Fluoride varnish: How it works and how to apply it
Fluoride Varnish It is the responsibility of the prescriber to ensure that a medicament is suitable for use A product licence indicates that the product is effective and safe.
Fluoride varnishes are effective at preventing and controlling dental caries Meta-analyses and other systematic reviews of the evidence show its efficacy in the clinical setting. In some situations it appears not to be effective for example as a public health measure when applied to children aged between six and eightyears-old in schools, with low levels of caries, suboptimal application conditions and no home care advice given.
Evidence for the use of fluoride varnish for caries control on primary teeth Evidence level one the highest Three studies involving 1,107 children 33% reduction in decayed surfaces of primary teeth Marinho et al. 2002
Evidence for the use of fluoride varnish for caries control in permanent teeth Evidence level one the highest Seven studies involving 2,278 participants 46% reduction in decay in permanent teeth Marinho et al. 2002
Why apply it? For caries prevention For caries control For arresting carious lesions For desensitising teeth
What s in it? Constituents of Duraphat fluoride varnish 5% sodium fluoride = 22,600 ppm fluoride Colophony adhesive (also found in chewing gum) Shellac/mastic permeable hard surface Beeswax and ethanol bulking and stabilisation Saccharine sweetener Raspberry essence flavour
Who needs it? DBOH all children from age three upwards, twice yearly DBOH all children aged 0-6 at higher risk of developing caries two or more times a year DBOH adolescents and adults at higher risk of, or from, caries two or more times a year eg ortho patients, those with exposed roots or active caries...
Who should avoid it? Those who have been hospitalised because of asthma Those who have an allergy to colophony Those who do not agree to have fluoride varnish applied
Colophony Col Off On Eee
The consent issue Varnish application in practice will be part of an agreed treatment plan Separate written consent is not required Patients and parents must be informed of the purpose and nature of the procedure be given the opportunity to ask questions be aware that the trained dental nurse will be applying the varnish Patients and parents can decline without giving a reason
Advice to patient and parent before application The purpose is to help prevent decay Anyone with an allergy to colophony should not receive fluoride varnish Anyone who has been hospitalised because of asthma should not have varnish applied Patients should eat and drink normally before application The procedure is quick and simple The varnish has a banana flavour The varnish is coloured and leaves a tint on teeth for a day or so
How does it work? It works topically Puts high concentration fluoride on enamel surface and in sub-surface lesions enamel and dentine Forms calcium fluoride which provides a reservoir of fluoride for several months Varnish adheres for hours or days Works best on dried teeth
Fluoride varnish how much to use As little as possible Apply sparingly Be stingy Don t slosh it about Use a micro brush
Fluoride varnish recommended maximum quantities Primary dentition no more than 0.25 ml Mixed dentition no more than 0.40 ml Permanent teeth no more than 0.75 ml
A rough guide to maximum amounts of varnish to use: 0.25ml 0.40ml 0.75ml
Apply it to initiating site where caries starts and to existing lesions
Which teeth? which surfaces? A suggested prescribing plan Patients with no caries activity (yet) from age three upwards Apply to fissures and pits molars (erupted and partially erupted), premolars All those with enamel lesions or higher risk, starting before age three Apply to fissures and pits molars (erupted and partially erupted), premolars Apply to existing early lesions anterior and posterior Apply to approximal surfaces anterior and posterior Those with established lesions into dentine Apply to all surfaces listed above plus existing lesions Those with exposed roots Apply to exposed roots
The application procedure: Prepare the equipment Check notes for dentist s prescription Check relevant medical history Explain to patient and parent what you will do and why Make sure patient and you are comfortable Check mouth for abnormalities Insert cotton wool rolls in one lower quadrant lingual and buccal Dry the teeth to receive varnish Apply varnish sparingly Remove cotton wool rolls Move to the other lower quadrant Repeat and complete upper quadrants
Fluoride varnish applied a bit too much
Advice to the patient/parent after application Do not rinse or brush teeth, eat or drink for 30 minutes after application Avoid eating hard foods for four hours after application Don t brush with toothpaste until the following morning The tint will stay on teeth for a day or so
Acclimatisation Work in stages Chair upright Chair half reclined Show brush on parent s fingernails, child s fingernail, dry brush on front tooth Accept imperfect application in the hope of improvement at a later visit Give positive reinforcement Planning for next visit
Using the opportunity to... Build a relationship with the patient/family Find out re any changes since last visit Be positive about changes towards better oral health Listen to patient/parent about possible further changes Give specific advice and support Answer questions or seek answers on patient s behalf
Application of varnish to reduce sensitivity
Application of varnish to treat sensitivity For sensitivity apply where the teeth are stimulated by hot and cold Often at cervical margins
The next four weeks
Practise in practice Clinical supervisors / mentors prescribe preventive advice +/- fluoride varnish Students gives advice +/- applies fluoride varnish under diminishing supervision Recording of activity in case notes, with mentor assessment Support of course tutor Observation by course tutor of one application of fluoride varnish case during fourth week