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Open Collection of Student Writing (OCSW)

Managing Dentin Hypersensitivity With Fluoride Varnish

Dentin hypersensitivity is a common problem encountered in the everyday clinical dental practice. Dentin hypersensitivity can be defined as a painful tooth condition that often causes discomfort and stress in a large number of patients seen.  This discomfort is described as short, sharp pain that is usually caused by fluids within exposed dentinal tubules being disturbed by various triggers in the oral cavity such as; thermal, chemical, osmotic, or tactile (Kopycka-Kedzierawski, 2017). Dentin hypersensitivity be localized or generalized through the individuals mouth, but generally there is higher incidence with maxillary premolars and molars. The five percent varnish is a type of fluoride that offers higher fluoride uptake and easy application as compared to other fluorides, which is why it is highly recognized and a valid treatment for dentin desensitization in adults. Fluoride varnishes increase the efficiency of fluoride when in contact with the tooth surface, and allows for a slow and continuous release of fluoride. Varnishes consist of natural resin-based vehicles for fluoride, and are highly adhesive to the tooth structure (Veridiana Camilotti, 2012). The varnish works by covering even moist teeth with a coating of film for several hours which occludes the openings of the dentin tubules.

The generic name for a fluoride varnish is simply sodium fluoride oral. There is numerous name brand of this widely used dental material. Colgate PreviDent Varnish is one such brand of fluoride that has an indication for the treatment of dentin hypersensitivity. It has a chemical composition of Ethanol, Methyl Hydrogenated Rosinate, and the active ingredient of five percent Sodium Fluoride. The sodium fluoride varnishes are approved as a Class II Medical Devices (FDA 510k compliance), as a desensitizer and cavity liner and is used “off-label” for dental caries prevention. Located in the Material Safety Data Sheet is where the physical and chemical properties can be found. Its appearance is a white liquid, and has an odor of either grape bubble gum, mint or raspberry. There is no data available for the pH, viscosity, or the boiling point. The flash point is twenty-seven degrees Celsius, and it is insoluble with water. This material should be administered by the dental professional according to the instructions to avoid acute or chronic side effects. (Colgate Oral Pharmacuticals, 2014).  The directions for use are to wash and dry tooth surface and make sure that it is mixed well prior to application. Apply product with supplied brush in the conventional manner. Thin excess varnish on the tooth’s surface until the varnish surface is dry. PreviDent hardens on contact with saliva so the patient may leave immediately after application of the product. It is recommended to instruct the patient to eat only soft foods for approximately two hours after treatment. Do not use this product with other topical fluoride treatments the same day and instruct patient to refrain from using oral fluoride supplements for four days after treatment. By doing this, it can help prevent any toxicity of fluoride as it may be harmful if swallowed in large quantities. According to Colgate Oral Pharmaceuticals (2014) contraindications are to not use on patients with ulcerative gingivitis, stomatitis, or a known sensitivity to colophony (pine tree rosin).  The OSHA and safety issues reported are small, but there are some potential health effects. An overexposure may cause respiratory tract irritation with inhalation. This varnish also may cause severe eye irritation on direct contact, or skin irritation upon prolonged or repeated contact. Some warnings and precautions the dental professional may also consider are noted as well. They should discontinue use if an allergic reaction, such as dermatitis, or a rash develops and have patient consult their primary care physician. In rare instances, edematous swelling has been reported after extensive fluoride varnish treatment and dyspnea in asthmatic children. Some patients have experienced nausea after application. If nausea persists, the company recommends thoroughly brushing to remove the varnish film (Colgate Oral Pharmacuticals, 2014).

According to the professional interview with a previous co-worker J M RDH, her experience with fluoride varnish and tooth sensitivity has been a positive one. This is what she recommendations for individuals seen in the office with mild to moderate sensitivity. In more severe cases, the dentist, her, and the patient may opt for a more invasive approach. She states that sometimes it is difficult to convince patients to pay out of pocket, and not know the exact outcome. However, her method of encouraging them, explaining what it does, and how small of cost they will incur versus the relief it may give has helps her be more productive in providing exceptional care. Currently the lead assistant in the office she practices in orders the Vanish five percent sodium fluoride white varnish with TCP by the company 3M ESPE.  It is important to mention that J does not have a preference of a brand though. Her only concern is that the fluoride varnish contains the five percent sodium fluoride as the active ingredient to be the most effective. She believes that all clinician should remain flexible in regards to the products that they use, as some may work better or worse depending on the individual being treated.

While there are many products on the market to help ease the discomfort of dentin hypersensitivity, it is important for a hygienist to be mindful of the many factors that influence the selection of the product. These factors include long-term effectiveness, cost for the patient, the characteristic of the product being applied, as well as how it may affect the restorations and tissue. This information is a good and bad situation for the dental professional. Good in that there are many products such as Colgate PreviDent Varnish to choose from on the market that have many studies that have also been proven to be effective. The bad aspect is that it may take trial and error, research, and time to determine what will work for each individual patient. There is new research coming out recently that indicates the use of a laser as well as the fluoride varnish application which states that it may be the best combination to help patients with dentin hypersensitivity. This could possibly be the most accurate way to see results quickly and efficiently. Until this research is more concrete however, it is recommended the clinician continue using a varnish for his or her patient care with focus on its cost-effective approach, the ease at which it can be applied, and on the needs of each case that comes to their attention.

Works Cited

Colgate Oral Pharmacuticals, I. (2014, 06). PreviDent Varnish. Material Safety Data Sheet. New York, NY, USA.

Kopycka-Kedzierawski. (2017). Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiaion of a clinical study on this topic. BMC Oral Health, 17:41.

Veridiana Camilotti, J. Z. (2012). Desensitizing treatments for dentin hypersensitivity: a randomized, split-mouth clinical trial. Restrative Dentistry, 263-8.

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