Operative Dentistry

Preventive Agents

ICCMS guidance on use of preventive agents to managing caries risk 

preventive agents



Vanish (3M ESPE) fluoride varnish 3M ESPE

  • Description: 1mL contains 50mg sodium fluoride, equivalent to 22.6 mg fluorine (22,000 ppm), in an alcohol-based solution of modified rosins. Sweetened with xylitol.
  • Instructions for use: On ‘toothbrush’ clean, relatively dry teeth apply thoroughly mixed varnish with supplied brush. Patient should leave varnish in contact with teeth for a minimum of four hours by avoiding, hard food, tooth brushing and products containing alcohol.






Chlorhexidine VARNISH

Cervitec Plus (Ivoclar Vivadent) chlorhexidine varnish

  • Description: 1% chlorhexidine:1% thymol in ethanol (90%) and co-polymers (85) used for primarily for root caries prevention in adults.
  • Instructions for use: On clean, dry teeth apply thin coat of varnish with applicator or brush, use floss to apply in proximal areas, remove cotton after 30 seconds, ask patient to not rinse their mouth and not to eat or drink for 1 hour.



Silver Diamine Fluoride (SDF)

Advantage Silver Arrest™ (Elevate Oral Care)  

  • 38% SDF, purified water
  • Shelf life: 3 years unopened; Do not refrigerate. Avoid freezing and extreme heat
  • Maximum dose: 25 uL (1 drop) per 10kg of body weight per treatment visit
  • SDF Contraindication: Silver allergy
  • SDF Relative Contraindications: Ulcerative gingivitis, Stomatitissilver diamine fluoride


  • High caries risk/rate (eg. Xerostomia or Severe Early Childhood Caries)
  • Treatment challenged by behavioral or medical management
  • Patients with carious lesions that may not all be treated in one visit
  • Difficult to treat dental carious lesions
  • Patients without access to dental care


  • Decayed dentin will darken as the caries lesions arrest; most will be dark brown or black
  • SDF can stain the skin, which will clear in 2-3 weeks without treatment
  • SDF can permanently stain operatory surfaces and clothes
  • A control restoration (e.g. GIC via ART/M-ITR) may be considered after SDF treatment
  • Re-application is usually recommended, biannually until the cavity is restored or arrested or the tooth exfoliates


1. Plastic-lined cover for counter, plastic-lined bib for patient.

2. Standard Personal Protective Equipment (PPE) for provider and patient.

3. 1 drop of SDF into the deep end of a plastic dappen dish.

4. Remove bulk saliva with saliva ejector.

5. Isolate tongue and cheek from affected teeth with “2x2” gauze or cotton rolls.

6. Apply petroleum jelly to gingiva near affected areas with a cotton applicator.

7. Dry (desiccate) affected tooth surfaces with triple syringe, or if not feasible dry with cotton.

8. Bend microsponge, immerse into SDF, remove excess on side of dappen dish.

9. Apply directly onto the affected tooth surface(s) with microsponge.

10. Allow SDF to absorb for up to 1 minute if reasonable, then remove excess with gauze or cotton roll.

11. Rinse with water.

12. Place gloves, cotton, and microbrushes into plastic waste bags.

Dental Sealant

UltraSeal XT® plus (Ultradent) 

Manufacturer’s Description: UltraSeal XT plus is a light-cured, radiopaque, fluoride-releasing composite sealant. 58% filled resin. The spiral brush action of the tip causes shear thinning of the filled, thixotropic UltraSeal XT plus, reducing its viscosity as it is placed. The resin firms when shear thinning ceases and placement is complete, preventing it from running before it can be light cured.

Instructions for use (adapted from Pedo Dept Protocol):

  1. The teeth to be sealed must be fully erupted, clean, and free of plaque or food debris. Use either a dry prophy brush alone or with some fluoride free pumice. Rinse the tooth and confirm it is not carious
  3. Isolate the tooth and etch for 15-30 seconds. Rinse, re-isolate if necessary and dry. The tooth must be totally dry with a frosty appearance. If it is wet at all, the sealant will not be retained. Poorly placed sealants are worse than no sealants at all.
  4. Apply sealant using supplied Inspiral Brush tip from Ultradent. The sealant must not be so thick that it results in intolerable occlusion, but it must cover all fissures. Make sure there are no air bubbles.
  5. Light cure all surfaces for at least 20 seconds.
  6. Check with an explorer. If your sealant pops off with an explorer check, it was doomed to fail. If is better to discover it now and redo it immediately.ultraseal