Incorporating Fluoride Varnish Into Routine Dental Visits

Introduction

Maintaining good dental health is important for overall well-being, and has a huge influence on nutrition, communication, and social interactions. Cavities, gum disease, and even some serious health problems throughout the body, like heart disease and diabetes, can be prevented by taking care of your dental health.¹ Prophylactic dental care is very important and involves regular dental check-ups, proper oral hygiene through daily brushing, the use of interdental aids, the use of fluoride, and maintaining a balanced diet to reduce sugar intake. Education on oral health practices plays a crucial role in encouraging people to maintain their dental health. Moreover, preventative care offers significant economic benefits by reducing the need for costly dental treatments and decreasing the overall financial burden on healthcare systems. Overall, prioritising preventative dental care is essential for sustaining oral health, enhancing quality of life, and achieving long-term health benefits.

What is fluoride varnish?

Dentists often use fluoride varnish, a highly concentrated form of fluoride, to protect the teeth. The varnish is applied by a dental professional and sticks to the teeth, slowly releasing fluoride to strengthen enamel and prevent decay. This treatment is temporary and suitable for patients of all ages, even young children and those with special needs. The varnish is made from a resin or synthetic base that allows it to adhere to both dry and wet surfaces.

Fluoride varnish works through a specific mechanism of action that involves several key processes to enhance dental health and protect against decay: 

• Enhances demineralization:² Fluoride varnish enhances remineralization by incorporating fluoride ions into tooth enamel, forming a more acid-resistant fluorapatite crystal. This helps prevent demineralization caused by plaque acids from sugary foods and drinks, reducing the risk of decay and enhancing the tooth's resistance to acid attacks
• Prevents demineralisation: Fluoride varnish inhibits demineralization by slowing down the rate at which teeth lose minerals when exposed to acids. The protective barrier provided by fluoride helps to keep essential minerals in the teeth, maintaining their strength and integrity³ 
• Antibacterial properties: Fluoride varnish also has antibacterial effects.⁴ inhibiting the growth and activity of cavity-causing bacteria in dental plaque. By reducing the production of acid by these bacteria, fluoride helps to lower the risk of tooth decay

Unlike some topical treatments that only impact the outer layer of the enamel, fluoride varnish seeps into deeper layers of tooth enamel. It can also reach into pits and crevices, areas that are often overlooked by brushing and more prone to decay. Once within the enamel, the fluoride continues to offer protection over time. Fluoride varnish acts as a slow-release source of fluoride, providing ongoing protection against decay for several months after being applied. Its easy application, effectiveness in reducing decay, and ability to enhance tooth hardness and resistance to acid attacks make it a valuable tool in preventive dental care.

Current recommendations for fluoride varnish

According to the American Dental Association (ADA), children should get fluoride varnish (NaF 22,500ppm) applied to their teeth every three to six months after their teeth come in.⁵ This suggestion is made based on each person's likelihood of getting cavities. Adults who are at a high risk of tooth decay (like those with dry mouth, bad oral hygiene, or existing dental work) can also benefit from fluoride varnish treatments.

The WHO recommends the application of 22.6mg of fluoride/22.600 ppm) not less than 2 times a year. This can be increased to four times a year depending on the caries risk of the patient and existing dental caries severity. 

Benefits of fluoride varnish

Fluoride varnish application has a lot of benefits. Here are some key advantages of fluoride varnish.⁶ 

• Ease of Application: Applying the varnish is quick and simple, usually only taking a few minutes at the dentist's office. It sticks well to the tooth, even if it's slightly wet, and dries quickly when exposed to saliva. This makes it a great option for children or those with special needs
• Long-lasting Protection: Once the fluoride varnish is applied, it continues to release fluoride for several months, giving extended protection against tooth decay. This slow release helps maintain a barrier against acid attacks long after the initial application
• Safety: Fluoride varnish is safe for individuals of all ages. The risk of fluoride toxicity is minimal as only a small amount is used. Fluoride varnish is not easily absorbed once it sticks to the teeth
• Ease of application: The application of fluoride varnish is painless and gentle, which is crucial when treating children or anxious patients. Fluoride varnish can also be applied in different settings, including dental offices, community health programs, and school clinics, making it available to a large population
• Sensitivity: For those with sensitive teeth, fluoride varnish can help minimise sensitivity by strengthening enamel and dentin, creating a protective layer against triggers that cause discomfort
• Cost-effective: Fluoride varnish is a cost-effective option for treating tooth decay, making it a great choice for both health systems and individuals looking to prevent dental issues

Incorporating fluoride varnish in routine dental visits

Adding fluoride varnish to regular dental appointments is a simple yet powerful way to improve preventative care and overall oral health in a variety of patients. Here is a guide on how dental offices include this treatment in their usual protocols: 

• Initial Evaluation: Dentists evaluate each patient's likelihood of developing cavities during routine appointments. This assessment takes into account factors such as diet, fluoride intake, oral hygiene habits, and previous history of cavities
• Education: Patients are educated on the benefits of fluoride varnish, particularly its ability to prevent tooth decay and strengthen teeth. It is important to communicate clearly to address any concerns or misunderstandings about fluoride treatments
• Application: When it comes to the application process of fluoride varnish, timing is key. It can be conveniently applied during regular cleaning appointments, making it efficient for both patients and dental practices. The procedure involves lightly drying the teeth with gauze before applying the varnish using a small brush. This quick process only takes a few minutes, and the varnish sets rapidly upon contact with saliva. After the application, patients should refrain from eating or drinking for 30 minutes to allow the varnish to fully take effect
• Documentation and Follow-Up -Records are kept of fluoride application along with any notes on a patient’s oral health that could affect future treatments. Follow-up appointments are scheduled according to each patient's risk of cavities. Patients with a high risk may need more frequent treatments, while those with a lower risk can stick to the usual twice-a-year schedule

Possible patient concerns regarding fluoride use

Fluoride varnish is a commonly used and highly effective treatment for preventing dental cavities. However, some patients may have worries or doubts about its application.⁷ It is important to address these concerns with care and provide them with reliable information based on evidence to maintain their trust and make sure they are comfortable with the treatment. Below are some typical concerns that patients may have regarding fluoride usage:

• Fluorosis: Dental fluorosis, caused by too much fluoride intake during tooth development, is a cosmetic issue that results in faint white lines or streaks on the teeth. However, in most cases, it's usually mild and not a major concern in terms of appearance or function. Parents may worry about fluorosis when their children receive fluoride varnish, but it's important to reassure them that the amount of fluoride in the varnish is small and applied infrequently, so the risk of developing fluorosis from it is very low
• Toxicity and safety: Some patients may have concerns about fluoride's safety. While it's generally safe in small amounts, excessive intake can lead to health issues. Some patients may develop skeletal fluorosis⁸ over time. It is important to inform patients that the fluoride content in varnish is regulated and that it is applied only to specific areas, without being consumed. This makes it a secure choice for enhancing dental health and protecting against decay
• Allergies and Sensitivities: If patients are concerned about allergic reactions to fluoride varnish, it's important to discuss the ingredients with them. True allergies to fluoride are very uncommon, but other components like colophony (a type of resin) in the varnish could potentially lead to reactions in sensitive individuals. Before applying the varnish, dental staff should check for any known allergies
• Understanding Effectiveness and Importance: Some patients may wonder if fluoride treatments are necessary, especially if they already have good oral hygiene habits or live in areas with fluoridated water. It's important to explain how fluoride varnish offers added protection against decay, benefiting even those who take excellent care of their teeth and can be particularly helpful in certain circumstances

Summary

Incorporating fluoride varnish into regular dental check-ups is a big step forward in preventive dental care. It offers a straightforward, successful, and convenient way to greatly decrease the occurrence of cavities in various groups of people. The advantages of fluoride varnish - including its easy application and strong safety record, as well as its powerful ability to strengthen tooth enamel and stop decay - make it an essential part of contemporary dental care practice.Using fluoride varnish not only enhances dental health but also saves money by reducing the necessity for expensive dental procedures in the future. This treatment is especially important for vulnerable populations such as children, seniors, and individuals with special needs, providing a higher level of cavity prevention that regular brushing and fluoridated water alone cannot match. In addition, using fluoride varnish proactively supports wider public health objectives by narrowing gaps in oral care. This ensures that preventive measures reach individuals who are frequently at higher risk for dental issues. Thus, incorporating fluoride varnish treatments into regular dental appointments is a simple and effective approach that improves overall oral health results, increases patient happiness, and promotes the durability of dental health resources.