If you've practiced dental hygiene for a while, you've likely seen the evolution of in-office application methods for tooth remineralization and desensitization medicaments. As a child growing up in rural New York State in the 1980s, I remember a dental professional visiting my first-grade class and passing around small cups of fluoride mouth rinse for the students to swish. The unique, sweet flavor is forever burned into my memory! As I reached my adolescent years, my parents started taking me and my siblings to the dentist, where Andy, my dental hygienist, would let me choose the flavor of fluoride gel used in my trays. Eventually, I became a dental hygiene student in 2010, where our program clinic used fluoride foam on patients.
These days, fluoride varnish has become the contemporary standard for many reasons: Faster application time, decreased risk of ingestion, ease of use in pediatric patients, and benefits that last from three to six months.1 Clinicians no longer have to sit and supervise their patients' two-minute fluoride tray sessions, which provides additional time to focus on other aspects of their appointments.
But how does one choose the right varnish? Are they all the same? There are definitely some considerations that oral health-care professionals should be aware of.
Consistency
Although clinicians know the benefits of a professional fluoride application, many patients struggle with the experience. Some varnishes can have a rather thick consistency that can prevent the product from spreading evenly on the teeth. Colophony (rosin) is an ingredient that provides most varnishes with their adhesive property, but it feels sticky and gummy to the patient. Colophony-free varnishes use ingredients like dimethicone gel to enable the fluoride to adhere to the teeth, and leave a smooth, hydrating feeling after application.
Variations of fluoride
Most fluoride varnishes are made with 5% sodium fluoride, delivering about 22,600 ppm fluoride. Other varnishes contain added remineralization compounds such as calcium and phosphate additives, including CPP-ACP and TCP. These enhanced formulations might be especially helpful in orthodontic patients.
Flavor and color
Varnishes come in virtually every flavor these days, and it's good to have several options to offer to patients. Many patients, including children, enjoy the standard mint flavor while others appreciate fruit and dessert flavors. Patients love having choices, even for something as simple as a varnish application. It's also important to note that varnishes can be either clear or tooth-colored. This can come in handy when applying around visible restorations, as a tooth-colored varnish might be more noticeable against dark-colored fillings and prosthetics.
A fluoride-free option
Whether we support it or not, we can't ignore the fact that the safety of fluoride has been scrutinized in recent years. It's become much more common to interact with patients who request only fluoride-free products, and clinicians must be knowledgeable of alternatives. One of the most popular fluoride replacement ingredients is nanohydroxyapatite (nHA), based on its ability to prevent caries and remineralize enamel.2 Varnishes that contain nHA are available and can serve as a worthwhile investment for practices wishing to appeal to their patients' needs and preferences.
Although professionally applied varnishes might sound simple and basic, clinicians need to know about their many variations. Personal research and experience can help determine what is best for your patients.
Editor's note: This article appeared in the July 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
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Bonetti D, Clarkson JE. Fluoride varnish for caries prevention: efficacy and implementation. Caries Res. 2016;50 Suppl 1:45-9. doi: 10.1159/000444268
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Pushpalatha C, Gayathri VS, Sowmya SV, et al. Nanohydroxyapatite in dentistry: a comprehensive review. Saudi Dent J. 2023;35(6):741-752. doi: 10.1016/j.sdentj.2023.05.018
