Fluoride varnish
Encyclopedia
Fluoride varnish is a highly concentrated form of fluoride
which is applied to the tooth
's surface, by a dentist
, dental hygienist
or other health care professional, as a type of topical
fluoride therapy
. 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
. Fluoride varnishes are relatively new in the United States
, but they have been widely used in western Europe
, Canada
, and the Scandinavia
n countries since the 1980s as a caries prevention therapy. They are recognised by the Food and Drug Administration
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.
as a salt or silane
preparation in a fast drying, alcohol
and resin
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
base.
Disadvantages
Contraindications for use
Fluoride
Fluoride is the anion F−, the reduced form of fluorine when as an ion and when bonded to another element. Both organofluorine compounds and inorganic fluorine containing compounds are called fluorides. Fluoride, like other halides, is a monovalent ion . Its compounds often have properties that are...
which is applied to the tooth
Tooth
Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...
's surface, by a dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
, dental hygienist
Dental hygienist
thumb|right|300px|Dental hygienist holding a scalerA dental hygienist is a licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Local dental regulations determine the scope of practice of dental hygienists...
or other health care professional, as a type of topical
Topical
In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.Many topical medications are epicutaneous, meaning that they are applied directly to the skin...
fluoride therapy
Fluoride therapy
Fluoride therapy is the delivery of fluoride to the teeth topically or systemically in order to prevent tooth decay which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic delivery involves...
. 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
Tooth enamel
Tooth enamel, along with dentin, cementum, and dental pulp is one of the four major tissues that make up the tooth in vertebrates. It is the hardest and most highly mineralized substance in the human body. Tooth enamel is also found in the dermal denticles of sharks...
, dentine or cementum
Cementum
Cementum is a specialized calcified substance covering the root of a tooth. Cementum is excreted by cells called cementoblasts within the root of the tooth and is thickest at the root apex. These cementoblasts develop from undifferentiated mesenchymal cells in the connective tissue of the dental...
of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity
Dentine hypersensitivity
Dentine hypersensitivity is sensation felt when the nerves inside the dentin of the teeth are exposed to the environment. The sensation can range from irritation all the way to intense, shooting pain...
. Fluoride varnishes are relatively new in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, but they have been widely used in western Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, and the Scandinavia
Scandinavia
Scandinavia is a cultural, historical and ethno-linguistic region in northern Europe that includes the three kingdoms of Denmark, Norway and Sweden, characterized by their common ethno-cultural heritage and language. Modern Norway and Sweden proper are situated on the Scandinavian Peninsula,...
n countries since the 1980s as a caries prevention therapy. They are recognised by the Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
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.
Composition
Fluoride varnish is composed of a high concentration of fluorideFluoride
Fluoride is the anion F−, the reduced form of fluorine when as an ion and when bonded to another element. Both organofluorine compounds and inorganic fluorine containing compounds are called fluorides. Fluoride, like other halides, is a monovalent ion . Its compounds often have properties that are...
as a salt or silane
Silane
Silane is a toxic, extremely flammable chemical compound with chemical formula SiH4. In 1857, the German chemists and Friedrich Woehler discovered silane among the products formed by the action of hydrochloric acid on aluminum silicide, which they had previously prepared...
preparation in a fast drying, alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
and resin
Resin
Resin in the most specific use of the term is a hydrocarbon secretion of many plants, particularly coniferous trees. Resins are valued for their chemical properties and associated uses, such as the production of varnishes, adhesives, and food glazing agents; as an important source of raw materials...
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
Sodium fluoride is an inorganic chemical compound with the formula NaF. A colorless solid, it is a source of the fluoride ion in diverse applications. Sodium fluoride is less expensive and less hygroscopic than the related salt potassium fluoride....
at least one brand of fluoride varnish contains 1%
difluorsilane in a polyurethane
Polyurethane
A polyurethane is any polymer composed of a chain of organic units joined by carbamate links. Polyurethane polymers are formed through step-growth polymerization, by reacting a monomer with another monomer in the presence of a catalyst.Polyurethanes are...
base.
Application procedure
- Although it is not necessary to do a professional prophylaxisScaling and root planingThe objective of scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its products and calculus, thus helping to establish a...
prior to the application of a fluoride varnish, it is recommended that the teeth be cleaned with a toothbrush. - Wiping with a cotton gauze is adequate in cases where there is no heavy plaqueDental plaqueDental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...
or debris. - The teeth should be lightly dried with air or a cotton gauze.
- The varnish will adhere even if the teeth are moist.
- Isolate the teeth (e.g. with cotton rolls) to prevent recontamination with salivaSalivaSaliva , referred to in various contexts as spit, spittle, drivel, drool, or slobber, is the watery substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands,...
- A small amount of varnish (e.g. 0.5ml) is dispensed. The entire dentitionDentitionDentition pertains to the development of teeth and their arrangement in the mouth. In particular, the characteristic arrangement, kind, and number of teeth in a given species at a given age...
may be treated with as little as 0.3-0.6 ml. - Some manufacturers offer individual dose systems which come with their own varnish filled well.
- A small brush or applicator is then used to apply the varnish
- The varnish will set on contact with the slightly moist teeth
- The patient is instructed to avoid brushing for the rest of the day. Normal oral hygiene procedures can begin again the following day.
- As a result of the time needed for frequent reloading of the brush/applicator, Hodgson (2005) has suggested an alternative technique utilizing a 5 ml plastic syringe. This method allows a more efficient application of the varnish which can be particularly useful in cases where speed is important, such as with a difficult pediatric patient.
- In order to be effective in decay prevention the varnish should be reapplied at least twice yearly.
Advantages and disadvantages
Advantages- Fluoride varnishes are available in different flavours which can be advantageous when treating younger patients
- 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.
- They are easily and quickly applied
- They dry rapidly and will set even in the presence of salivaSalivaSaliva , referred to in various contexts as spit, spittle, drivel, drool, or slobber, is the watery substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands,...
- 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
- Application requires very little equipment and so it can be applied in settings where a dental operatory is not available
- 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 fluorosisDental fluorosisDental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development. The risk of fluoride overexposure occurs between the ages of 3 months and 8 years. In its mild forms , fluorosis often appears as unnoticeable,...
, 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.
Disadvantages
- Due to the colour and adherence of most fluoride varnishes they may cause a temporary change in the surface colour of teeth as well as some filling materials. As the varnish is worn away by eating and brushing the yellowish colour fades.
Indications and contraindications
Indications for use- Use as a topical fluoride agent on moderate and high-risk patients, especially children 5 and younger
- Desensitizing agent for exposed root surfaces
- Fluoridated cavity varnish
- 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
- 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 fluoridatedWater fluoridationWater fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride...
- Treatment of areas where discoloration after treatment may be an aesthetic concern
See also
- Dental cariesDental cariesDental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...
- Fluoride therapyFluoride therapyFluoride therapy is the delivery of fluoride to the teeth topically or systemically in order to prevent tooth decay which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic delivery involves...
- XerostomiaXerostomiaXerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or...
- Dental fluorosisDental fluorosisDental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development. The risk of fluoride overexposure occurs between the ages of 3 months and 8 years. In its mild forms , fluorosis often appears as unnoticeable,...
- Dentin hypersensitivity
- Dental restorationDental restorationA dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the...
- Dental surgeryDental surgeryDental surgery is any of a number of medical procedures that involve artificially modifying dentition, in other words surgery of the teeth and jaw bones.-Types:Some of the more common are:...