Fluoride varnish is a highly concentrated form of fluoride 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,

dental hygienist A dental hygienist or oral hygienist is a licensed dental professional, registered with a dental association or regulatory body within their country of practice. Prior to completing clinical and written board examinations, registered dental hygien ...

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 classes ...

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 Dentin () (American English) or dentine ( or ) (British English) ( la, substantia eburnea) is a calcified tissue of the body and, along with enamel, cementum, and pulp, is one of the four major components of teeth. It is usually covered by e ...

cementum Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.Illustrated Dental Embryology, Histology, ...

of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity. 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 states, a federal district, five major unincorporated territori ...

, but they have been widely used in western

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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 tot ...

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

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. Complicat ...

prevention therapy. They are recognised by the

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...

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 fluoride 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 quant ...

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 Sodium fluoride (NaF) is an inorganic compound with the formula . It is used in trace amounts in the fluoridation of drinking water, in toothpaste, in metallurgy, and as a flux. It is a colorless or white solid that is readily soluble in water. I ...

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 units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethane is produced from ...

base and one brand contains 2.5%

that has been milled to perform similar to 5% sodium fluoride products in a

shellac Shellac () is a resin secreted by the female lac bug on trees in the forests of India and Thailand. It is processed and sold as dry flakes and dissolved in alcohol to make liquid shellac, which is used as a brush-on colorant, food glaze and ...

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 Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...

, 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 Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation. It appears as a range of visual changes in enamel causing degrees of intrinsic tooth d ...

, 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 Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, and misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial ...

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 and

stomatitis Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration. In its widest meaning, stomatitis can have a multitude of different cau ...

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