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Caries risk assessments: Should they lead to more fluoride varnish applications?

May 26, 2017
Data reveal the frequency of fluoride varnish applications, but the real story is a call for action for caries risk assessments.

Over the last six weeks, we have taken a look at a lot of data that can impact hygienists and their practices. We have looked at everything from prophys per month to scaling and root planing (SRP) statistics. In the majority of these articles, there have been data trends that have gone up and down. In this article, however, we’re going to examine one set of data that has done nothing but climb over the last seven years.

Let’s examine how many times in a month fluoride varnish is applied to a patient in the average dental practice. For the purposes of this article, the patient could be a child or adult. To find these numbers, we took data from Sikka Software over the last seven years. The data we are using for this comparison has been collected by Sikka Software from more than 12,500 dental practices from around the country.

So how many times per month does the average hygienist apply varnish? Here are what the numbers told us:

  • 2010 – 10.5
  • 2011 – 11.33
  • 2012 – 11.5
  • 2013 – 11.75
  • 2014 – 11.83
  • 2015 – 13.5
  • 2016 – 14.25

Now, let’s look at how many patients are seen each day on average by a hygienist:

  • 2010 – 20.17
  • 2011 – 20.17
  • 2012 – 20.25
  • 2013 – 20.5
  • 2014 – 20.58
  • 2015 – 21.25
  • 2016 – 21.33

My guess is that you’re sitting there thinking to yourself, “There’s no way I could see that many patients in a day.” You’re right; no hygienist could. That’s because Sikka data takes into account the average of group practices and solo practices, which can bump these numbers up. The data doesn’t only look at hygienists but the hygiene portion of the practice.

Does it also bump up the number for varnish applications? Perhaps, but let’s break those numbers down even further.

If the average dental practice was open four days a week in 2016, that means that roughly 85 patients were seen by the hygiene department. Multiply that by four weeks in the month and that is 340 patients per month. If we take the varnish numbers of 14.25 applications per month, that is 23.9 percent of patients who receive varnish in a given month.

So how can the topic of fluoride varnish come up in a conversation with patients without sounding like a salesperson? Heidi Arndt, RDH, BSDH, the CEO and founder of Enhanced Hygiene, believes that a caries risk assessment is key to that conversation.

“The caries risk assessment (CRA) is a valuable part of the dental hygiene appointment, and helps providers identify the patients risk for developing caries,” Arndt said. “Fluoride is our main weapon against caries and is recommended for all moderate and high risk patients.

“From a practice management standpoint, by implementing a strong caries risk assessment (CRA) into your practice you can add instant revenue into your practice. We have seen our clients increase hygiene revenue by over 50% in one month by implementing a strong CRA program.”

As always, education is a key part of any conversation with a patient. Fluoride is often an out-of-pocket expense so educating the patient on its value comes with perhaps a tougher way to reach a desired end result. However, tools such as CRA can help the patient better understand what might be needed to achieve optimal oral health.

An advocate of today’s dental assistant, Kevin Henry speaks to dental audiences across the nation on topics that empower dental assistants, helping them recognize the leadership role they hold in the practice. He is the cofounder of, a community designed to enlighten, empower, and educate dental assistants.