A patient comes in complaining of extremely sensitive teeth. It’s painful to drink a cold beverage or eat ice cream. They may even struggle with the simple act of brushing their teeth. You know the answer to their problems and so does every dental hygienist across the nation: Fluoride. Whether you have patients that are suffering from sensitive teeth or at high risk of dental caries, fluoride is highly effective. However, when it comes to applying this solution, not every dental office will opt for the best form of fluoride. When it comes to research, the evidence is showing that fluoride varnish far outweighs the efficacy of fluoride foam.
Fluoride Varnish: A History
For nearly 50 years, dental professionals have been employing the power of fluoride. Stannous fluoride came first, next gel appeared on the market, and then foam was introduced. With each version of fluoride, an improvement was made. It became less messy to apply, it tasted a little bit better, and it started to be more convenient to apply. A quarter of a century ago, countries like South Africa, Canada, and the United Kingdom embraced the newest version of fluoride: Varnish. A few years later, in 1994, America’s FDA approved fluoride varnish for the treatment of sensitive teeth. In addition to this, many dental professionals across the United States, who stayed abreast of the latest research, chose to use fluoride varnish “off-label” because of its usefulness in preventing dental caries.
Fluoride Varnish: The Benefits
The basic benefits of fluoride are clear and have been proven repeatedly. However, when it comes to specifically looking at fluoride varnishes, as distinguished from foam fluoride application, some dental professionals are unaware of the numerous advantages.
Ease of Application
One of the biggest benefits to both dental professionals and patients is how quickly fluoride varnish can be applied and how easy it is to apply it. This allows for more time during a patient’s appointment to scale, explain recommended treatment, review oral hygiene practices, answer patient questions, take x-rays, perform oral cancer screenings, or any other important piece to the appointment that needs to be completed within the appointment time.
A second significant advantage to fluoride varnish can be seen very clearly in research studies. When fluoride varnish is compared to fluoride foam with computer imaging, over several weeks, it becomes apparent that the level of efficacy that varnish provides is far superior.
Levels of Fluoride
Another potential benefit is the higher concentration of fluoride that varnishes contain when compared to foams. When a large enough longitudinal study is completed, it could show that the more concentrated form of fluoride in varnishes gives this application method additional efficacy.
Duration of Treatment
Beyond the benefit of enhanced remineralization with varnish, it is also ten times as effective at lessening the amount of cariogenic bacteria, S. mutans. Fluoride foam, on the other hand, is less effective at fighting S. mutans than a simple chlorhexidine mouthwash. Fluoride varnish extends its efficacy through the fact that it is sticky. This means that it will remain on the tooth for much longer than foam, allowing the patient to eat and drink soon after application while also allowing the fluoride to continue being absorbed by the tooth. But while the varnish does stick well to teeth, it also dries quickly and is not negatively affected if saliva is present, making the whole process easier for both the dental hygienist and the patient. In fact, when the varnish comes into contact with saliva it hardens and can stay on the tooth and continue to be absorbed for up to seven days. Foam fluorides, on the other hand, will only remain on the tooth for roughly 15 minutes.
Then there is the advantage of being able to use fluoride varnish without having the risk of dental fluorosis, which can not only discolor the teeth but also cause physical damage. Because the varnish is applied directly to the teeth, it is able to set very quickly. This stickiness allows the varnish to adhere to the teeth, and not only is less of the substance used but the minimal amount that is used is less likely to be swallowed than fluoride foam.
This reduction in the risk of swallowing fluoride also enables dental practitioners to apply fluoride to children under the age of 6, which is not safe with other fluoride application methods such as fluoride foam. In fact, applying fluoride varnish to children’s teeth is so safe that the United States Preventative Services Task Force has recommended to primary care physicians that, in an effort to prevent dental caries, they should apply fluoride varnish to all of the primary teeth of children under the age of five.
Another aspect of fluoride varnish that makes applying fluoride on children’s teeth easier for a dental professional and more comfortable for the child is the fact that the varnishes come in many different flavors. The American Academy of Pediatrics recommends fluoride varnish treatments beginning at initial tooth eruption.
The ADA recommends fluoride varnish over foam for children under six years of age, not only due to efficacy but the risks (ingestion) outweighing the benefits.
- February 17, 2019 Published in Todays RDH online