The 21st century method for delivering fluoride
by Carol A. Jahn, RDH, MS
Professional fluoride treatments are a mainstay in the prevention of dental caries. For years, the standard practice was gel or foam applied via trays for up to four minutes. This type of delivery method was effective, but it was not easy. At best, it could be messy and at worst it had the potential for ingestion. Today, a new standard of care is emerging for fluoride treatments: the application of varnish.
Fluoride varnish is easy to use. The American Dental Association notes that varnish applications “take less time, create less patient discomfort, and achieve greater patient acceptability than fluoride gel, especially in preschool-age children.”1 One advantage of using varnish is that the patient can eat or drink almost anything immediately afterwards. Exceptions are hot beverages or crunchy food. Instead of being the foe, saliva is a friend — setting the varnish. The only contraindication is no brushing or flossing for six to eight hours. Most of today's products are clear; some in the past made the teeth look yellow. The application may make teeth feel a bit fuzzy initially, but most patients find it tolerable. Application time can take from one to four minutes depending upon the number of teeth present.2 Most brands come in a single unit dose package with a brush applicator. See Table 1 for a list of popular varnish products. The purchasing cost of varnish vs. trays and gel is relatively similar. In terms of time, varnish is more economical. It requires less preparation to apply and is less messy, reducing cleanup time.
Fluoride varnish is safe. While relatively new to the United States, fluoride varnish is considered safe and well-accepted in Europe, where it has been used extensively for more than 20 years.3 Ingestion of fluoride via varnish application appears to be minimal. Plasma levels have been shown to be similar to brushing with fluoridated toothpaste and significantly less than with APF gel.2 Varnish has been applied without incident to infants as young as six months of age.4
Fluoride varnish is effective. Clinical recommendations from the American Dental Association note that fluoride varnish applied “every six months is effective in preventing caries in the primary and permanent dentition of children and adolescents.”1 In high-risk populations, twice yearly applications are recommended;1 some clinical trials have had up to four applications per year.2 Varnish has reduced early enamel lesions in primary dentition.3 It has also been found to reduce the number of white spot lesions in orthodontic patients.5 Fluoride varnish has been shown to release fluoride over a 24-hour time frame as well as increase the calcium fluoride reservoirs that aid in long-term fluoride release.6
Fluoride varnish is for everyone. Varnish can be applied to a baby's first tooth,4 adolescents in orthodontic treatment,5 and adults. While studies on adults are limited, varnish has been shown to be effective on both primary and permanent teeth.1 In addition to the prevention of caries, fluoride varnish has been shown to decrease cervical dentin hypersensitivity.7
Fluoride varnish is quickly becoming the preferred method for delivery of professional fluoride treatments. It is proven safe and effective, and is easy to use. Patients are more comfortable and accepting of fluoride varnish than with standard trays and gels, making it perfect for patients of any age.
About the Author
Carol Jahn, RDH, MS, is the manager of professional education and communications for Water Pik, Inc. She provides continuing education programs on periodontal disease and the oral-systemic link and diabetes. She can be reached at [email protected].