Monthly Archives: December 2017

Embrace Varnish: Timed-release fluoride varnish for superior caries prevention

By Amber Auger, RDH, MPH

Community water fluoridation is the single most effective public health measure to prevent tooth decay.(1) Early studies of Grand Rapids, Mich., fluoridated water demonstrated a decrease in tooth decay by 60% in babies and 40% in adults.(1) Today, there are thousands of products that offer fluoride. However, selecting a varnish that provides effective ingredients in a great-tasting time-released formula should be our standard of care.

History overview
Water fluoridation first began in the early 1940s, and toothpaste-containing fluoride was commercially available in 1954.(2) By end of the 1960s, 5% sodium fluoride varnish was researched to be the “new application method with a special long-lasting intensive fluoridating effect.”(3) Fluoride varnish has continued to improve for the ease of the clinician, with advanced science behind effective ingredients and improved taste for the patient.

Review of tooth decay
Dental caries involves demineralization that occurs in response to the diffusion into the enamel or dentin of acids produced by cariogenic bacteria, as they metabolize fermentable carbohydrates. Calcium and phosphate are the primary minerals that leak out from hydroxyapatite crystals during demineralization.(3)

Patients who have xerostomia have reduced or no access to calcium and phosphate from their saliva.(3) When demineralization is quicker than remineralization, subsurface lesions develop, leaving the patient with tooth decay. The appearance of a white spot lesion, known as demineralization, indicates sufficient subsurface mineral content has been lost; however, there is still potential for remineralization.(3) Remineralization of the tooth is possible with the reintroduction of calcium, phosphate, and fluoride.

Latest technology: 5% fluoride with cXp™ available in Embrace™ Varnish
When evaluating the dental caries process, we understand that the tooth loses calcium and phosphate when the oral pH is low. Therefore, adding these ingredients to fluoride treatments can enhance the beneficial effect for the patient. By incorporating xylitol-coated calcium and phosphate (cXp) in a permeable resin matrix, the ionic components in Embrace™ Varnish remain bioavailable. Also, the fluoride salts do not separate from the resin matrix, which ensures uniform dosage that is more effective than the average fluoride varnish, slowly releasing over four hours.(4)

Xyiltol offers a pleasing flavor while also preventing the calcium and phosphate salts from reacting until they come in contact with saliva.(5) The saliva dissolves the xylitol and activates the calcium and phosphate ions, which continue to interact with fluoride ions to form protective fluorapatite on the teeth.(5)

Review of Embrace Varnish
The slow release of bioavailable calcium and phosphate ions reinforces the benefits of the fluoride varnish, which continues working throughout the treatment period and helps reverse the effects of dietary sugars. Studies demonstrate that the four-hour cumulative fluoride release is superior in Embrace Varnish, releasing 10 times more fluoride than the leading brand.(5) There is no mixing required, which allows for an effective and uniform dose.(5)

The application of Embrace Varnish is simple. First, dry the teeth with a gauze pad. Next, pinch the varnish foil pack to push contents back from tear line and open the varnish pack. Dispense the varnish on the back of the glove and use the brush to pick up the varnish. Then, with a thin coat of the Embrace Varnish, apply the varnish with one horizontal swipe of the brush.

There are hundreds of products that offer fluoride. However, choosing a fluoride varnish with effective ingredients is paramount to decreasing patients’ risk of decay. As dental professionals, we are educators responsible for helping our patients have a healthier oral cavity with proper education and effective products. The slow release of xylitol-coated calcium and phosphate found in Pulpdent’s Embrace Varnish utilizes state of the art technology for supreme benefits.

1. American Dental Association. Water Fluoridation Facts: Celebrating 60 Years of Water Fluoridation. 2015. Available at: Accessed May 25, 2017.
2. National Institute of Dental and Craniofacial Research. 2015. Available at: Accessed May 25, 2017.
3. Collins, Fiona. The Development and Utilization of Fluoride Varnish. 2014. Available at: Accessed May 25, 2017.
4. Yapp R, Powers JM. Fluoride Ion Release from Several Fluoride Varnishes. Dental Advisor Res Rpt 45:1, March 2012.
5. Pulpdent® Corporation. Embrace™. 2016. Available at: Accessed May 25, 2017.

This article was first published via on June 22, 2017.

Amber Auger RDH

About Amber Auger, RDH, MPH
Amber Auger, RDH, MPH, is a hygienist with experience in multiple clinical settings, including facilities abroad. Amber obtained a master’s degree in public health from the University of New England and a bachelor’s in dental hygiene from the University of New Haven. She holds a part-time position at an elite dental office in Boston, and is chief of clinical technology for Jameson Management. Amber Auger is a key opinion leader for several dental companies, speaker and published author, and can be contacted at


The Social Dentist Tip #1: Be Authentic and Friendly

Dr. Ryan McCall grew his Indiana-based dental practice by engaging new and existing patients through Facebook, Instagram, Snapchat and Twitter. In this series, The Social Dentist, Dr. McCall offers tips on how to market your dental practice using social media.

Be Authentic
People fear the dentist. More than almost any other profession, dentistry is looked upon as a necessary evil. Patients fear a visit to the dentist will end in pain, both physical and financial. We overcome this fear by representing ourselves and our work with openness, honesty and humility.

Authentic social media leads to higher conversion rates ̶-more followers, more clicks, and more appointments scheduled. Authenticity is palpable when you show gratitude and are committed to doing the right thing for your patients in a warm, friendly, inviting environment. 

Be real. I posted pictures on Instagram of my visit to Pulpdent’s research and manufacturing facility in Watertown, Massachusetts that featured a flying Bobby Orr. Go Bruins! Folks relate to that and feel comfortable. The fear quickly dissipates.  

Be friendly
We welcome everyone. Our goal on social media is to foster engagement, which includes responding to negative feedback. We focus on content that encourages potential patients to comment and ask questions. An attitude of AMA (Ask Me Anything) has led us to more shares, better engagement, and happier patients. New patients often reach out via social media with inquiries about pricing, insurance reimbursement, and treatment offerings. We respond in a timely manner and a cheerful tone.

Dr. Ryan McCall

About Dr. Ryan McCall
Dr. Ryan D. McCall was raised in Illinois. He received his BS in Biology and Chemistry from Indiana University and dental degree from the University of Illinois School of Dentistry. He maintains private practices in Indianapolis and Lebanon, Indiana.

Heroic Dentistry: Saving the Day for Judy

By Dr. Matthew Gilchrist

The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence. 

Judy was distraught. The loss of a large composite filling on her upper right lateral incisor left a gaping hole in her smile. She didn’t want her students, or anyone else, to see her this way, and she wanted an immediate repair before returning to school to teach her afternoon class.

Judy was concerned that same-day treatment might not be possible for this tooth. I shared her concern, but I had to find a solution, alleviate her emotional stress, and let her get back to work and life as usual.

Upon examination, I could see some secondary decay and a sub-gingival distal margin with a small amount of bleeding. We discussed several options. We could perform root canal treatment followed by a post and core and a crown, which might require crown lengthening. This would take one to two months at a cost of several thousand dollars or more. Another approach would be extraction followed by either an implant and crown, at considerable expense, or a more affordable removable partial denture. A third option would be a direct composite build up and restoration, and although the long-term prognosis might not be as favorable as for the other options, it could be done immediately.

Judy did not want to wait, so we seated her and got right to work. After administering anesthesia and cleaning out the decay, I chose to use ACTIVA BioACTIVE-RESTORATIVE over a traditional composite for several reasons. Isolation was difficult, especially at the distal margin. I needed to be able to hold the matrix in place with one hand and place the material with the other. ACTIVA’s injection delivery system would allow me to accomplish this very easily. I could also bulk fill quickly with ACTIVA in large increments, and not have to rely as long on the less than ideal matrix placement. This would be a great benefit.

I etched and bonded, and I built up the distal wall with ACTIVA and light cured the material. The material flowed nicely and seems to have an affinity to stay on the tooth and in the area where it is placed. I then continued to dispense ACTIVA to fill the tooth, and again light cured. There is no need for condensing, and the delivery system and the way the material handled allowed me to complete the procedure quickly and without an assistant.

Judy was thrilled when she looked in the mirror. In one short same-morning visit, she was smiling with confidence and was ready to walk back into the classroom without embarrassment.

ACTIVA is my material of choice for many restorations, but this particular case really demonstrates the ease-of-use and versatility of the material.  In addition to using the material for routine fillings, it provides me with a go-to material for the more heroic restorations that I attempt for my patients.

Figure 1. Pre-op periapical radiograph shows the extent of the decay and the sub-gingival nature of the distal margin.

Figure 2. Shows the tooth after caries excavation. Note the sub-gingival margin and bleeding on distal. A facial bevel was added for better seal and retention.

Figure 3. Another image of the tooth after caries excavation.

Figure 4. Shows MIDBL restoration with ACTIVA prior to doing a final polish. The tooth was etched and bonded prior to placing the material.

Figure 5. Another view of the ACTIVA restoration. To protect the large restoration, it was taken out of occlusion. Note the articulating paper marks on the adjacent teeth.

Dr. Matthew Gilchrist is a general dentist at Avenue Dental in Charlottetown, Prince Edward Island, Canada.  He graduated from Dalhousie University, Faculty of Dentistry, in 2008 and holds a Bachelor of Science degree from St. Francis Xavier University (2004).  Dr. Gilchrist resides in Stratford, PE with his wife and two children.