Fluoride varnish is a highly concentrated form of

fluoride Fluoride (). According to this source, is a possible pronunciation in British English. is an inorganic, monatomic anion of fluorine, with the chemical formula (also written ), whose salts are typically white or colorless. Fluoride salts ...

which is applied to the

tooth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, t ...

's surface, by a

dentist A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry (the diagnosis, prevention, management, and treatment of diseases and conditions of the oral cavity and other aspects of the craniofacial co ...

, dental hygienist or other health care professional, as a type of

topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of class ...

fluoride therapy Fluoride therapy is the use of fluoride for medical purposes. Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. It is typically used as a liquid ...

. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat

dentine hypersensitivity Dentin hypersensitivity (DH, DHS) is dental pain which is sharp in character and of short duration, arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which c ...

. There are more than 30 fluoride-containing varnish products on the market today, and they have varying compositions and delivery systems. These compositional differences lead to widely variable pharmacokinetics, the effects of which remain largely untested clinically. Fluoride varnishes are relatively new in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., federal district, five ma ...

, but they have been widely used in western

Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a subcontinent of Eurasia and it is located enti ...

Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tota ...

South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring count ...

and the

Scandinavia Scandinavia; Sámi languages: /. ( ) is a subregion in Northern Europe, with strong historical, cultural, and linguistic ties between its constituent peoples. In English usage, ''Scandinavia'' most commonly refers to Denmark, Norway, and Swe ...

n countries since the 1980s as a

dental caries Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complicatio ...

prevention therapy. They are recognised by the

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

for use as desensitising agents, but, currently, not as an anti-decay agent. Both Canadian and European studies have reported that fluoride varnish is as effective in preventing tooth decay as professionally applied fluoride gel; however, it is not in widespread use for this purpose. Fluoride varnish is composed of a high concentration of

as a

salt Salt is a mineral composed primarily of sodium chloride (NaCl), a chemical compound belonging to the larger class of salts; salt in the form of a natural crystalline mineral is known as rock salt or halite. Salt is present in vast quanti ...

silane Silane is an inorganic compound with chemical formula, . It is a colourless, pyrophoric, toxic gas with a sharp, repulsive smell, somewhat similar to that of acetic acid. Silane is of practical interest as a precursor to elemental silicon. Sila ...

preparation in a fast drying, alcohol and

resin In polymer chemistry and materials science, resin is a solid or highly viscous substance of plant or synthetic origin that is typically convertible into polymers. Resins are usually mixtures of organic compounds. This article focuses on n ...

based solution. The concentration, form of fluoride, and dispensing method may vary depending on the manufacturer. While most fluoride varnishes contain 5% sodium fluoride at least one brand of fluoride varnish contains 1% difluorsilane in a

polyurethane Polyurethane (; often abbreviated PUR and PU) refers to a class of polymers composed of organic chemistry, organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethan ...

base and one brand contains 2.5% sodium fluoride that has been milled to perform similar to 5% sodium fluoride products in a shellac base.

Clinical recommendations

A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied, prescription-strength and home-use topical fluoride agents for caries prevention. The panel recommends the use of 2.26 percent fluoride varnish for people at risk of developing dental caries. As part of the evidence-based approach to care, these clinical recommendations should be integrated with a practitioner's professional judgment and the patient's needs and preferences.

United Kingdom

Fluoride varnish is widely used in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

, following guidelines from multiple sources backing its efficacy. Public Health England, a UK government organisation sponsored by the Department of Health, released guidance in 2014 recommending fluoride varnish application at least twice yearly for children and young adults. Similarly, the Scottish Intercollegiate Guidelines Network and the Scottish Dental Clinical Effectiveness Programme have both released independent guidance recommending at least twice yearly fluoride varnish application, citing a strong clinical evidence base. SIGN recommends fluoride varnish at a concentration of 2.2%, while SDCEP recommends 15%.

Types of varnish

Different varnish products release varying amounts of calcium, inorganic phosphate, and fluoride ions. MI varnish releases the most amounts of calcium ions and fluoride. Enamel Pro varnish releases the most inorganic phosphate ions. Each type of varnish is designed to be used in specific situations. To date, there have been no studies that show that altering the basic formulation recommended by the FDA will result in greater caries reduction.

Effectiveness

There is some evidence that fluoride varnish treatment has a better outcome at preventing cavities at a lower cost compared to other fluoride treatments such as the fluoride mouth rinsing. For fluoride varnish treatment, the benefit to cost ratio 1.8:1, whereas fluoride mouth rinsing is 0.9:1. With fluoride varnish treatments, one can save by preventing future restorations. Fluoride varnish also requires fewer treatments for measurable effectiveness, therefore in the long run it is cost effective when compared to other treatments. A 2020 Cochrane systematic review found that while varnish may be effective at preventing cavities when applied to first permanent molars, there is no evidence to suggest if varnish is superior to resin-based fissure sealants. There is low quality evidence suggesting that when tooth surfaces were sealed and varnished with fluoride, as opposed to when varnished only with fluoride varnish, there may be an advantage.

Advantages and disadvantages

Advantages

*Fluoride varnishes are available in different flavours which can be advantageous when treating younger patients *They dry rapidly and will set even in the presence of saliva *Because they do not require the use of fluoride trays they are suitable for use in patients with a strong gag reflex (See image to the right) *Due to the small amounts used and the rapid setting time there is only a small or negligible amount of fluoride ingested *It has a sticky consistency which helps it to adhere to the tooth’s surface thereby allowing the fluoride to stay in contact with the tooth for several hours *Based on published findings, professionally applied fluoride varnish does not appear to be a risk factor for dental fluorosis, even in children under the age of 6. This is due to the reduction in the amount of fluoride which may potentially be swallowed during the fluoride treatment because of the small quantities used and the adherence of the varnish to the teeth. *Fluoride varnish treatments are shown to reduce the number of the cariogenic bacteria S. Mutans by over ten-fold. *Fluoride varnish was a higher concentration than the foam and gel. There was not a significant difference in the amount of remineralization between gels, foams, and varnish. A study with a larger sample size and a longer time frame could show differing results. *They can be applied easily and quickly

Disadvantages

*Due to the color of and adherence of some brands of fluoride varnish, they may cause a temporary change in the surface color of teeth as well as some filling materials. As the varnish is worn away by eating and brushing, the yellowish colour fades. *Varnish costs more than gel and requires a prescription unlike the gel that is over the counter. *They do not have the bitter taste of some fluoride gels, but in some patients the taste of the varnish can cause nausea especially when consuming food within the 24 hours post treatment.

Indications and contraindications

Indications for use

* Use as a topical fluoride agent on moderate and high-risk patients, especially children aged 5 and younger * Desensitizing agent for exposed root surfaces * Fluoridated cavity varnish * When a higher concentration of fluoride is needed for high caries risk patients * In the elderly to prevent increasingly prevalent root dentin lesions, which may require higher concentration of fluoride * On advanced enamel carious lesions, which may also require higher fluoride concentration for remineralization * Fluoride treatment for institutionalized patients or in other situations where setting, equipment and patient management might preclude the use of other fluoride delivery methods * Caries prevention on exposed root surfaces * Remineralization of lesions in root dentin * Fluoride application around orthodontic bands and brackets (See image to right) * Fluoride treatment on patients when there is a concern that a fluoride rinse, gel or foam might be swallowed

Contraindications for use

*Areas with open cavities *Patients that are at low-risk or are decay-free and live in an area where the water is fluoridated *Treatment of areas where discoloration after treatment may be an aesthetic concern *Fluoride varnish application is contraindicated in patient with

ulcerative gingivitis An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...

and stomatitis.

References

External links

The Canadian Dental AssociationThe American Dental AssociationCanadian Dental Hygienists AssociationAmerican Dental Hygienists' AssociationCenters for Disease Control and Prevention
{{Authority control Dental materials