Fluoride varnishes: Should we be using them?

Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Fluoride varnishes: Should we be using them?
Author(s): Vaikuntam BDS, Jay
Journal: AAPD
Year. Volume (number). Page #’s: 200. 22-6. 181-186
Major topic: Fluoride varnish’s use and effectiveness
Minor topic(s): Type of FV
Main Purpose: To evaluate the efficacy and use of FV in the US
Overview of method of research: Clinical Review

Findings: Recognition and identification of children at risk of developing caries is paramount. Once a child’s risk has been determined, an appropriate regimen tailored to suit their individual needs must be instituted. With an growing emphasis on prevention based dentistry, new treatments are coming on the market all the time. In 1994, the FDA approved the use of FV for liners and desensitization agents(they’ve been used in Europe for many years).
Topical fluoride can provide effective control and protection against caries. Recently, concerns regarding fluorosis, ingestion, and toxicity have spurred recent research evaluating the clinical efficacy of FV agents. Numerous studies have shown a reduction in caries after having FV applied. When used appropriately, a possible 40-56% reduction is possible.
There are many different types of FV on the market today. Duraphat, Fluor protector, Duraflor, Cavityshield, and Vanish are a few trade names you may see.

How to apply it?
Studies have shown that a prophy is NOT essential prior to FV application, although it is preferred. The most important thing is that the teeth are dried. Not bone dry…. Just dry. Apply the FV to every tooth surface, and instruct the parents not to brush the child’s teeth that night.
There are 3 different recommended treatment applications of FV. Every 6 months, 4x a year, and 3 applications of a 1 week period.
Is ingestion an issue?
Yes and no. While FV have a high amount of Fl in them, and the fact that over application is often a problem, there is concern. However, the toxic dose for a 20kg child is 100mg. If .5ml FV is used, and the child ingests the entire dose, they will ingest 11.2 mf, well below the toxic dose. So be aware, but don’t sweat it.

Key points/Summary:
1. FV are a safe and effective way of delivering and retaining Fl on a tooth.
2. They can help control the caries process.
3. They are most effective when used on early lesions (white spot lesions), and not cavitations.
4. Great for special needs kids.
5. Children in Ortho tending to have poor plaque control can benefit greatly from FV.

Assessment of Article: Good stuff. Good info to give worried parents.