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Megan Arnold, LDH, BSDH, MA, has worked clinically in the private and public sector as well as a faculty member at the University of Minnesota, School of Dentistry and Herzing University. She is a past president of the Minnesota Dental Hygienists’ Association and currently is the US Professional Services Manager at 3M Oral Care.
In this sponsored article from 3M Oral Care, five hygienists explain their approach to fluoride and varnish application.
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Varnishes have become the fluoride treatment of choice because they are easy to apply and allow hygienists to save time while still providing fluoride protection and relief for hypersensitivity. There are a handful of things to consider when selecting the right varnish because although varnishes may seem the same, not all varnish formulations are the same.
Choosing a varnish comes down to considering what’s best for the patient as well as what meets the clinician’s needs. We asked five hygienists from different areas of the country what factors are important to them, and they gave us three things they consider:
1. Ease of application
The technique for applying different varnishes can vary widely depending on the formulation. Some varnishes require drying the teeth before, and even during application – especially if the patient salivates heavily. Varnishes that work with saliva don’t have to be dried before application and actually use the saliva to help maximize movement to coat more tooth surfaces before fully drying. This can make application very fast and efficient.
“I really like a varnish that can be applied in a wet environment,” says Christina Norori, RDH from Fort Meyers, Florida. “I like to be able to put a nice thin layer on the teeth and know that it’s staying on for a long time.”
“Varnishes should only take about a minute to apply. Some varnishes are really thick and don’t flow well, but I prefer varnishes with a white or clear color that don’t leave a drastic film on teeth,” says Patrice Hugo, RDH, BS from Chicago. “Immediate effectiveness is important as well. People-especially kids-like to be able to eat and drink right after application.”
Gwendolyn Montoya, RDH, OMT from Albuquerque, NM says, “I’ve been using varnish pretty exclusively for the last 4-5 years. There are a lot of reasons I prefer it to other fluoride treatment applications, particularly for children, because it’s easy to apply and it stays where I put it. I like the ease of application and the patient compliance that occurs when I use a varnish that has a pleasant taste and texture.”
2. Fluoride exposure and wear time
Varnishes are designed to stay on the teeth for a longer period of time to maximize the protection and effectiveness. Even though most varnishes contain 5% sodium fluoride, the way the fluoride is released from the coating and the durability of the coating on the teeth varies greatly.
Norori prefers varnish treatments that “stay on the teeth and have a longer contact time.” Fluoride varnish with a continuous, long-lasting release allows fluoride to be released over a longer period, allowing absorption into the tooth.
Hugo, however, prefers a faster release of fluoride due to patient compliance. "Knowing how patients are, the faster the release the better," she explains. "You never know what they’re going to do when they leave your office." For some patients, a quick release of fluoride is better because they may not be compliant with the wear time.
3. Formulations with added minerals: calcium and phosphate
A majority of the hygienists we spoke with believe most patients could benefit from a fluoride varnish treatment. Fluoride works by taking the calcium and phosphate minerals found in saliva and circulating them into the enamel to create stronger teeth. Although calcium and phosphate occur naturally in saliva, the addition of these minerals into a varnish formulation enhances the saliva, and promotes the natural processes already occurring in the mouth.
Side effects from dry mouth, medications and dietary choices can cause a patient to have inadequate amounts of saliva, which hinders natural protection for the teeth. “I recommend a varnish treatment more often than not, because almost everyone is at risk to some degree,” says Staci Williams, RDH in New Braunfels, Texas.
Norori educates her patients by explaining that the things they eat-even healthy things-could be detrimental to their teeth, which is why they may require a fluoride treatment. "I like a varnish that has calcium and phosphate in it, so that I know it is putting minerals back into their teeth," she says. "I help my patients understand that fluoride is almost like a multivitamin, and that it’s needed to prevent them from ending up in the doctor’s chair."
Montoya begins assessing her patients’ need for fluoride application as soon as they walk in the room. She reviews their medical histories, and walks through their oral hygiene practices and habits to identify any issues that may impact their oral health.
“I’m a big proponent of giving a fluoride varnish treatment to every patient,” Montoya says. “Even patients who have good oral hygiene habits have so much working against them that we might not know about … so I want to take every precaution I can.”
Hygienists use varnishes because they are effective in delivering fluoride protection. Some are faster and easier to apply, while others provide advanced protection, with longer fluoride contact time and added minerals like calcium and phosphate. Some can release fluoride quickly, to offer quick protection for those patients who may remove their varnish too soon. After all, it’s better to get some protection for those not-so-compliant patients.
“My go to varnish has been 3M™ Vanish™ White Varnish because it’s so durable, and the longer fluoride is in contact with the teeth, the more effective it is,” says Kelli Swanson Jaecks, RDH, MA from Salem, Oregon. "However, some patients simply don’t like the taste or feel of fluoride treatments, and tend to brush off or remove their coating too soon. The new 3M Fast Release Varnish gives clinicians an alternative for patients just like these. It has a fast fluoride release and a nice smooth coating, so for certain patients, I know I’m giving them the quick protection they need.”
As an important part of the oral health care team, hygienists determine the most appropriate treatment based on risk assessment and patient preference. You have many choices in varnishes in the market, but knowing the differences will empower you to choose the best option for you and your patients.
This content was sponsored by 3M Oral Care and was written by and provided to Modern Hygienist by 3M Oral Care.