Fluoride varnishes have proven to be a safe and efficacious part of a cariesprevention program that includes caries diagnosis, risk assessment, and regular dental care. The ADA recently encouraged the Food and Drug Administration “to consider approving professionally applied fluoride varnish for reducing dental caries, based on the substantial amount of available data supporting the safety and effectiveness of this indication.”1
In previous years we have been able to select from a variety of varnishes (Table 1). A study was conducted to measure the fluoride concentration gradient in 10-mL tubes of fluoride varnish, based on resting position of the tube prior to use, ➊ to compare and contrast fluoride concentration gradients of Duraphat, Duraflor, and CavityShield; ➋ to compare this gradient to the ability to inhibit caries in an artificial caries environment; and ➌ to determine if quantitative light fluorescence (QLF) can detect differences in lesions developed when exposed to an artificial caries environment and fluoride varnish.
The results indicate that all three brands of fluoride varnish are able to remineralize incipient in vitro carious lesions, regardless of what part of the 10-mL tube the varnish comes from. However, a fluoride concentration gradient exists in tubes of Duraflor. The weight of the ions inside a tube of fluoride varnish vary, so when the fluoride varnish comes inside a reservoir that can be mixed, the ions will not separate.2
Another study concluded that fluoride content can vary between doses dispensed from the same tube. Uniformity also varies between different varnishes and affects the retention of fluoride in the varnish. Clinicians should be aware that the nonuniform appearance of fluoride varnish squeezed out of the tube could indicate separation of ingredients and result in the variation of fluoride content.3
Fluoride varnishes can be a good preventive measure for orthodontic patients. Patients who wear orthodontic bands have a higher incidence of tooth decay as well as decalcification at the gingival margin of the teeth. Fluoride varnish is a perfect adjunctive service for prevention of decay during orthodontic treatment when used every three months.
Many patients and practitioners object to fluoride varnishes because of the discoloration. In 2005, Omnii Oral Pharmaceuticals introduced the first clear fluoride varnish called Vanish. Vanish 5 percent NaF White Varnish combines the proven benefits of standard fluoride varnish with the new benefits of improved fluoride release; neutral color; great taste; and exceptional application, flow, and adhesion from a patented, innovative delivery system.
There is also a new 5 percent sodium fluoride product available through Omnii Oral Pharmaceuticals. It is visible upon application but blends onto the tooth surface and is not detectable following application. The product is available in a unit dose with a unique peel pouch design for patient asepsis and ease of delivery.
Clinical trials on Vanish provided excellent flow, application, and adhesion properties. The new solvent system allows the varnish to “creep” along and around tooth surfaces to spread into interproximal and occlusal groove areas, where the protective actions of varnish are most needed. Once set, Vanish is tenacious, holding and releasing fluoride into saliva in a usable ionic form.
There is less mess due to Vanish’s unique combined solvent and rosin system. The new rosin has a neutral taste, which allows for improved and expanded flavoring of the varnish. Vanish comes in cherry and melon flavors. In vitro analysis showed a 23 percent better fluoride release than the next closest brand.
In the 1970s there was a lot of focus on fluoride and decay prevention. Times have changed, and today the focus is on the periodontium. Here in the 21st century hygienists have more choices than ever! Research is being conducted in the field of decay prevention, and there is more documentation about the scientific evidence behind the use of fluoride.
When doing a search of current research on fluoride varnishes, search the “Cochrane Collaboration,” an evidence-based health-care database. The most recent evidence-based data suggests a substantial caries-inhibiting effect of fluoride varnish in both the permanent and deciduous dentitions based largely on trials with no treatment controls. There is still a need for more high-quality trials to show the effects.4
Fluoride varnish provides a new way of thinking. It is helping us move forward with the available tools in our 21st century armamentarium. There is now scientific evidence that supports how well this can work in our daily practice. Take a good look at your toolbox and reassess what is best for your patient population.
1 Donly K. Fluoride varnishes. J Am Dent Assoc Feb. 2002; 133(2):176-82. Available at http://www.cdafoundation.org/journal/jour0303/donly.htm.
2 Hazelrigg CO, Dean JA, Fontana, M. Fluoride varnish concentration gradient and its effect on enamel demineralization. Pediatr Dent Mar./Apr. 2003; 25(2):119-26.
3 Shen C, Autio-Gold J. Fluoride varnish concentration gradient and its effect on enamel demineralization. Assessing fluoride concentration uniformity and fluoride release from three varnishes. J Am Dent Assoc Feb. 2002; 133 (2):176-82.
4 http://www.cochrane.org/reviews/en/ab002279.html. Web site accessed on 11-27-05.
Fluoride Varnishes Marketed in the United States
• Duraphat (Colgate Oral Pharmaceuticals, Inc., Canton, Mass.) - Duraphat is a 5 percent sodium fluoride varnish provided in tubes containing 10 ml of product.
• Duraflor (Pharmascience, Montreal, Canada). Duraflor is also a 5 percent sodium fluoride varnish, which is provided in 10 ml tubes.
• Fluor Protector (Ivoclar/Vivadent, Amherst, N.Y.). Fluor Protector is a 1 percent difluorsilane varnish provided in 1 ml ampules and 0.4 ml single dose units.
• Cavity Shield (OMNII Oral Pharmaceuticals, West Palm Beach, Fla.). Cavity Shield is a 5 percent sodium fluoride varnish but comes in unit-dose packages with an application brush.
• Vanish (OMNII Oral Pharmaceuticals, West Palm Beach, Fla.). Vanish is a 5 percent clear sodium fluoride varnish and comes in unit-dose packages with an application brush.