Clinical Pearl: Fluoride Varnish

Looking for a pearl of wisdom to improve your quality of dental care?

Clinical Pearl: Fluoride Varnish 1

Ironically, many pediatric dentists who have accumulated years of valuable experience seldom enjoy opportunities to collaborate with one other. So, when we attend conventions or go to meetings, we often seek out those pearls of wisdom which will help improve our quality of care and enable us to treat our patients more proactively. Here’s one pearl I want to share with you. 

Among the dental materials which have profoundly affected the field of pediatric dentistry, fluoride varnish stands out as having played a key role. Fluoride varnish is a great tool in our dental armamentarium. This product helps bring fluoride ions into contact with children’s teeth, and, with the help of the associated rosin, binds these ions to the outer matrix of teeth for up to 12 weeks. 

Unfortunately, the rosin, which performs such an important role, also generates a sticky sensation which many children find annoying. We pediatric dentists regularly hear complaints from children about the “icky taste” of fluoride. We have all watched our patients, crying, wincing, or otherwise rejecting this sensation, and trying to scrub off the stickiness. 

Currently, this unpleasant sensation is not one we can prevent or remove. However, occasionally we also will hear a child complain about a “burning feeling” when receiving fluoride varnish treatment. Can fluoride cause this burning sensation? The answer is “no,” but the ethanol contained within the product can. Ethanol acts as a skin irritant. Since the purpose of ethanol is significant in the chemical bonding process, ethanol will not be removed from fluoride varnish. However, there are steps we can take to minimize or eliminate the “burning” sensation. 

I have spoken with a number of varnish companies. Here is a simple step they recommend eliminating the burning effect caused by ethanol. Mix the varnish together for a minimum of 10 seconds before applying. As you mix the varnish, it is exposed to air, and the ethanol evaporates. Allowing time for this evaporation to occur is the key to preventing a burning sensation. 

Although, at this time there does not yet appear to be an acceptable means of addressing the sticky sensory feeling associated with fluoride varnish treatment or a flavor we can use to adequately disguise it, we can easily solve the other problem of experiencing a “burning feeling.” Following the above advice, no practitioner needs to ever hear complaints about burning again. Remember, first mix the fluoride varnish for 10 seconds, then apply—a simple pearl with a very nice shine.