focus with Melanie Joyce

Topical Fluoride Varnishes have been used for over 3 decades1 and typically over the years 22,600ppm of sodium fluoride has been the active ingredient in the most popular varnishes. Although current evidence would suggest these varnishes are effective1, some contain the ingredient colophony and also latex in their tubing and can produce aesthetically unpleasing results with unrealistic post operative advice. Ivoclar Vivadent produced an alternative fluoride varnish which I have been using since January 2014 with great results and excellent patient acceptance.

An innovative aesthetic fluoride varnish suitable for all patients.

The key difference between Fluor Protector S and most of the alternative varnishes is that Fluor protector S is an ammonium fluoride, solvent based varnish as opposed to a sodium fluoride, resin based varnish.

When you use a sticky resin based varnish, the sodium fluoride is contained in the resin and needs to come into contact with the saliva whereas ammonium flouride is bioavailable and has a high fluoridation effect in a shorter period of time.

www.ivoclarvivadent.co.uk

Fluor Protector S Benefits

• Goes twice as far as other varnishes

• Colophony and latex free

• Indicated for caries prevention

• No prescription needed

The first huge benefit for me has been the fact there is no need to ask the dentist for a prescription to apply the varnish. Fluor Protector S is registered as a medical device and not a prescription only medicine.

This has been great for me, the dentist and my patients as it means I can have the autonomy of applying the varnish when it is clinically necessary without having to ask the dentist for a prescription and without sometimes having to pause treatment to do so.

If patients have allergies or asthma especially if they’ve been hospitalised it is advised not to use fluoride varnishes containing colophony and so patients who fit into that group are not having fluoride varnish applied, Fluor protector S is colophony and latex free and has no known reaction in asthmatic patients or those with allergies to colophony, this has really solved a problem because it has meant that none of my patients are at a disadvantage and missing out on having fluoride varnish applied.

Unlike some varnishes Fluor Protector S is also indicated for long term caries prophylaxis in addition to being effective in the treatment of hypersensitivity so it has a range of indications for use in my practice.

Simple Application

The first step is to ensure the teeth are clean and isolated with a relatively dry working field. (see fig 1 & 2). The varnish is a liquid formula as opposed to a sticky gel, it is also homogenous which means the product does not need to be agitated as other brands do. The varnish is applied directly from the multidose tube onto the viva brush G that is provided with the varnish (pack of 50). Application from the multidiose tube is similar to applying bond to a microbrush (see fig BLA), this ensures minimal waste and thus increases efficiency. I have found the tubes I’ve had have lasted significantly longer than other products.

The varnish is applied to the required area, as it’s a liquid it flows into the high risk areas where plaque and debris is likely to adhere such as the pits and fissures and interdental areas (Fig 3). The varnish is gently air dried or left to dry for 60 seconds to allow the solvent to evaporate and the varnish to set on the teeth (fig 4). Fluor Protector S’ active ingredient is Ammonium fluoride which is an inorganic compound that crystallizes as small colourless prisms. In solution the concentration is 7,700ppm and on placement once the solvent evaporates the concentration increases 4 fold to just under 30,000ppm of fluoride.

As patients are increasing their awareness of the need for preventative measures they are also increasingly demanding aesthetic results. Unfortunately fluoride varnishes historically have been visible after application and have a sticky unpleasant texture in the mouth. In my experience this can lead to poor patient compliance especially in children. With Fluor Protector S, once dry the varnish is set on the teeth forming a smooth colourless film which has shown to produce an increase in calcium fluoride layer and also structurally bound fluoride in comparison to other fluoride varnishes 2 3.

Fig 1 Isolate

Fig 2 The varnish can be dispensed directly onto a brush to minimise waste

Fig 3 Apply to a relatively dry working surface

Fig 4 Allow to dry for 60 seconds or gently airdry

Following application one patient commented:

“I could feel that there was ‘something’ when I bit down on my back teeth, but there was no evidence of it on my teeth, no discolouration or raised sections. The fluoride varnish barely left any taste and there was no thick tacky feeling or noticeable residue that I have experienced before with different fluoride treatments. After leaving the surgery I had almost forgotten it had been applied.”

Melanie Joyce, Alexandra Road Dental Practice, 14 Alexandra Road, Leeds, LS18 4HD | e. melanie.joyce@ivoclarvivadent.com

Melanie Joyce is Dental Therapist working one day a week in private practice, she runs her own CPD training company dedicated to dental hygienists and therapists and is the Professional Services Clinical Specialist at Ivoclar Vivadent. Melanie has over 11 years’ experience in total as a DCP. She has treated patients in busy NHS & Private dental practices, teaching hospital and community settings working with experienced Clinicians.

In addition to her primary dental qualifications she also holds qualifications in management and teaching and is currently studying towards an MSc in Advanced Professional Dental Practice at the University of Kent where her specialism is Fluoride Varnish. Over her career so far Melanie has been active in the dental industry, doing volunteer work teaching DCP’s, writing numerous educational and clinical articles for journals as well as being on the council for the BADN and the BADT. In 2013 Melanie was awarded the accolade of Dental Therapist of the Year at the Dental Awards.

The patient is then advised to wait 1 hour before eating and drinking. Something my patients were pleased to hear as previously with other varnishes they have been advised to wait for 4 hours before chewing food.

When do I use Fluor Protector S?

I currently work in 2 private practices, each with a different demographic. One is a practice where we carry out a lot of adult orthodontics, this increases the risk of plaque accumulation where brackets are used and thus increases the risk of caries developing so I use fluor protector S on many of our orthodontic patients as part of their preventative treatment which also includes oral hygiene instruction.

At the other practice where I work I see a lot of older patients and some of which suffer with a dry mouth due to polypharmacy and even hypertrophy of the saliva glands due to cancer of the head and neck. I apply Fluor Protector S to these patient’s twice a year after they have had their check up and hygiene visit as a preventative measure because they are at a much higher risk of developing caries and in particular root caries.

The Irish Oral Health Services guidelines initiative (2009) recommend 2-4 applications of fluoride varnish per year for any high risk children. Although there are no guidelines available for high risk adults in Ireland, in the UK the department of health recommend to apply fluoride varnish twice a year if the patient is considered high risk. Fluor Protector S also work really well on areas of hypersensitivity so I also use it for this reason too.

Evidence based practice

Evidence based practice is a movement that emerged in healthcare in the 1990’s and was first introduced to the dental world in 1994 by the evidence based medicine working group 4 Clinicians are taught to practise evidence based dentistry and act in the best interests of their patients, however evidence based dentistry is not just about the evidence itself it is also about assessing the patient’s wants and preferences and using your clinical judgement (fig 5).

Therefore, applying a coloured sticky varnish to a patients tooth and advising incorrect post-operative advice is unlikely to be what the patient wants and is also unlikely to be effective. I use Fluor Protector S because I know it is flowing into the high risk areas and has an increased fluoridation effect with aesthetics and comfort that the patient will appreciate as well as realistic post-operative instructions to ensure its effectiveness.

1) Marinho VCC, Worthington HV, Walsh T, Clarkson JE. (2013), Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. 2) Ivoclar Vivadent R&D, (2013) Superficial, alkali-soluble fluoride one hour after treatment with fluoride varnishes. Schaan. 3) Ivoclar Vivadent R&D, 2013. Structurally bound fluoride one hour after treatment with fluoride varnishes. Schaan. 4) Richards, D., Clarkson, J., Matthews, D., Niederman, R. (2008) Evidence-based Dentistry: Managing Information for Better Practice. London: Quintessence Publishing Co. Ltd. 5) Department of Health, (2014) Delivering Better Oral Health: An evidence based toolkit for prevention. Department of Health, London.

Structurally bound fluoride one hour after treatment with fluoride varnishes. The fluoridating effect of the individual fluoride varnishes differs: Fluor Protector S achieved the highest fluoridation. The choice of competitor products related to their importance in the market.

the fluoridevarnish suitable for

all patients

The alternative fluoride varnish that doesn't require a prescription• Goes twice as far as other varnishes• Colophony and latex free• Indicated for caries prevention

Fluor Protector SThe protective fluoride varnish

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Phonares® IISR

Expressive esthetic denture teeth

The innovation continues

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Expressive aesthetic denture teeth

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No prescription needed•