By Amber Auger RDH, MPH
As a practicing hygienist, I come across a lot of misconceptions about treatment options, especially fluoride varnish. Here are the top four myths I’ve heard about fluoride varnish and what you need to know:
Myth #1: It’s all about the flavor
From Salted Caramel to Tutti Frutti, fluoride varnishes are available in a dizzying array of flavors. While great taste can help increase case acceptance, it is not the only factor to keep in mind when selecting a fluoride varnish. Consider the other ingredients in the varnish and the role they play in reducing the risk of dental decay.
Myth #2: Fluoride is the key ingredient
Fluoride is one of several important ingredients to look for in a fluoride varnish, including:
Calcium and Phosphate
During demineralization it is calcium and phosphate ions, not fluoride, that are released by the tooth. When the process of demineralization happens more quickly than remineralization, subsurface lesions develop, leaving the patient susceptible to tooth decay. The appearance of a white spot lesion indicates that, while subsurface mineral content has been lost, there is still potential for remineralization. The combination of calcium, phosphate, and fluoride help support remineralization and preserve tooth structure.
Xylitol promotes an increased salivary flow and a balanced pH which work to reduce the number of cariogenic and periodontopathic bacteria. The use of xylitol has been shown to lead to a reduction in the proportion of streptococci mutants in plaque, neutralize plaque acids, and help remineralize white-spot lesions.
Myth #3: More is better
Counterintuitive as it may seem, using more fluoride varnish is not necessarily better. Patients tend to be less compliant when they have multiple layers of fluoride varnish on their teeth.
Some may even chip away at a varnish treatment that feels “thick” or uncomfortable. To ensure patient compliance, the varnish should be uniformly mixed and placed in a thin, even layer, so that it can dry quickly.
Myth #4: Parts Per Million (PPM) Determines Efficacy
Many varnishes contain a high concentration of parts per million of fluoride (usually 22,600 PPM) in order to extend the contact time between fluoride and tooth surfaces. Research shows that it is the mechanism of action, rather than the parts per million of fluoride ions, that matters most. This mechanism involves interaction of fluoride from the varnish with saliva to form calcium fluoride (CaF2). The CaF2 deposits slowly release fluoride ions into the oral environment, supporting the natural remineralization process.
Interested in learning more about hygiene and prevention? Join the Embrace Prevention Facebook Group to engage with dental hygiene professionals from all over the world. Click here to join Embrace Prevention on Facebook.
- Collins, Fiona. The Development and Utilization of Fluoride Varnish. 2014. Available at: https://www.dentalacademyofce.com/courses/2093/PDF/1106cei_varnish_web4.pdf. Accessed October 23, 2018.
- Nordblad A, Suominen-Taipale L, Murtomaa H, Vartiainen E, Koskela K. Smart Habit xylitol campaign, a new approach in oral health promotion. Community Dent Health. 1995;12:230–234.[PubMed]
- A Maguire, A J Rugg-Gunn. Xylitol and caries prevention — is it a magic bullet? British Dental Journal volume194, pages429–436 (26 April 2003)
- Gold, J. Fluoride Varnish Products in the U.S. Market. J Res Development 2013. DOI: 104172/2311-3278.1000e102. Accessed November 6, 2018.
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 amberaugerrdh.com.
In the following case Dr. Todd Snyder shows how he replaced crowns on teeth #8 and #9 using ACTIVA BioACTIVE-CEMENT.
About Dr. Todd Snyder
Dr. Todd Snyder received his doctorate from the UCLA School of Dentistry and trained at the F.A.C.E. institute. He is an Accredited Fellow of the American Academy of Cosmetic Dentistry, a Member of the American Society for Dental Aesthetics and a member of Catapult Education. Dr. Snyder created and co-direct at UCLA the first two-year graduate program in Aesthetic and Cosmetic Restorative Dentistry. He lectures internationally and has authored numerous articles in publications worldwide. Dr Snyder is a consultant for numerous companies and has his own online training program known as Legion Pride. Dr Snyder also owns two software companies, is a professional race car driver and entrepreneur.
By Dr. Susan McMahon
Older patients are at increased risk for root caries because of gingival recession that exposes root surfaces and increased use of medications that produce xerostomia. Age related visual impairment and decreased dexterity also can lead to higher caries rates and a decreased ability to adequately maintain good oral hygiene. This makes the margins of restorations particularly susceptible to recurrent decay. Choosing a cement that will not only retain the restoration but also help stimulate remineralization is extremely beneficial for these patients.
ACTIVA BioACTIVE-CEMENT helps stimulate apatite formation, supporting the natural remineralization process and helping seal the margin between the tooth and the restoration. ACTIVA helps to prevent microleakage, maintain the integrity of a sealed margin, and keep the restoration, tooth and surrounding tissues healthy. ACTIVA BioACTIVE-CEMENT is a combination of bioactive resin, rubberized resin and ionomer glass filler. It is dual cure, moisture tolerant, and indicated for all indirect restorations except veneers. ACTIVA is very easy to use, with no additional etching or adhesive steps, and clean-up is simple and quick.
This 93-year-old female patient had mobility in her upper central and lateral incisors. A four-unit splinted HT Zirconia restoration was indicated for functionality and to increase the likelihood of keeping these teeth for the duration of the patient’s life. Previous PFM crowns were removed and the central and lateral incisors were prepared for a four-unit splinted zirconia restoration.
The patient had +1 mobility on the central and lateral incisors (Figure 1). After removal of the old crowns, the visible areas of demineralization on the central incisors and dark staining on the preps were noted (Figure 2). New splinted crowns would increase a favorable prognosis for these teeth.
Because of the oral health challenges facing geriatric patients (gingival recession, xerostomia, and home care issues), the margins of this new restoration have an increased susceptibility to recurrent decay. I chose ACTIVA BioACTIVE-CEMENT because of its bioactive properties, which help support the natural remineralization process and seal the margins.
At the insert appointment, the provisional restoration was removed, the preps were cleaned, and the restoration was tried in. After assuring the fit of the restoration, it was cleaned with Ivoclean, loaded with ACTIVA BioACTIVE-CEMENT, and seated (Figure 3). The restoration was initially flash cured to set the excess cement to the gel-like set. The excess cement was then very easily removed (Figure 4). The bioactivity and the ease of use of ACTIVA BioACTIVE-CEMENT make it an excellent choice, not just for geriatric applications like this, but also for many other indirect restorations where recurrent caries is a concern.
About Dr. Susan McMahon
Dr McMahon, an University of Pittsburgh School of Dental Medicine graduate, is in private practice in Pittsburgh and at University Dental Professionals in Chicago. She is an accredited member of the American Academy of Cosmetic Dentistry, the American Society for Dental Aesthetics, and a fellow in the International Academy of Dental Facial Esthetics. She is the Director of Product Evaluation for Catapult Education and a member of Catapult Speaker’s Bureau. She can be reached at 412.298.2734 or firstname.lastname@example.org.