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Posted: March 27, 2016

Early Childhood Caries and Fluoride Varnish

By Rae McFarlane

Dental decay found in children under six years of age is classified under the term, Early Childhood Caries (ECC).

The definition includes any deciduous (baby or primary) teeth that has or had one or more decayed, missing, or filled tooth surfaces. The prevalence of ECC in preschool children is six to eight per cent (1) but in some disadvantaged Indigenous communities, the prevalence of decay can be over 90%. (2) If cases of ECC become advanced, it becomes necessary to restore the teeth under general anesthesia. Did you know this is the most common surgical procedure performed in preschool children at most paediatric Canadian hospitals? (3)

ECC is a chronic disease influenced by multiple factors such as diet, bacteria, the host themselves and by the social determinants of health. Inappropriate infant feeding practices (eg., frequent, prolonged bottle-feeding and excessive juice consumption) are an important factor in ECC development – high risk activity for primary teeth decay. (4) Caries is preventable and controllable through the combined measures of community (e.g., dental program in our health authorities), professional (e.g., dental and dental hygiene practices) and individual measures (e.g., what happens in the home), such as promoting proper feeding, improving diet, water fluoridation, increasing the use of dental sealants and topical fluorides by primary health care providers, and using fluoride toothpaste. This brings me to the topic of professional applied Fluoride Varnish.

Fluoride varnish is a viscous resin base that sets on contact with the tooth and with moisture; perfect for the wet conditions of the mouth. It contains five per cent sodium fluoride or 22,600 ppm fluoride.

Not only does the fluoride form an ionic bond to the enamel to form a newer, more resistant surface to tooth decay called fluorapatite, but it has a bacteriostatic effect on dental plaque (or biofilm as it is presently known). For high risk clients, it is applied every three or four months. Those who are low risk, every six months.

The fluoride varnish is easily applied to the teeth of infants and toddlers in the “knee-to-knee” position. The parent and dental hygienist or assistant sit opposite with the child’s head on the dental clinician’s lap and the legs straddling the parent’s waist. The parent can hold the child’s hands while the clinician applies the varnish to the teeth using a small brush. The varnish is palatable to children.

Although sticky, it could be described as tasty with all the available flavours such as caramel, cherry, mint, bubble gum to name a few. After application, the fluoride varnish leaves the teeth feeling waxy with a white streaky appearance. For the next three to six hours we instruct the parent to not brush or floss the teeth and choose softer foods that will not rub it off too early. Rinsing and drinking after it application is perfectly acceptable. A far cry from the days of old with the four-minute trays and fluoride gels!

Here in the province of British Columbia, the health authorities offer a program called, “Lift the Lip.” This is a training program for parents with children one to three years of age. It includes:

– Learning about Early Childhood Caries.

– Learning a technique for checking the child’s teeth where the parent is taught how to lift the upper lip to obtain a clear view of the teeth and what the beginning stages of decay look like. We call these white spot lesions. These are whitish lines along the gum line on the teeth.

– Counseling on dental behaviours that may put the child at risk for decay.

– A screening to asses if the child would benefit from fluoride varnish applications.

It is from the Lift the Lip program that the child/parent is assessed for a referral to the fluoride varnish program. The fluoride varnish program is not meant to interfere with an established relationship with a dental office, but to offer a program to prevent tooth decay to those who choose it. If you would like to learn more about the “Lift the Lip” program or the fluoride program, please call the Cranbrook Health Centre Dental Program.


1. Locker D, Matear D; Community Health Services Research Unit, Faculty of Dentistry, University of Toronto. Oral disorders, systemic health, well-being and the quality of life: A summary of recent research evidence. (Available February 10 2016).

2. Schroth RJ, Harrison RL, Moffatt ME. Oral health of indigenous children and the influence of early childhood caries on childhood health and well-being. Pediatr Clin N Am 2009;56(6):1481-99.

3. Schroth RJ, Morey B. Providing timely dental treatment for young children under general anesthesia is a government priority. J Cam Dent Assoc 2007;73(3):241-3.

4. Nunn ME, Braunstein MS, Krall Kay EA, Dietrich T, Garcia RI Henshaw MM. Healthy eating index is an indicator of early childhood caries. JDR. 2009:88(4);361-366.

Rae McFarlane, BScD, MEd, RDH, is the Community Dental Hygienist Supervisor with Interior Health, East Kootenay Health Services

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