Fluoride varnishes: should we be using them?

Author(s): Jay Vaikuntam, BDS
Journal: Pediatric Dentistry
Volume (number): 22(6)
Month, Year: 2000
Major topic: use of fluoride varnish for caries control
Minor topic(s): none
Type of Article: continuing education article
Main Purpose: to review efficacy, types and usage of fluoride varnish
Overview of method of research: review of literature
Findings: Europe and Canada use fluoride varnish as the standard of care in prevention techniques; however, fluoride varnishes are not yet approved by FDA for use as caries preventive agents and are considered cavity liners and desensitizing agents. To determine clinically applicable use of fluoride varnish, one must recognize an individual’s caries risk and then design an appropriate prevention strategy. The efficacy of fluoride varnishes as anti-caries agents has been reported to offer a 40-56% reduction in caries incidence, a 51% reversal of decalcified tooth structure and a 21-35% reduction in enamel demineralization. One study concluded that fluoride varnishes have a definite cariostatic effect on approximal caries. The authors note that NaF can settle due to its particulate manner, and so actual dosing of fluoride per child is more accurate in individualized packaging.
Contents Fl: mg/ml Package Cost/package Est. cost / application
Duraphat 5% NaF in viscous colophonium base 22.6
10 ml tube $25/tube $1.25-2.50
Duraflor 5% NaF in alcoholic resin suspension w/xylitol 22.6
10 ml tube $24-28/tube $1.00-2.00
Fluor Protector 1% difluorosilane in polyurethane base 1
1 box of 20 vials with 0.4 ml/vial $81.58/ 20 vial box $4.00
CavityShield 5% NaF in resin base 22.6
Unit doses, (0.4 ml or 0.25 ml) $24-34/ box $3.00-3.75
The three most used application regimens are: (1) one application/6 months; (2) one application/3 months; (3) three applications over a one-week period. Ultimately reapplication is necessary for fluoride varnishes to be effective. Studies have shown that plaque removal and/or professional prophy-cup cleanings are not necessary prior to varnish application; Nonetheless, proper varnish protocol is as follows: (1) prophylaxis (TB or Cup), (2) cotton roll isolation/ dry teeth; (3)dispense and apply varnish to entire surface of tooth, (4) patient instructed to avoid brushing for remainder of day and avoid eating for 2 hrs. In terms of toxicity, the potential exists but studies show that levels used are well below toxic does, even if patient consumes most of it throughout day. (Toxic dose is 5 mg/kg)
Key points/Summary: Fluoride varnishes are most effective when used on early white spot lesions with intact surface layer rather than on cavitated lesions.
Assessment of article: the article is a succinct reference on fluoride varnish