An alternative technique for applying fluoride varnish.

F luoride varnish is a valuable tool in the prevention of tooth decay. Studies have demonstrated its effectiveness at arresting early cavitated lesions, remineralizing interproximal incipient smooth surface lesions and preventing caries. Medical personnel in many public health clinics now are applying these varnishes in an attempt to minimize treatment needs and reduce accessto-care problems. Several authors have reviewed the literature and recommended that fluoride varnishes be incorporated increasingly into preventive dentistry programs. One of the main advantages of fluoride varnish is that it releases fluoride over 24 hours and appears to increase the calcium fluoride reservoirs that aid in long-term fluoride release. In an in vitro model, fluoride was released over five to six months. In addition, SkoldLarsson and colleagues demonstrated that these varnishes are capable of maintaining elevated fluoride levels in the plaque adjacent to fixed orthodontic appliances for up to one week. Fluoride varnish is welltolerated by patients and is relatively easy to apply. The varnish can be purchased in bulk 10-milliliter tubes or in individual prepackaged applicators. The varnishes currently available in the United States are Duraphat (5 percent sodium fluoride/2.26 percent fluoride, Colgate Oral Pharmaceuticals, Canton, Mass.), Duraflor (5 percent sodium fluoride/2.26 percent fluoride, Medicom, Buffalo, N.Y.), Fluor Protector (1 percent difluorosilane/0.1 percent fluoride, Ivoclar Vivadent, Amherst, N.Y.) and CavityShield (5 percent sodium fluoride/2.26 percent fluoride, Omnii Oral Pharmaceuticals, West Palm Beach, Fla.). The application technique recommended by manufacturers is as follows. dDispense approximately 0.5 mL of varnish into a small well. (Prepackaged individualdose systems come with their own well that is filled with varnish.) dLightly dry the teeth with air or gauze. dIsolate the teeth to prevent moisture recontamination. dPaint the varnish onto the teeth with a brush or another type of applicator. The varnish sets on contact with the slightly moist teeth. From a clinical practice perspective, the major limitation of this technique is the need to frequently reload the brush with the varnish. Because the brush can hold only a limited quantity of varnish, much of the time needed to administer this treatment involves multiple reloadings of the brush and re-entry into the mouth to apply the varnish to the teeth. These time and motion inefficiencies are particularly problematic when treating an uncooperative child. The following technique improves the efficiency of applying the varnish in an active pediatric practice, and this procedure can be performed easily in a public health clinic.