In the current environment, dental professionals are generally working at a reduced capacity; especially since guidelines surrounding treatments that generate aerosols can mean increased infection control measures and more time between patients. We also receive advice to avoid aerosol-generating procedures where possible. This means that if there are measures we can implement that reduce the need for an aerosol-generating procedure, such as alternative treatment options, we should all be offering these solutions for our patients. In addition, patients may have developed snacking habits while at home or be visiting the dental office less often, increasing their risk for dental caries. Caries preventive measures are stepped up for patients at moderate or high risk for caries.
The application and use of 5% sodium fluoride varnish is an example of such a measure. This intervention has always been an important preventive tool for managing risk for dental caries in our patients. Fluoride varnish use is supported globally, and is included as one of the interventions in the FDI position statement 'Promoting Oral Health Through Fluoride.' Should we be considering the use of fluoride varnish in more of our patients and more often?
NICE (the UK's National Institute for Health and Clinical Excellence) has summarised the evidence showing that fluoride varnish is an effective preventative strategy for the prevention of dental caries. Fluoride varnish works by:
Inhibiting demineralization;
Promoting remineralization and making enamel more resistant to acid attack; and,
Inhibiting bacterial metabolism that results in less bacterial acid production.
Dental professionals should provide applications of 5% sodium fluoride varnish, such as Colgate® Duraphat® Varnish not only to prevent dental caries, but also to manage non-cavitated coronal caries in children and adults and reverse early lesions. It is also one of the options for managing root caries.
Prioritizing the application of fluoride varnish within a dental office is something that can be achieved by the whole dental team. Dental hygienists, dental therapists and expanded function dental assistants can provide this treatment so that space in the schedule can be freed up for the dentist to prioritize other treatments and ensure efficient team work within the office.
Many patients, especially those who are anxious or elderly, might prefer less invasive treatments to manage their issues, especially in this time where many might feel more anxiety overall when interacting with medical teams. The application of fluoride together with other advice surrounding hygiene and diet can empower these groups to manage their problems in a minimally invasive way.
Effective prevention is always important and minimally invasive care preferable. Additional benefits of the varnish are that it is moisture tolerant and a prophy isn't needed before applying it. This has been a benefit in managing some children and easy application of the varnish. Now, we have the added benefit that this makes it possible to avoid generating an aerosol. Of course, prevention also reduces the need for invasive treatment that could also generate aerosols. We should consider the role of 5% sodium fluoride varnish in managing our patients during COVID-19 and avoiding aerosol generating procedures.
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