The many faces of fluoride varnish: Alternative uses
Dental treatment has a funny way of placing certain products and treatments into a “box.” We may go through the motions that have become so routine we forget why we’re doing something. However, today’s dental research demonstrates that we need to break out of the mold and think outside of the lackluster, never-changing box.
One of the products that’s fallen victim to this “box” mentality is fluoride varnish. It’s become something we do because we’re supposed to. It’s a production booster under the guise of benefitting patients. Truth be told, this story line is no longer enough to keep hygienists motivated. It’s all over social media: “Our office is telling us we must do fluoride for every patient. How do I convince them we may not need to?” or “I know fluoride is beneficial for my patients, but I feel bad selling it to them.”
What if we can change this feeling among hygienists?
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Alternative uses for fluoride varnish
Just like patients have diverse needs, fluoride varnish can be used in diverse ways. Revisiting these uses can restore value and belief in the product. Some of these uses include:
- After silver diamine fluoride (SDF) treatment
- To prevent hypersensitivity after nonsurgical periodontal therapy
- After in-office whitening to prevent hypersensitivity and remineralize enamel1
- To recharge fluoride release of glass ionomer sealants or restorations2
- After restorative dental treatments that leave the tooth susceptible to hypersensitivity (e.g., class V restorations, crown prep margin of a temporary crown, and microabrasion)
- Sealing a resin-infiltration procedure for white-spot lesions
There are a few factors to consider when billing for these uses. First, is the fluoride treatment part of a procedure? For example, in most SDF protocols, we recommend sealing the area with a fluoride varnish. Practices may bill using the fluoride varnish CDT code D1206 with an associated fee. But with the range of uses for fluoride, a consideration could be to assign a zero-dollar fee to the D1206 code and assume the cost within other procedures. This allows it to be appropriately attached to dental claims and ledgers and help patients receive the treatment without being concerned about “selling” it to them.
For patients experiencing hypersensitivity, or who are at high risk of hypersensitivity, CDT code D9910 could be an option, and some insurances provide reimbursement for this code. Remember, fluoride varnish is FDA-approved as a desensitizing agent and is used off-label as a caries preventing medicament.3
Regardless of its use, associated fees, and codes, it’s important to not only document the treatment performed in clinical notes, but to indicate the reason for treatment and the material used.
Selecting a varnish
Not all fluoride varnishes are created equal. Consider what you want your product to accomplish. If you wish to provide a quick result in a desensitization situation, consider a product that has a quick release of fluoride. More evidence is needed to determine benefits of extended fluoride release.4
In most situations, a moisture-tolerant fluoride varnish is ideal for the provider. When paired with dental procedures, patients may be numb, and a dry field may be challenging to achieve. Varnish products that have this capability will indicate it on the packaging or promotional materials.
Lastly, think about performance and patient satisfaction. A patient who has just undergone teeth whitening certainly does not want to leave with chunky fluoride and discoloration. A smooth application with a uniform, natural appearance is a must. Flavors that are pleasant for patients will also lead to an increase in case acceptance.
Providers should consider all factors when determining what product best fits their needs. In my experience, Profluorid Varnish by Voco, a 5% NaF varnish, meets the various clinical needs of my patients. Available in seven great tasting, transparent flavors with no tooth discoloration, it sets quickly in the presence of saliva, and with its high immediate fluoride release, it relieves hypersensitivity. It has also exceeded performance expectations in ease of use, clinical outcomes, and patient satisfaction when compared to other options I’ve used. I’ve concluded that Profluorid Varnish is the best fit for the needs of my patients and me.
Editor's note: This article appeared in the November 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Kemaloğlu H, Tezel H, Ergucu Z. Does post-bleaching fluoridation affect the further demineralization of bleached enamel? An in vitro study. BMC Oral Health. 2014;14(9):113. https://doi.org/10.1186/1472-6831-14-113
- Poggio C, Andenna C, Ceci M, et al. Fluoride release and uptake abilities of different fissure sealants. J Clin Exp Dent. 2016;8(3):e284-289. https://doi.org/10.4317/jced.52775
- Beltrán-Aguilar ED, Goldstein JW, Lockwood SA. Fluoride varnishes. JADA. 2000;(131)5:589-596. https://doi.org/10.14219/jada.archive.2000.0232
- Zero DT. Fluoride varnish: A clinical perspective on the ADA laboratory evaluation. ADA Pro Prod Review. 2015;10(2):2-3. www.ada.org/en/es-MX/member-center/oral-health-topics/~/media/737FB2A4B88A4E9496F0F0A340525C29.ashx
