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

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

Older child

• Have child sitting or lying with head tilted back  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

• 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

• 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