Fluoride Varnish application procedure

Pre-application instructions

These instructions could be written and/or verbal:

  • advise patient on the purpose, benefits, process, possible side effects and answer any queries
  • recommend the patient eats and drinks normally before attending
  • advise that fluoride supplements should not be taken for two days after the fluoride application. After that, continue as directed
  • advise that the patients’ teeth may appear discoloured temporarily after fluoride varnish application and not to brush until the following morning.

Duraphat® fluoride varnish application can be undertaken:

In Practice: by a dentist, under the prescription of a dentist by a dental therapist, hygienist or Childsmile trained Extended Duty Dental Nurse (EDDN) and is currently registered with the General Dental Council.

In school/nursery: by a Childsmile-trained EDDN in participating establishments without an individual prescription as long as they are working under a Childsmile protocol for supply and application of treatment.

The dose of fluoride varnish for children is:

  • 0.25ml per child in Nursery and Primary 1
  • 0.4ml per child in Primary 2 and above

Consent and medical history:

  • EDDNs should ensure they are familiar with the ‘Childsmile protocol for the supply and application of Duraphat® varnish to children aged 3 years and over’, and have signed it
  • check that you have valid consent for the application
  • in practice setting - check that you have a valid prescription for the fluoride varnish application. Check any medical history with the parent, specifically check for allergy to sticking plaster or severe allergy or asthma that has required hospitalisation
  • if there are changes to the medical history or concern regarding consent refer back to dentist.

Preparation:

  • place your equipment so that it is accessible for yourself but away from the child
  • dispense 0.25ml or 0.4ml Duraphat® and ensure that the remaining varnish remains inaccessible to the child
  • welcome each child and explain the procedure in simple terms
  • ensure you and the child are comfortable and the child is wearing safety glasses and bib
  • apply your own safety glasses, and follow local hand hygiene policies.

Risk assessment

The extra-oral assessment:

  • check the skin of the face and around the mouth for abnormalities (spots, inflammation, swelling etc)
  • check the lips for lesions/infections.

The intra-oral assessment:

  • check the inner cheeks and the insides of the lips
  • check the upper and lower surfaces of the tongue.

Children showing obvious signs of systemic illness (e.g. colds, flu) or any abnormality of the face, lips or soft tissues of the mouth should be excluded on the day from fluoride varnish application.

  • check the teeth and gums in a systematic order for signs of decay and/or infection.

If everything appears normal the fluoride varnish may be applied. If the child has signs of decay the fluoride varnish may be applied as it may help protect from further decay and it will acclimatise the child to dental treatment. However, fluoride varnish should not be applied to exposed pulps, in case it is uncomfortable.

In the Nursery/School setting - If the child has any abnormality of the lips or mouth, or has dental caries identified in the risk assessment, send appropriate letter to parents advising that their child should be seen by a dentist. If the child is in pain follow local procedures to ensure the child is seen as soon as possible.

The application procedure:

A systematic approach is more important than adopting a specific order or technique. However, the following represents one method, which could be followed:

  • if a child gets upset or protests during any part of the procedure, then the procedure should be abandoned
  • gently retract the right cheek with your finger or mirror and dry the upper right canine and molars with a cotton roll
  • place the cotton roll in the upper right buccal sulcus
  • holding the roll in place, apply a small amount of Fluoride Varnish to the buccal, palatal, approximal and occlusal surfaces of the molars
  • remove the cotton roll
  • retract the upper lip with a finger. Dry the incisor teeth with a cotton roll
  • apply varnish to the buccal, approximal and palatal surfaces of the canines and incisors
  • repeat for upper left
  • repeat process for whole lower arch
  • if there is insufficient varnish for full lower arch give priority to buccal, approximal and occlusal surfaces of molars on both sides of the mouth
  • ensure all equipment is removed from the mouth. Count four cotton rolls, one brush, gloves, and one mirror and place all disposable equipment in the clinical waste bag
  • complete patient record (on paper or electronically). In dental practice ensure relevant code is included on GP17 claim form or electronic equivalent. In nursery/school ensure the visit record is completed on the Health Informatics Centre (HIC) system
  • if any immediate allergic reaction, remove product by toothbrushing and rinsing and follow local protocol. Complete and submit a BNF yellow card as per local procedure.

Post application instructions:

  • advise the patient not to eat or drink for 30 minutes following the procedure.
  • advise to eat soft food for the rest of the day
  • advise that teeth should not be brushed that day but toothbrushing with fluoride toothpaste should resume the following morning
  • fluoride supplements should not be taken for two days after fluoride application. After that, continue as directed
  • advise that the patients’ teeth may appear discoloured temporarily
  • in the nursery/school setting - provide the fluoride varnish aftercare instructions leaflet.

The beanbag or chair must be wiped with a detergent wipe after each child. At the end of the session leave the application area clean and tidy.