Embracing a Preventative Plan for Pediatric Patients

By Jarod W. Johnson, DDS, ABPD

Dental caries is the most common chronic disease in children. It is more common than obesity, asthma, and diabetes.1 It is estimated that one in five children will experience tooth decay in a primary tooth between ages two and five, and three in five will experience tooth decay between age twelve and nineteen.2 If left untreated, tooth decay can lead to pain, swelling, infection, and in rare occasions, hospitalization or death. Because infants and toddlers are often uncooperative, treating young children can be challenging for dental practitioners.  

Prevention Starts with a Dental Home
The AAPD, AAP, and ADA all recommend establishing a dental home by age one or when the first tooth erupts.3  This provides parents and caregivers with guidance and information regarding the health and wellbeing of the child’s teeth. In addition to a clinical assessment and necessary diagnostic tests, preventive guidance should include counseling on oral hygiene, diet, injury prevention, non-nutritive habits (pacifier or digit habits), and speech and language development.4 A complete assessment allows practitioners to establish a patient’s caries risk and make a referral to a pediatric dentist, if necessary.
Completing a caries risk assessment is important because dental caries is a multifactorial disease. Parents must be educated and motivated to change habits, and it is unrealistic to assume this can be done after one visit. The assessment allows practitioners to establish a preventive plan for high caries risk patients with the use of fluoride treatments, such as Embrace Varnish, to release calcium, phosphate and fluoride, and potentially delay expensive or high risk procedures, such as sedation.

Embrace Varnish as a Component of Active Surveillance and a Preventative Plan
The application of fluoride varnish has been shown to reduce primary tooth decay by over one third when applied professionally,5 and therefore, the prevention plan for high risk pediatric patients should include quarterly applications of fluoride varnish.

The application of Embrace Fluoride Varnish, which contains 5% sodium fluoride, Xylitol, and bioavailable calcium and phosphate, can help treat superficial, non-carious enamel lesions (white spots) and provide minerals known to be beneficial for tooth structure. Calcium and phosphate are the building blocks of teeth, and the addition of these minerals provides benefits to patients who may be deficient in these minerals, such as patients with xerostomia or poor dietary habits.

Embrace Fluoride Varnish can play a key role in the active surveillance of a child’s cavities. Applications every three months in high risk children with sub-acute needs may help delay the necessity for sedation for dental treatment and provide practitioners with the opportunity to improve oral hygiene and correct dietary habits over time. More frequent visits can also help desensitize children to the office experience and detect problems in the early stages.

At each visit the child should have a clinical exam and necessary diagnostic testing; a child’s risk for developing cavities should be assessed. While we can’t always control what patients do at home, we can utilize the abilities of a prevention program. Embrace Varnish applied at the appropriate frequency, to help improve oral conditions, can create an environment that helps reduce the incidence of dental decay.

Why Choose Embrace Varnish?
As clinicians we must choose products that maximize efficacy for our patients. In vitro studies have shown that Embrace Varnish has ten times more cumulative fluoride release than the leading brand during the 4-hour treatment period.6 High fluoride release in varnishes helps provide conditions that are favorable for strong, healthy, more acid-resistant teeth. Embrace has a proprietary resin carrier with Xylitol-coated calcium and phosphate. In the mouth, saliva dissolves the xylitol and releases significant amounts of calcium and phosphate ions, which are key components of enamel.7

Teeth are made of calcium and phosphate in the form of hydroxyapatite. The presence of fluoride precipitates fluorapatite onto the enamel surface. Fluorapatite is more resistant to the acidic environment than hydroxyapatite.8 The ability of a product to deliver calcium, phosphate and fluoride is important to consider when selecting an in-office fluoride treatment. The high concentration of calcium, phosphate and fluoride release makes Embrace Varnish appealing for use in high caries risk patients and those with compromised tooth structure.

1. American Academy of Pediatric Dentistry. Early Childhood Caries (ECC). Chicago: American Academy of Pediatric Dentistry.
2. Dye B, Thorton-Evans G, Li X, J. Lafolla T. Dental Caries and Sealant Prevalence in Children and Adolescents in the United States, 2011–2012. Centers for Disease Control. November 6, 2015. Available at: https://www.cdc.gov/nchs/data/databriefs/db191.htm. Accessed February 7, 2018.
3. American Academy of Pediatric Dentistry. Policy on the Dental Home. Pediatric Dentistry. 2017;39(6):29-30.
4. American Academy of Pediatric Dentistry. Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Infants, Children, and Adolescents. Pediatric Dentistry. 2017;39(6):188-195.
5. Marinho V, Worthington H, Waslh T, Clarkson J. Fluordie varnishes for preventing dental caries in children and adolescents. Chochrane Database of Systematirc Reviews. 2013(7):1-95.
6. Milburn J, Henrichs L, Banfield R, Stansell M, Vandewalle K. Substantive Fluoride Release from a New Fluoride Varnish Containing CXP. Dentistry. December 2015;5(12).
7. Neelakantan P, Hemagaran G. Remineralization of the Tooth Structure – The Future of. International Journal of PharmTech Research. April-June 2014;6(2):487-493.
8. Casamassimo P, Fields H, McTigue D, Nowak A. Pediatric Dentistry: Infancy through Adolescence. 5 ed. St Lous: Elsevier; 2013.


About Jarod Johnson, DDS, ABPD
Dr. Jarod Johnson of Arctic Dental is a provider of pediatric dentistry in Muscatine, IA. He earned a bachelor’s degree in biomedical engineering from the University of Iowa in 2009, and his DDS from the same school in 2013. He earned a certificate in pediatric dentistry from the University of Nevada, Las Vegas, School of Dental Medicine. Johnson is a diplomate of the American Board of Pediatric Dentistry.