Sodium fluoride0.05 kg  in 100 L
Inactive Ingredients
Ingredient NameStrength
BENZYL ALCOHOL 
EDETATE CALCIUM DISODIUM ANHYDROUS 
CETYLPYRIDINIUM CHLORIDE 
EDETATE DISODIUM  
SODIUM PHOSPHATE, DIBASIC, ANHYDROUS 
FD&C GREEN NO. 3 
MENTHOL 
METHYL SALICYLATE 
POLOXAMER 407 
POLYSORBATE 20 
POTASSIUM SORBATE 
PROPYLENE GLYCOL 
SODIUM BENZOATE 
SODIUM PHOSPHATE 
SACCHARIN SODIUM DIHYDRATE 
SORBITOL 
WATER 
FD&C YELLOW NO. 5 
Product Characteristics
Color    Score    
ShapeSize
FlavorImprint Code
Contains    
Packaging
#Item CodePackage DescriptionMultilevel Packaging
1NDC:42507-231-44.532 L in 1 BOTTLE, PLASTICNone

Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
OTC monograph finalpart35508/06/2003

Labeler - Hy-Vee, Inc. (006925671)
Registrant - Vi-Jon Inc (790752542)
Establishment
NameAddressID/FEIOperations
Vi-Jon, Inc790752542manufacture

Revised: 05/2012 Hy-Vee, Inc.