Varnishes and Sealants

Erin Haley-Hitz, RDH, BSDH, MS, FADHA, MAADH, is immediate past president of the American Dental Hygienists’ Association (ADHA) and chair of the ADHA Foundation. She is co-founder of Pearly White Prevention, www.pearlywhiteprevention.com.

Inside Dental Hygiene (IDH): What criteria do you use to determine whether a patient’s teeth would benefit from a sealant or fluoride varnish?

Erin Haley-Hitz, RDH, BSDH, MS, FADHA, MAADH: It’s essential to assess each patient’s caries risk based on their medical and dental history, dietary habits, oral hygiene practices, and clinical presentation. For sealants, I could focus solely on newly erupted permanent molars, particularly those with deep pits and fissures that are difficult to clean, as well as any posterior teeth with early non-cavitated lesions. However, it’s important to realize that even adults can benefit from sealants, and partially erupted molars can also benefit from interventional techniques and materials. Fluoride varnish is typically recommended for patients at moderate to high risk for caries, including children, older adults with exposed root surfaces, individuals with xerostomia or orthodontic appliances, and those with dentinal hypersensitivity. I also consider social determinants of health for each patient that may impact access to regular dental care and their current oral health status.

IDH: Can you share any best practices or time-saving techniques for applying sealants or varnishes effectively?

Haley-Hitz: For me, preparation and preplanning are keys to success. For traditional resin-based sealants, I employ isolation methods, such as cotton rolls or dry angles, and utilize a well-trained dental assistant to ensure efficient placement. I have found that having ready-made packets with isolation items, and a curing light already in the hygiene room, can make this easier to complete in a preventive appointment. I rely on a clear, step-by-step protocol: polish with pumice, etch, rinse, dry, apply sealant, cure, and evaluate. Ultimately, fluoride varnish is the last item placed. I apply it as the final step of a preventive visit, often after polishing and scaling, and I also use varnish to help control sensitivity when patients indicate they need this benefit from fluoride varnish. Having varnish packets and sealant packets prepped and within reach saves time and can facilitate the same-day application of sealants during preventive appointments.

IDH: What features or qualities do you look for when selecting a varnish or sealant product? Do you prefer resin-based or glass ionomer products?

Haley-Hitz: I look for products that are easy to apply, have strong adhesion, and demonstrate proven clinical effectiveness. I have found that having multiple sealant materials to choose from can be beneficial. Sealants are meant to flow into pits and fissures. I prefer an unfilled sealant material, such as 3M Clinpro Sealant. I find this works well as long as isolation is achievable. If placed successfully, it has sustained fluoride release to provide a fluoride-rich enamel layer if the sealant is lost. The other material I have on hand is GC Fuji Triage Glass ionomer. This makes it easier to place on patients when isolation is not possible; instead of risking a poorly placed resin sealant, I choose a glass ionomer. Acid exposure is likely in the current nutritional environment, where many children and adults are exposed to acidic foods and beverages. A poorly placed resin in an acidic environment could result in caries under or around the resin sealant. Selecting the right product is key to long-term success, especially when the goal is to minimize the risk of decay.

It’s essential to note that there are numerous alternatives to sealants, and they all can effectively protect newly erupted or at-risk tooth structures. Silver fluorides, extended light-cured varnishes, such as Solventum Vanish XT, and Curodont Repair, are all options for high-risk surfaces. For sealants, I weigh the pros and cons of resin-based versus glass ionomer sealants, as well as the pros and cons of whether other products are more suitable. Each individual’s situation must be evaluated to determine the dental material that is right for their teeth and their current oral health. Not everyone benefits from a resin sealant or a glass ionomer material. Resin-based sealants are my go-to when moisture control is ideal, as they offer excellent retention. However, I use glass ionomer sealants in situations where isolation is more difficult or when there’s a need for fluoride release, such as with high-caries-risk patients or partially erupted molars. I also determine if silver diamine fluoride (SDF), nano fluorides, or Curodont are more appropriate.

For varnish, flavor, viscosity, and fluoride concentration matter—especially with pediatric patients. Engaging the patient with simple, age-appropriate education during application also helps with cooperation, especially in pediatric settings. In my opinion, the most revolutionary fluoride varnish on the market is the Clinpro Varnish by Solventum, which features a lack of sticky resin, faster uptake into the tooth structure, and an allergy-free formula. This is my new go-to fluoride product.

IDH: Has your use of fluoride varnish changed in light of concerns or changes in public water fluoridation?

Haley-Hitz: My use and recommendations for fluoride varnish and fluoride supplementation have not changed. I’ve become more vigilant in educating patients on fluoride, efficacy, and the safety of use. Many patients have questions about fluoride and are unsure what to believe. Therefore, I return to the basics of naturally occurring fluoride minerals and the efficacy of fluoride in water supplies, toothpastes, and when supplementation may be necessary. This is an ideal opportunity to also educate patients on the social determinants used to assess patient risk. In areas where community water fluoridation has been reduced or discontinued, I place an even greater emphasis on fluoride varnish applications, especially during routine visits. I also ensure that patients and caregivers understand the role topical fluoride plays in remineralization and caries prevention. It’s become a crucial part of patient education and risk management protocols, especially for those in underserved or rural communities.

Duraflor® Ultra™

This 5% sodium fluoride varnish works fast and tastes great. Its smooth, non-clumping formula ensures easy application throughout treatment. Dries clear without flaking and comes in four xylitol-sweetened flavors patients enjoy—plus allergen-free peace of mind.
Medicom.com • 800-361-2862

ACCLEAN® Pit and Fissure Sealant System

A hydrophilic, wet-bond material that bonds well in a moist environment. This light-cured, resin-based sealant contains fluoride, and its white opaque color improves visualization during application and at recall appointments. A direct-delivery syringe and low viscosity make it quick and easy to apply.
henryscheindental.com/accleanpreventives • 800-372-4346