Protective dental procedures
  • Effective fluoride varnish strategy needs coordinated, long-term, well documented approach
  • Start at 18 months, do every 6 months until adulthood
  • Helps reduce cavities/decay

Attention

  • Fluoride varnish is an S4 poison — can only be applied by dentists, dental/oral health therapists, dental hygienists, general practitioners, nurses, and ATSIHPs who have received accredited training

Do not

  • Do not use more than recommended amount of varnish
  • Do not apply varnish if child has
    • Had varnish applied less than 3 months ago
    • Been treated for asthma in past week
    • Not taken their asthma medicine on the day
    • Been hospitalised for any allergic reaction in the past 12 months — reactions to fluoride varnish such as swelling and breathing difficulties are very rare but can happen

Do first

  • Take time to gain child’s trust — child will need to feel safe and comfortable
  • Provide written information about the procedure if available

What you need

  • 2–4 cotton rolls, for older children if tolerated
  • Toothbrush, or use gauze wipes
  • Gauze wipes
  • Fluoride varnish and dosage pads if available
  • Fluoride varnish
    • 0.25mL for children 18 months to 6 years, about the size of a pea, smaller than paracetamol tablet — Figure 8.52
    • Up to 0.4mL for 7 years and over
  • Mini plastic (dappen) dish — Figure 8.52
  • Applicator brush (if supplied) OR microbrush applicator — Figure 8.53

Figure 8.52   

Figure 8.53   

What you do

  • Try to clean and varnish all surfaces of teeth
    • If not possible (eg young child too restless) — give priority to front upper teeth

Position person

Young child

  • Sit child on parent/carer's lap facing you — Figure 8.54
  • OR Sit child on parent/carer's lap facing them. Sit knee to knee with parent/carer and lie child back onto your lap — Figure 8.55

Figure 8.54   

Figure 8.55   

Older child

  • Have child sitting or lying with head tilted back  Figure 8.56

Figure 8.56   

Clean teeth 

  • Gently brush teeth using wet toothbrush only with no toothpaste
    • Clean all surfaces of teeth using circular motion — Figure 8.57

Figure 8.57   
  • If no toothbrush available — use gauze to wipe teeth clean

Dry teeth and apply varnish

  • Most important step. Try to get child to keep mouth open and tongue off teeth
  • Keep wet cheeks, lips and tongue away from teeth
    • Put fingers or a finger and a thumb on either side of teeth
    • OR If tolerated put cotton roll between teeth and cheek/lip
  • Dry 2–3 teeth at a time using gauze wipe — Figure 8.58
    • Start with upper front teeth, then upper back. Lower front and lower back teeth last

Figure 8.58   

Figure 8.59   
  • Paint varnish onto dried teeth straight away using applicator — Figure 8.59
    • Apply to outside, inside and biting surfaces
  • Check the tongue at intervals for any varnish, wipe away with gauze
  • If using cotton roll, change when it becomes too wet
  • Continue drying and painting 2–3 teeth at a time until all teeth have been varnished
  • Finish by checking the tongue and wiping away any varnish

Tell parent/carer

  • Do not brush child’s teeth for 24 hours
  • Do not pick at varnish — works best if left on for as long as possible, but will come off over next 1–2 days
  • Varnish will help to protect teeth and prevent cavities
  • Child can drink but mustn't eat for half an hour, then soft foods for the rest of the day
  • Varnishes may be barely visible but will have a rough feel
    • AND may have a yellow colour that will last for the rest of the day
  • Older children and teenagers may be put off by appearance, so make sure they understand it won't last long

  • Reapply varnish in 6 months