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Fluoride varnish: The who, what, when, and how

Aug. 1, 2018
Sarah Clark, RDH, explains how properly choosing a fluoride varnish can increase case acceptance.
Evaluate product selection with the goal of improving case acceptance

By Sarah Clark, IPDH, RDH, CSMC

I vividly remember the days of my childhood dental appointments. My wonderful hygienist took the time to educate me, and the doctor always provided a warm welcome. Essentially, the dental office and everything associated with it was, and always has been, a comfortable environment for me. The only experience I truly struggled with from a patient standpoint was the fluoride treatment at the end of my appointment. The bulky foam tray never quite had enough space to fit in my mouth properly, and I always felt anxiety about it. To say the least, it was the only less-than-ideal part of my dental treatment, so much so that I stopped receiving fluoride treatments because of it. A necessary tool for prevention (in my case, since as a child I did need some restorative treatment) was missed out on, simply because of the poor experience I had with it.

In contrast, fluoride varnish has now become the standard for dental practices to utilize—much preferred over fluoride foam or gel methods. In fact, out of a sample set of 204 dental hygienists, 94% stated that they use fluoride varnish as the sole fluoride treatment option in their office. Yet, it still seems that acceptance for fluoride treatments can be difficult to obtain, whether it is due to dislike of the flavor or product texture, the exposure to fluoride itself, or the lack of insurance coverage creating an additional cost for the patient.

For those of us achieving great patient acceptance, it raises the question: Are all fluoride varnishes created equal? Another question is: What can we do differently to achieve a higher fluoride treatment acceptance? Let’s take a fresh look at the who, what, when, and how of fluoride varnishes, as well as improving case acceptance.

The need for fluoride varnish

Fluoride treatments generally are understood by the public to be applied as a routine treatment for children to help prevent caries as they develop. As dental professionals, we know that there are a multitude of fantastic uses for fluoride treatments. It is our duty to educate our patient base about the benefits and importance of fluoride treatments as well as the many different ways that it can be successfully used.

We know that fluoride treatments are used off-label for caries prevention, and their primary use is labeled to treat hypersensitivity. Both of these situations are examples of how many of us currently use fluoride treatments in clinical practice.

Why use fluoride varnish treatments over other delivery methods, such as trays with foam or gel? As we know, the uptake of a fluoride varnish is greater than that of a fluoride gel or foam method.1 The question is: To what degree? When fluoride varnish uptake results were compared to that of acidulated phosphate fluoride (APF) gel, they were determined to be statistically significant: “The fluoride uptake value in varnish and gel groups was 2069.78 ppm and 1050.99 ppm, respectively.”1This evidence is more than enough to guide our decision-making in choosing a fluoride varnish product over gel or foam treatments.

What can we gain from employing a fluoride varnish treatment in clinical practice? Benefits over other treatment methods include higher fluoride uptake; no tray delivery, which improves patient comfort; quick application; increased contact time with the tooth surface; and it is safer for at-risk populations such as children, special needs patients, or the disabled.

Additionally, varnish allows for patients to eat and drink (with limitations) immediately following application, which improves patient compliance. The versatility and efficacy of fluoride varnish makes it an ideal component to our practice armamentarium. With it, we can address high caries risk patients, patients experiencing xerostomia, patients with generalized recession, and patients experiencing hypersensitivity.

Product selection

From surveying 200 RDHs from across the country, many expressed the importance of product selection in increasing patient acceptance. This was influenced heavily by factors such as taste, texture, and postapplication instructions. Those who reported poor taste and rough texture stated that many will decline the treatment due to this poor experience alone. However, offices that have found a premium product where patients enjoyed the flavor and texture have found that they do not receive the same hesitation to accepting fluoride varnish treatments.

Now more than ever, patients are conscious of the risk of products that are recommended to them as well as potential side effects. This can seem frustrating, as we know we are providing a recommendation with the best interest of our patients in mind. Any skepticism should be viewed as a good thing. Patients are trying to make health-conscious decisions, and we can be prepared to help them with choosing a fluoride varnish that meets certain criteria (such as being gluten-free, naturally sweetened, or excluding controversial ingredients).

A product that is my go-to for many reasons—but a big one for its appeal to the health-conscious patient—is Voco’s Profluorid Varnish. Profluorid Varnish does not contain tree nuts, peanuts, corn, shellfish, eggs, milk protein, soy, gluten, triclosan, petroleum, red dye/artificial coloring, saccharin, or aspartame, and it is naturally sweetened with xylitol. Knowing this information about my go-to product has greatly helped me increase acceptance of fluoride varnish treatments.

Dental hygienists should be encouraged to review the information about current in-office products and, if needed, make the switch to a product that will ease the concerns of the health-conscious patient.

Since utilizing the methods above to improve case acceptance of fluoride varnish treatments in office, I have seen a dramatic increase in patients who not only accept the recommendation for a fluoride varnish treatment but they actually ask to be sure they receive their treatment!

By adding value through risk assessment, offering it as a complimentary service in many instances (after periodontal treatment or for those with hypersensitivity), and choosing a product that meets my ideals, I can proudly say that a majority of my patients receive a fluoride varnish treatment.

I have always incorporated the case acceptance recommendations above. But, until I found a fluoride varnish that also provided a pleasant patient experience, I would never know just how powerful proper product selection would be to the success of providing fluoride treatments in-office.

About a year ago, I received a sample of Profluorid Varnish—caramel flavor to be exact! At my personal preventive appointment, I had my co-worker and fellow dental hygienist apply it to my teeth. I was in shock with how smooth the product was after application, how the flavor was actually desirable, and the fact that the product was clear and not yellow when applied. Together, we decided to incorporate it into our daily practice, and it has been a pleasure hearing the verbal feedback from patients compared to prior products.

Think of it this way: a sickle scaler is a sickle scaler. It can perform the same job no matter the company that made it. However, each of us has a difference in preferences, such as handle material, handle size, actual shape of the sickle, sharpness, and more. The result we receive when we fit the correct premium product to our needs is a great improvement (and truly enjoyable!) compared to what we can do with just the standard one-size-fits-all product. The same principle applies when choosing something such as a fluoride varnish product.

Evaluate your fluoride treatment protocol. What are you using? How are you educating your patients on efficacy or need for the treatment? Is your product health-conscious friendly? How do your patients react when the product is applied? Answer these questions and make the changes where needed—and watch your case acceptance increase!


1. Anafi B, Keidrich P, Khan Z, Ansari G, Navami B. Fluoride Uptake Level of the Enamel by a Fluoride Varnish and a Fluoride Gel (APF). Shiraz Univ Dent J. 2011;12(3):214-220.

Sarah Clark, IPDH, RDH, CSMC, is a dental hygienist from Maine who also holds independent practice dental hygiene authority. In addition to working full-time in private practice, Sarah is vice president of her local Maine Dental Hygiene Association and owns Professional Wellness Solutions LLC, which is home to her blog, Mindful Hygienist (mindfulhygienist.com), speaking programs, and client coaching programs. Sarah is a 2014 graduate of NHTI in Concord, New Hampshire, and holds her certificate in stress management coaching. She can be reached at [email protected].

Gaining case acceptance

While we know the true benefit and wide range of uses for fluoride varnish in practice, gaining case acceptance from our patients can be another challenge. Patients may decline or not receive a fluoride varnish treatment for varying reasons such as cost, not understanding the value, or simply not being offered the treatment. Here are some key components to increasing acceptance of fluoride varnish treatments in your office.

Risk assessment—It can be difficult for a patient to understand how much they can truly benefit from a fluoride varnish treatment without delivering our recommendation based upon a measurable scale. This is where a risk assessment, such as CAMBRA or the interactive Previser website can greatly improve patients understanding of their need to accept recommended fluoride treatments.

The Previser risk assessment for caries is a favorite of mine to complete chairside with my patients, as it asks a mix of clinical questions for me to answer and many habit-related questions for patients to answer. Once completed, a “forecast” for caries risk will appear on the screen and explain to patients what their caries risk is and why.

The generated report can be printed for the patient and is visually engaging, helping the patient to truly understand that there is a basis for the recommendation of a fluoride varnish treatment. Evidence based upon a measurable scale is a strong reinforcement tool to increase acceptance for fluoride varnish treatments for those who truly need them.

Education—It is important for our patients to know that fluoride varnish treatments are not just for children with developing teeth. This is often the understanding due to insurance companies only paying for children to receive this preventive benefit.

More insurance companies, though, are beginning to reimburse fluoride treatments for adults. By taking the time to research this benefit and educate the patient as to why it is a fitting treatment for them as well, case acceptance can be greatly increased.

Complimentary service—Fortunately, fluoride varnish treatments are low cost to provide. Because of this, many offices have begun to offer them as a complimentary service to all patients. If your office philosophy is set strongly based on prevention and you wish to highly increase case acceptance for fluoride varnish treatments to benefit the patient population, you may consider adding them as a complimentary service with all preventive appointments.