Preventing Decalcification with a Fluoride Treatment

When decalcification occurs under brackets due to poor oral hygiene or other problems, the patient, parents, and referring dentist--not to mention the orthodontist--are all unhappy. Of course, we could elicit the cooperation of the general dentist in improving the patient's hygiene, but the patient and parents usually raise the excuse of inadequate time or money for more dental checkups.

I have recently begun using a 5% sodium fluoride varnish^* on bonded teeth, especially in the maxillary anterior segment, with patients who seem to brush inadequately. The procedure can be easily handled by a chairside assistant in a few minutes, as follows:

1. Brush the teeth, retract the lips, and dry the tooth surfaces (Fig. A).

2. Paint the fluoride varnish on the teeth with a small brush, and let it dry for a couple of minutes.

3. Instruct the patient to leave the varnish on without rinsing, eating, or drinking for two hours.

This technique keeps decalcification to a minimum without disrupting the office routine.