focus Edition 4 - April 2015
with Melanie Joyce www.dental-education.co.uk // www.ivoclarvivadent.co.uk
An innovative aesthetic fluoride varnish suitable for all patients. Topical Fluoride Varnishes have been used for over 3 decades1 and typically over the years 22,600ppm of sodium fluoride has been the active ingredient in the most popular varnishes. Although current evidence would suggest these varnishes are effective1, some contain the ingredient colophony and also contain latex in their tubing which can produce aesthetically unpleasing results with inaccurate post operative advice. Ivoclar Vivadent provide an alternative fluoride varnish which I have been using since January 2014 with great results and excellent patient acceptance. Fluor Protector S is registered as a medical device and not a prescription only medicine which is a huge benefit as there is no need ask the dentist for a prescription to apply the varnish. Fluor Protector S great for me as a therapist, the dentist and my patients as it means I can have the autonomy of applying the varnish when it is clinically necessary without having
to ask the dentist for a prescription and without sometimes having to pause treatment to do so. If patients have allergies or asthma, especially if they’ve been hospitalised, it is advised not to use fluoride varnishes containing colophony and so patients who fit into that group are not having fluoride varnish applied. Fluor Protector S is colophony and latex free so it can be used on all patients.
Fluor Protector S benefits:
• Goes twice as far as other varnishes • Colophony and latex free • Indicated for caries prevention • No prescription needed
Including those with allergies and asthma, which really solved a problem because it means that none of my patients are at a disadvantage by missing out on having fluoride varnish applied. Unlike some varnishes, Fluor Protector S is also indicated for long term caries prophylaxis in addition to being effective in the treatment of hypersensitivity, so it has a range of indications for use in practice.
Simple Application
Fig 1
Isolate
Application is simple, firstly clean the surfaces, ensure the teeth are isolated with a relatively dry working field by using a lip & cheek retractor such as Optragate® (Fig 1) The varnish is a liquid formula as opposed to a sticky gel, it is also homogenous which means the product does not need to be agitated as other brands do. The varnish is applied directly from the multidose tube onto the VivaBrush G that is provided with the varnish. Application from the multidiose tube is similar to applying bond to a microbrush (Fig 2), this ensures minimal waste and thus increases efficiency. I have found the tubes last significantly longer than other products.
Fig 2
Fig 3
Fig 4
The varnish can be dispensed directly onto a brush to minimise waste
Apply to a relatively dry working surface
Allow to dry for 60 seconds or gently airdry
The varnish is applied to the required area, as it’s a liquid, it flows into the high risk areas where plaque and debris is likely to adhere such as the pits and fissures and interdental areas (Fig 3). The varnish is gently air dried or left to dry for 60 seconds to allow the solvent to evaporate and the varnish to set on the teeth (Fig 4). Fluor Protector S’s active ingredient is Ammonium Fluoride which is an inorganic compound that crystallises as small colourless prisms. In solution the concentration is 7700ppm and on placement once the solvent evaporates the concentration increases 4 fold to just under 30000ppm of fluoride. As patients are increasing their awareness of the need for preventative measures, they are also increasingly demanding aesthetic results. Unfortunately I have found that fluoride varnishes historically have been visible after application and have a sticky unpleasant texture in the mouth. In my experience this can lead to poor patient compliance, especially in children. With Fluor Protector S, however once dry the varnish is set on the teeth forming a smooth colourless film which has shown to produce an increase in calcium fluoride layer and also structurally bound fluoride in comparison to other fluoride varnishes2 3. Following application one patient commented;
“I could feel that there is ‘something’ when I bit down on my back teeth, but there was no evidence of it on my teeth, no discolouration or raised areas. The fluoride varnish barely left any taste and there was no thick tacky feeling or noticeable residue that I have experienced before with different fluoride treatments. After leaving the surgery I had almost forgotten it had been applied.”
The patient is then advised to wait just 1 hour before eating and drinking, which is something my patients are pleased to hear, as previously with other varnishes they have been advised to wait for 4 hours before chewing food.
When do I use Fluor Protector S? I currently work in 2 private practices, each with a different demographic. One is a practice where we carry out a lot of adult orthodontics, this increases the risk of plaque accumulation where brackets are used and thus increases the risk of caries developing, so I use Fluor Protector S on many of our orthodontic patients as part of their preventative
Fig 5
treatment which also includes oral hygiene instruction. At the other practice where I work, I see a lot of older patients and some of which suffer with a dry mouth due to polypharmacy and even hypertrophy of the saliva glands due to cancer of the head and neck. I apply Fluor Protector S to these patient’s twice a year after they have had their check up and hygiene visit as a preventative measure because they are at a much higher risk of developing caries and in particular root caries. The department of health5 recommend twice yearly applications of fluoride varnish for all children and twice or more yearly for all high risk children. With adults it is recommended to apply fluoride varnish twice a year if the patient is considered at high risk. Fluor Protector S also works really well on areas of hypersensitivity, so I also use it for this reason too.
Diagram of evidence based practice
Evidence Based Practice Evidence based practice is a movement that emerged in healthcare in the 1990’s and was first introduced to the dental world in 1994 by the evidence based medicine working group4 Clinicians are taught to practise evidence based dentistry and act in the best interests of their patients, however evidence based dentistry is not just about the evidence itself it is also about assessing the patient’s wants and preferences and using your clinical judgement. (Fig 5) Therefore, applying a coloured sticky varnish to a patients tooth and advising incorrect postoperative advice is unlikely to be what the patient wants and is also unlikely to be effective. I use Fluor Protector S because I know it is flowing into the high risk areas and has an increased fluoridation effect with aesthetics and comfort that the patient will appreciate as well as realistic post-operative instructions to ensure its effectiveness.
Structurally bound fluoride one hour after treatment with fluoride varnishes. The fluoridating effect of the individual fluoride varnishes differs: Fluor Protector S achieved the highest fluoridation. The choice of competitor products related to their importance in the market.
1) Marinho VCC, Worthington HV, Walsh T, Clarkson JE. (2013), Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. 2) Ivoclar Vivadent R&D, (2013) Superficial, alkali-soluble fluoride one hour after treatment with fluoride varnishes. Schaan. 3) Ivoclar Vivadent R&D, 2013. Structurally bound fluoride ne hour after treatment with fluoride varnishes. Schaan. 4) Richards, D., Clarkson, J., Matthews, D., Niederman, R. (2008) Evidence-based Dentistry: Managing Information for Better Practice. London: Quintessence Publishing Co. Ltd. 5) Department of Health, (2014) Delivering Better Oral Health: An evidence based toolkit for prevention. Department of Health, London.
Melanie Joyce is a Dental Therapist working within Private Practices, she runs her own CPD training company dedicated to dental hygienists and therapists and is the Professional Services Clinical Specialist at Ivoclar Vivadent. Melanie has over 10 years’ experience in total as a DCP. She has treated patients in busy NHS/Private dental practices, teaching hospital and community settings working with experienced clinicians. In addition to her primary dental qualifications she also holds qualifications in management and teaching and is currently studying toward an MSc in Advanced Professional Dental Practice at the University of Kent. Over her career so far Melanie has been active in the dental industry, doing voluntary work, teaching DCP’s writing a number of educational and clinical articles for journals, being on the council for the BADN and the BADT and in 2013 she was awarded the accolade of Dental Therapist of the year at Dental Awards.
Melanie Joyce, Alexandra Road Dental Practice, 14 Alexandra Road, Leeds, LS18 4HD E-mail: melanie.joyce@ivoclarvivadent.com
Fluoride Application & Plaque Indices with Melanie Joyce
Confidence with Composites Applied Technology and Techniques
Objectives: Chris McConnell how fluoride • withUnderstand works
This hands-on course is to provide Dental Nurses, Therapists & Hygienists with the structured programme, this course will provide hands-on training, focusing• on how to achieve knowledge and skills toAsbea able to advise patients on fluoride use,comprehensive apply fluoride varnish Explain the difference optimum results using highly efficient equipment. Guiding you through the science behind Empress Direct, safely and carry out plaque scores correctly. betweenour topical and systemic experienced tutors will provide you with knowledge you need to combine this innovative composite with adhesives such fluoride as the easy to use single component ExciTE F. On this one day course you will gain in depth knowledge of fluoride, its mode of action, • Discuss health and safety VENUE methods of delivery, its This safety and thewith care your patients. course aimsits to place provide within participants theof knowledge and understanding to ICDE UK, issues related to fluoride confidently apply techniques learnt in conjunction with advanced materials to promote
Compass Building, • Apply fluoride varnish safely Feldspar Close, Enderby, Leicester, LE19 4SD • Give post treatment advice
andskills function You will then attain theaesthetics practical to in beclinical abledentistry. to apply fluoride varnish safely and give post treatment advice. Additionally you will learn the theory behind plaque scoring and Objectives: the practical skills to correctly carry out a plaque score. •
Clarify the factors that influence success and failure of composite restorations
DATE: 24th July• 2015 // 23rd October 2015 Be familiar with how the structure of dental tissues can influence the success and failure of composite restorations
•
Recognise how techniques need to be adapted to
maximise the success of composite restorations VENUE: Ivoclar Vivadent, Compass Building • Observe demonstrations of how materials and Feldspar Close, Leicester, LE19 4SD
fluoride application DATE: following 16th Jan 2015 TIME: 9.30am 5.00pm • List the different types of plaque indices available th DATE: 17 Apr 2015
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+vat 5 9 1 £
techniques can be used to optimise composite for aesthetics and function
TIME: - 5.00pm • 9.30am Carry out a plaque free score using Plaque Test disclosing th DATE: 17 July 2015 solution TIME: 9.30am - 5.00pm
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DATE: 17th Oct 2015 TIME: 9.30am - 5.00pm
Products Mentioned
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Natural-looking tooth moulds for sophisticated needs Fluor Protector S
OptraGate ®
the fluoride varnish suitable for all patients The innovation continues Shape – Extended selection of lower anterior moulds Shade – Now available in 20 lifelike tooth shades The alternative fluoride varnish that doesn't Strength – For universal use • Goes twice as far as other varnishes • Colophony and latex free • Indicated for caries prevention • No prescription needed
www.ivoclarvivadent.co.uk Ivoclar Vivadent Limited
Ground Floor Compass Building | Feldspar Close | Warrens Business Park | Enderby | Leicester LE19 4SE | United Kingdom | Tel. +44 116 284 78 80 | Fax +44 116 284 78 81
require a prescription
For more information on products used on this course please speak to your local Product Specialist.