5.1.15 Issue #686 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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Adding Topical Fluoride Varnish to Hygiene Appointments
By Carol Tekavec RDH

According to the ADA Center for Evidence Based Dentistry document, “Topical Fluoride for Caries Prevention” dated November, 2013, many more of our patients should be receiving fluoride treatments as part of their regular dental care. Fluoride varnish application is an inexpensive, quick, and readily accepted procedure for our patients, and it provides them with much needed protection against decay. In addition, no longer is professional topical fluoride just recommended for children and teens. Research is showing that almost all of our patients, adults and children, can benefit from this simple, easy treatment.

Some indications for use are:
• Preventing general caries in adults and children
• As a desensitizing agent for exposed root surfaces
• Preventing root caries in older adults
• As a remineralizing agent for some incipient caries
• Preventing caries around ortho brackets
• Xerostomia

The ADA has recently come out in support of fluoride varnish even in very young children. Instead of advising our patients to bring in their children at age 3, we should be telling parents to schedule appointments as soon as primary teeth emerge. Little ones should have their teeth wiped with gauze, and then fluoride varnish placed. All adults should be offered fluoride varnish as well. It is now considered to be a part of appropriate treatment as often as twice a year (or even more frequently as needed) for all ages.

How does fluoride varnish work?
Fluoride varnish hardens to a clear film which slowly releases fluoride ion to the underlying tooth surfaces. Fluoride helps apatite crystallites in the teeth block dissolution, which reduces the rate of any demineralization that might be occurring. The fluoride ion activity enhances mineral deposition and promotes remineralization in persons of all ages.

Who needs it?
Children at moderate to high risk of caries can greatly benefit from fluoride varnish. Risk factors include having had cavities in the past or any current white spot lesions or stained fissures. Little ones who are using a bottle filled with anything other than water at bedtime are at very high risk, as are children who have poor home care and/or diets high in carbohydrates. Current research also shows that the use of a “sippy” cup with anything other than water can also contribute to increased risk of caries (except when utilized at regular meals).

Adults at moderate to high risk of caries are also candidates for fluoride varnish, as are adults who have exposed root surfaces, sensitive teeth, white spots, demineralized areas or dry mouth.

All risk factors should be documented in the patient’s record, both for proper recordkeeping and to verify conditions when submitting a claim to insurance. Many insurance carriers cover fluoride varnish, even in adults, as long as there is adequate documentation. Adults at moderate to high risk will have had three or more restorations in the past five years, exposed roots, “white spots”, dry mouth, or inadequate home care.

Application Procedure
Teeth need to be “toothbrush” clean at a minimum. Application after a prophy is recommended. Dry teeth prior to application, but there is no need for teeth to be completely desiccated. Do not apply varnish in “a puddle” of saliva, but the presence of a small amount of saliva does not prevent uptake of the fluoride. It is ok for patients to eat or drink after application, but no brushing for 4-6 hours. It is a good idea to let patients know their teeth will feel “tacky” after application and that this is a sign the varnish is in the right place doing its job.

Hygienists can recommend fluoride varnish at any time during a patient’s appointment. If a patient has had decay or exposed roots, fluoride may be suggested to help prevent further problems. If a patient mentions that they brush and floss but still seem to get decay, fluoride can be offered. Patients understand that fluoride is helpful and are typically very receptive to the procedure. Adding fluoride varnish at $37 to an 8-patient day amounts to $296 in additional office revenue. For a four-day week this amounts to $1,184, and a month’s additional revenue of $4,736. Even if only half of the month’s patients are treated, the practice would gain $2,368. It is good for the practice’s bottom line and for our patients’ health.

Handling Objections
Water fluoridation is listed by the Centers for Disease Control and Prevention as one of the 10 greatest public health achievements of the 20th century. An estimated 51 million school hours are lost each year due to dental related illness. Water fluoridation can be effective in reducing this. All ages benefit. For over 50 years the best available scientific evidence indicates that water fluoridation is safe and effective (when amounts of fluoride are not excessive). Current recommendations are .7 parts per million (ppm) replacing the previous 1 ppm. Water fluoridation is also inexpensive. It is estimated that the lifetime cost per person to fluoridate water is less than the cost of one dental filling. Fluoride varnish in addition to water-system fluoride can prevent dental decay in a large number of individuals. Topical fluoride is not contraindicated despite the presence of fluoridated water supplies.

Tell patients to go to ADA .com to find out more. Even Wikipedia contains information supporting systemic and topical fluoride! Fluoride varnish can be an excellent addition to our hygiene appointments.

Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

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