Fluoride Varnish: What Parents Need to Know

Healthy gums and teeth are important to your child's overall health. This is why your child's doctor will talk with you about good dental habits even before your child's first tooth appears.
Once your child has a tooth, your doctor may recommend that your child receive fluoride varnish treatments in the pediatrician's office to help prevent tooth decay. This can be done 2 to 4 times per year. The number of treatments depends on how likely it is that your child may get a cavity.
Pediatricians are trained to apply fluoride varnish because many young children do not see or have access to a dentist until they are older. If your child is seeing a dentist at a young age, as recommended by the American Academy of Pediatrics, fluoride varnish may be applied in a dental office instead.
Read on for more information from the American Academy of Pediatrics about fluoride varnish.

What is Fluoride Varnish?

Fluoride varnish is a dental treatment that can help prevent tooth decay, slow it down, or stop it from getting worse. Fluoride varnish is made with fluoride, a mineral that can strengthen tooth enamel (outer coating on teeth).
Keep in mind that fluoride varnish treatments cannot completely prevent cavities. Fluoride varnish treatments can best help prevent decay when a child is also brushing using the right amount of toothpaste with fluoride, flossing regularly, getting regular dental care, and eating a healthy diet.

Is Fluoride Varnish Safe?

Fluoride varnish is safe and used by dentists and doctors all over the world to help prevent tooth decay in children. Only a small amount is used, and hardly any fluoride is swallowed. It is quickly applied and hardens. Then it is brushed off after 4 to 12 hours.
Some brands of fluoride varnish make teeth look yellow. Other brands make teeth look dull. However, the color of your child's teeth will return to normal after the fluoride varnish is brushed off. Most children like the taste.

How is Fluoride Varnish Put on the Teeth?

Fluoride varnish is painted on the top and sides of each tooth with a small brush. It is sticky but hardens once it comes in contact with saliva. Your child may feel the hardened varnish with his tongue but will not be able to lick the varnish off.
It does not hurt when the varnish is applied. However, young children may still cry before or during the procedure. Fortunately, brushing on the varnish takes only a few minutes. Also, applying the varnish may be easier when a child is crying because his mouth will be slightly open.
You may be asked to hold your child in your lap while you are placed knee-to-knee with the person applying the varnish.

How Do I Care for My Child's Teeth After Fluoride Varnish is Applied?

Here are general guidelines on how to care for your child's teeth after fluoride varnish is applied. Check with your child's doctor for any other special instructions. 

• Your child can eat and drink right after the fluoride varnish is applied. But only give your child soft foods and cold or warm (not hot) foods or liquids.
• Do not brush or floss teeth for at least 4 to 6 hours. Your child's doctor may tell you to wait until the next morning to brush or floss. Remind your child to spit when rinsing, if he knows how to spit.

Remember:

Steps to good dental health include: 

• Regular care by a dentist trained to treat young children
• Getting enough fluoride
• Regular brushing and flossing
• Eating right

The American Academy of Pediatrics recommends that all infants receive oral health risk assessments by 6 months of age. Infants at higher risk of early dental caries should be referred to a dentist as early as 6 months of age and no later than 6 months after the first tooth erupts or 12 months of age (whichever comes first) to establish their dental home. Every child should have a dental home established by 12 months of age.

FAQ: Fluoride and Children

Fluoride from drinking water and other sources such as toothpaste can strengthen tooth enamel and help prevent tooth decay. Below is a list of questions that parents frequently ask about fluoride and how it can help their children.

Q: Why do children need fluoride?

A: Fluoride is an important mineral for all children. Bacteria in the mouth combine with sugars and produce acid that can harm tooth enamel and damage teeth. Fluoride protects teeth from acid damage and helps reverse early signs of decay. Make sure your children are drinking plenty of water and brushing with toothpaste that has fluoride in it.

Q: Is fluoridated water safe for my children?

A: Yes. The American Academy of Pediatrics (AAP), along with the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay. 

Q: Should I mix infant formula with fluoridated water?

A: According to the ADA, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis (see below for more information on this condition). However, if you have concerns about this, talk with your pediatrician or dentist.

Q: What if I prefer not to use fluoridated water for infant formula?

A: If you prefer not to use fluoridated water with formula, you can:

• Breastfeed your baby.
• Use bottled or purified water that has no fluoride with the formula.
• Use ready-to-feed formula that does not need water to be added.

Q: What if we live in a community where the water is not fluoridated? What can we do?

A: Check with your local water utility agency to find out if your water has fluoride in it. If it doesn't, ask your pediatrician or dentist if your child is at HIGH risk for dental caries (also known as tooth decay or a cavity). He or she may recommend you buy fluoridated water or give you a prescription for fluoride drops or tablets for your child.

Q: How else can my child get fluoride?

A: There are many sources of fluoride. Fluoridated water and toothpaste are the most common. It is also found in many foods and beverages. So making sure your child eats a balanced diet with plenty of calcium and vitamin D is a great way to keep teeth healthy. Your dentist or pediatrician may also recommend a topical fluoride treatment during well child or dental visits at various stages of your child's development.

Q: When should my child start using fluoride toothpaste?

A: The AAP and the ADA recommend using a "smear" of toothpaste on children once the first tooth appears and until your child is 3. Once your child has turned 3, a pea-sized amount can be used.

Q: What is dental fluorosis and will fluoridated water mixed with infant formula increase the risk?

A: Although using fluoridated water to prepare infant formula might increase the risk of dental fluorosis, most cases are mild.
Fluorosis usually appears as very faint white streaks on the teeth. Often it is only noticeable by a dental expert during an exam. Mild fluorosis is not painful and does not affect the function or health of the teeth.
Once your child's adult teeth come in (usually around age 8), the risk of developing fluorosis is over.

Diet Tips to Prevent Dental Problems

A balanced diet, with plenty of calcium and vitamin D to increase calcium absorption, should provide all the nutrients necessary to build strong teeth and keep gums and mouth tissues healthy. Young people can get adequate calcium from 3 or 4 daily servings of dairy foods, as well as from many other sources (eg, calcium-processed tofu, calcium-fortified orange juice, green vegetables such as broccoli).

The Benefits of Fluoride

Fluoride reduces dental decay by making the enamel harder, reducing the ability of bacteria to produce acid that erodes enamel, and by replacing minerals in the teeth after they have been lost. In areas where the natural fluoride content of the water is low and water supplies are not fluoridated, or if your household uses bottled or reverse osmosis filtered water, pediatricians and dentists may advise fluoride supplements, fluoride toothpaste, or fluoride treatments to strengthen children’s tooth enamel against decay. Most bottled water does not contain adequate amounts of fluoride. Home water treatment systems like reverse osmosis and distillation units remove much of the fluoride from tap water. However, carbon or charcoal water filtration systems generally do not remove substantial amounts of fluoride.

Too Much Fluoride & Fluorosis

One of the complications of too much fluoride is dental fluorosis. Fluorosis ranges from minor white lines that run across the teeth to a chalky appearance of the teeth with brown staining. Fluorosis can be caused by prescribing fluoride supplements in communities with fluoridated water, or young children swallowing fluoridated toothpaste. To avoid this latter problem, children should use no more than a smear of fluoridated toothpaste before age 2, if your child’s pediatrician or dentist suggests using fluoridated toothpaste. For children older than age 2, use only a small pea-sized amount of fluoridated toothpaste. Also, your pediatrician or pediatric dentist will know the fluoride content of your local water and can advise you if a supplement is necessary or excessive.

Damaging Sugars

All sugars promote the growth of mouth bacteria that produce acid and cause tooth decay. Unrefined sugars such as honey, maple syrup, and molasses are just as damaging as refined white sugar in this respect. The worst offenders are the sugars in sticky foods that cling to teeth, such as dried fruit leathers and candies. Sodas and sweetened juice drinks leave the teeth awash in sugar. Cereals and other starchy foods, such as popcorn, leave a residue that bacteria rapidly convert to sugar.