With the advances
in dental practice, oral hygienists and dentist alike have found
better ways to reduce dental caries; methods that are safe and
easy to apply to older patients as well as young children.
The incidence of dental caries among children in the western
countries has declined sharply with the introduction of fluoride
supplements. However, there is still a significant number that
remains high-risk to dental caries. The decrease in caries in
the occlusion areas has not paralleled those in the smooth tooth
surfaces; occlusion lesions still remain persistent despite fluoride
Fluorides have long been used as a means to prevent tooth decay.
Measures have been made to add fluoride to water and toothpastes
to meet the right amount of fluoride needed by the teeth for
protection against cavities. Aside from toothpastes, Professionally
Applied Topical Fluorides or PATF come in the forms of gels,
foams, and varnishes. The first fluoride varnish was introduced
in Germany in 1964, as Duraphat, then a similar product, Duraflor,
was introduced in the United States in 1991.
Among the various types, toothpastes and varnishes are more
accepted by both dentists and patients because of the ease of
application. Fluoride varnish requires only a short time to apply
since the dentist or oral hygienist will only paint the teeth
with the solution. After which, fixation occurs in as short as
1-4 minutes, depending on the number of teeth involved. The fluoride
then adheres to the teeth surface, improving fluoride uptake
into the enamel and reducing demineralization.
In 2006, the American Dental Association concluded that fluoride
varnishes, gels and foams were able to prevent dental caries
in both the primary and permanent dentition in children and adolescents.
However, fluoride varnishes are more mode of treatment as these
have shorter application times and provide less discomfort, especially
to pre-school children.
Indications for use
Just as in any treatment, not everyone is advised or qualified
for varnish application. The treatment is recommended for those
considered to have moderate- to high-risk of having dental caries.
This population includes people with active orthodontic treatments
(e.g. with braces), patients undergoing chemotherapy, and head
and neck irradiation, those with poor oral hygiene and a high
titer of cariogenic bacteria, those with in-born enamel or teeth
abnormalities and defects, and those with xerostomia or dry mouth.
Fluoride varnish can be applied to all age groups, and to both
primary and permanent teeth, as long as there is a need to cease
the progression of caries or to prevent the occurrence altogether.
Fluoride varnish application has not been found to be cost-effective
against occlusion lesions or in patients at low to moderate risk
for caries, who live in communities with optimal fluoridation.
Also, treatment of patients with low risk for dental caries is
not recommended. Asthma patients are another category not recommended
for fluoride varnish applications.
Application of fluoride varnish takes in to consideration the
type of tooth involved, the degree of the infection, and the
susceptibility of the patient to dental caries. Fluoride varnish
offers an added benefit of up to 38% in children who are at high
risk of dental decay. The American Dental Association has recommended
that bi-annual application of fluoride varnish at 6-month intervals
may be appropriate for patients aged 18 years and below with
moderate risk for dental caries. Those with high risk may have
applications of up to four times a year at 3-month intervals.
However, the optimal frequency of applications and the optimal
intervals have not been established yet.
Previously a practice, cleaning before varnish application,
has now been shown to be unnecessary. Several studies have shown
that there were no significant differences in caries reduction
between those who underwent cleaning prior to varnish application
and those patients who did not.
Varnish application is simple and can be done by a dentist or
a trained assistant. The time taken for the entire process is
somewhere between 3-5 minutes, depending on the number of teeth
to be varnished. Teeth need not be thoroughly dried before or
after treatment as the saliva helps in the fixation of the varnish.
Although there are concerns regarding fluoride toxicity, no
serious side effects have been reported with properly applied
varnishes. Patients and parents should be enlightened however
that some fluoride varnishes will cause yellowish discoloration,
which will fade away with time and brushing.