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Home | Fluoride Varnish: A Critical Part of Primary Care

Fluoride Varnish: A Critical Part of Primary Care

November 5, 2018

By Eileen Crespo, MD, FAAP, Vice President of Medical Services, Delta Dental Minnesota; pediatrician at Hennepin Healthcare

When I was a child, I remember sitting with fluoride trays in my mouth for what seemed like hours at the dentist. Then, you couldn’t eat for an hour.
The advent of fluoride varnish has changed all of that.

Fluoride varnish is an effective cavity-fighting tool that’s not just for dentists anymore. In fact, pediatricians and primary care providers across the country have adopted the use of flouride varnish as part of providing comprehensive primary care — especially for the highest risk, most vulnerable populations.

Why Fluoride Varnish?
Fluoride varnish is effective for cavity prevention. A 2013 Cochrane review found fluoride varnish prevented 37 percent of caries in primary teeth and showed a 43 percent reduction of caries in permanent teeth. Flouride varnish is also an easy, quick, painless treatment that can be completed for children as young as 6 months or as soon as the first tooth erupts.

In Minnesota, flouride varnish is reimbursed in medical office settings every 3 months for infants age 6 months through 5 years. As of October 2017, flouride varnish application is required for children for Child and Teen Checkups on Medicaid. From age 6 to 21, flouride varnish applied during medical visits is reimbursed twice per year for high-risk children.

How does it work?
Dental enamel is a living substance that is at risk of attack by dietary factors, cariogenic bacteria as well as inadequate saliva flow. Acids from certain beverages/candy/foods as well as produced as a by-product of bacterial metabolism causes demineralization of enamel which weakens the tooth structure and leads to cavities. The first sign of enamel destruction in children are white spot lesions. These are most commonly seen along the upper incisors at the gum line but can be on any tooth.

Fluoride varnish can help remineralize white spot lesions. Enamel remineralization makes it more resistant to acid. Flouride varnish also reduces enamel demineralization and can inhibit bacterial metabolism and acid production.

As opposed to fluoride supplements, fluoride varnish has not been associated with dental fluorosis (a lacy-like appearance of the tooth surfaces).

Why focus on young children?
One basic reason that primary care providers should provide oral health education is that we typically see young children much earlier than dentists. Most children will have had around 6 routine visits with a medical provider by their first birthday, which is the recommended age for first dental visit. Medical providers have multiple opportunities to discuss establishing oral hygiene practices and providing fluoride varnish at each visit where teeth are present.

In 2015, Minnesota children participated in the Basic Screening Survey showing that half of 3rd graders had experienced caries. Rates were even higher in schools with a higher percentage of children receiving free and reduced lunch programs. Children from minority groups not only experience more caries but also have more unmet need for dental care. These statistics underline the need to work towards primary prevention of caries. Minnesota can do better.

So, continue working towards optimal child health by applying flouride varnish and asking families about their children’s last dental visit, making a verbal referral and/or helping families find a dental provider as they are all critical to a lifetime of excellent oral health.

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