Do you remember Felix the Cat? Whenever he got in a fix, he reached into his bag of tricks. All dental professionals love having items in their clinical "bag of tricks" that are easy to use, beneficial to the patients, and increase revenues for the practice. If you don't have fluoride varnish in your bag of tricks, you are missing out!
Here's why: Dentistry is forever evolving with new technologies. Many feel fluoride varnish is part of the current evolution. This new trend has a lot of potential revenue for dental practices, while it significantly increases your patients' dental health. Let us explore why fluoride varnish is changing the face of dentistry today and why many offices are switching from foams and gel in trays to a fluoride varnish.
In 2006, the ADA Council on Scientific Affairs published evidence-based research with fluoride recommendations. The conclusions from this article are changing the way we practice dentistry. This research recommends topical fluoride treatments based on caries risk. That means it does not matter if the patient is age 2 or 92, if it has been determined they are at moderate to high risk for caries, a fluoride treatment is recommended. The ADA also recommends that these topical fluoride treatments should be done not just two times per year, but anywhere from two to four times annually, depending on risk.
This research also steers away from using the traditional tray system to deliver fluoride. If trays are going to be used, gels, and not foams are supported ONLY if they are used for four minutes. One-minute foam or gel fluoride treatments were determined to be ineffective. And did you know thatonly a fluoride varnish should be used on children age 6 and younger? That's because one of the many benefits of using a fluoride varnish is that there is very little systemic exposure -- about the same as brushing with an over-the-counter toothpaste.
If all this sounds new to you, you are not alone ... many U.S. dental offices (pedo included) are stillnot using varnish. Fluoride varnishes have been used in Europe and Canada since the 1980s for caries prevention. Why is it taking so long to catch on in the U.S.? Until fairly recently, varnish wasn't very user-friendly. It was amber or yellow in color, very sticky, and many were thick to apply, leaving a clumpy or sticky feeling on the tooth surface. Patients did not like how varnish looked and felt on their teeth.
The role of remineralization
The truth is most clinicians are not well-educated about the benefits of fluoride varnish and have no idea how aesthetic and user-friendly varnish has become.
Today all varnish contains 5% sodium fluoride with 22,600 ppm fluoride ions. They help occlude tubules and prevent sensitivity, as well as release fluoride to be taken up into the tooth. Each is made from a resin and an alcohol-based solution that is fast-drying. Application is simple: minimally dry teeth and paint a thin strip along a tooth surface. This procedure takes only seconds.
Once set, varnish adheres to the tooth surface, and fluoride ions are released into the saliva. Saliva is the key with varnish -- it is the delivery mechanism for the fluoride ions.
It is important to understand that not all varnishes are created equal. They can vary in taste, texture, thickness, color, and price. But the most important differentiation is how therapeutic the various varnishes are. The release of fluoride ions from the varnish material and uptake of fluoride ions into teeth varies from varnish to varnish. Varnishes with calcium phosphate technologies release and uptake more fluoride than those without the technology. The unique chemical kinetics of calcium, phosphate, and fluoride together create an amazing arsenal in the war against dental disease and root sensitivity.
Currently, only three varnishes contain remineralization (calcium phosphate) technology: Premier Dental's Enamel Pro Varnish with ACP (amorphous calcium phosphate), 3M ESPE's Vanish with TCP (tricalcium phosphate), and GC America's MI Varnish with CPP-ACP (casein phosphopeptide-amorphous calcium phosphate; Recaldent). So which is the most therapeutic?
Independent research done at the University of Michigan School of Dentistry showed that Enamel Pro Varnish had the greatest release of fluoride ions when compared with 3M Vanish and Colgate Duraphat. In addition, Enamel Pro Varnish is the only varnish formulated to deliver ACP, which has been shown to be more effective in fluoride release and uptake when compared with Vanish with TCP (Journal of Clinical Dentistry, 2011, Vol. 22:2, pp. 51-54).
Advantages of ACP
Why ACP? Think about it -- the reason clinicians do fluoride treatments is to deliver fluoride into the tooth. ACP's unique formulation allows greater uptake due to the amorphous nature of the calcium. That unstructured, positively charged calcium ion is so attracted to the negatively charged tooth surface it calcifies on contact and pulls the available fluoride and phosphate ions into the tooth structure with it.
ACP strengthens the teeth by releasing more usable fluoride to be taken into the tooth and also remineralizes tooth structure with calcium and phosphate. This combination of fluoride and ACP is so powerful that it has been shown to diminish hydraulic conductance of dentin by 73%; this semipermanent occlusion is a result of ACP and fluoride creating fluorapatite. What dentist or hygienist would not want that in their bag of tricks?
Patients are extremely grateful if you are helping them reduce their risk of dental disease and remineralize and strengthen their teeth while eliminating tooth sensitivity. This is an easy sell to patients! How will it help the practice? If the current fluoride recommendations suggest all ages of moderate to high risk receive varnish treatments two to four times per year, then you have significantly increased the population of patients and the frequency at which varnish can and should be applied. If you are reimbursed anywhere from $25 to $65 per patient -- well, you do the math!
Increasing production while increasing the dental health of the patients means everyone wins. So be like Felix the Cat and reach for fluoride varnish to put in your bag of tricks!
Sandra Shapiro, RDH, received her bachelor's degree in dental hygiene and public health from the University of California, San Francisco School of Dentistry in 1986. Most of her career has been spent practicing clinical hygiene. She currently works for Premier Dental Products as a sales consultant and dental health educator, where her focus is on educating dental offices about the importance of enamel therapy and the use of fluoridated varnishes and remineralizaton technologies.
