Not using the paste was my husband's preference. He does my appliance changes and found it much messier to apply and much less secure than the tincture. My home care nurses guided us from the start as to what products are available and demonstrated their various techniques. But it was only because an ER doctor used tincture of benzoin and supplied us with some packets to try at home that we found secure adhesion. My home care nurse had never heard of or thought of using that product in this application but she said she will definitely suggest it to other patients who might have adherence issues. You don't need to use very much and it can be a bit of a challenge to remove but it is worth the trouble.