Fluoride varnishes: What we must know

Fluoride varnish has benefits for patients of all ages, including adults.

Five percent sodium fluoride varnish, such as Colgate PreviDent / Colgate Duraphat, has been used extensively worldwide in children and adolescents as an anti-caries agent (an off-label use in the United States). Plus, it is used in school fluoride programs, such as Scotland's Childsmile project. The evidence supports the use of fluoride varnish, noting that it offers a substantial caries-inhibiting effect in both permanent and primary teeth. Fluoride varnish is also an important preventive measure for adults.

For which adult patients should fluoride varnishes be considered?

The American Dental Association has produced guidelines on when to consider additional fluoride for patients in the prevention and management of caries. The use of 5% fluoride varnish is recommended for caries prevention in adults at increased risk for dental caries. Separate guidance is also available on the use of fluoride, including 5% sodium fluoride varnish, as one of the non-invasive treatments for caries lesions.

Numerous factors increase risk for dental caries including:

•  The presence of any active caries in the previous 12 months
• Poor oral hygiene
• A cariogenic diet
• Xerostomia
• Patients who have been treated with Head and Neck radiotherapy or Chemotherapy
• Fixed orthodontic appliances
• Sub-optimal fluoride exposure
• Exposed root surfaces or root caries•
• Poor family dental health
• Drug/alcohol abuse
• Genetic abnormality of teeth or enamel defects
• The presence of many multi-surface restorations
• Eating disorders
• Individuals with disabilities

Globally, other countries have also recognized the evidence-based benefits of fluorides in all age groups, for example, guidelines from Australia and England and Canada which include the use of fluoride varnish as effective in reducing dental.

Dental practitioners should consider a patient's risk of experiencing disease when developing an optimal caries-prevention plan, which can include the application of in-office 5% sodium fluoride varnish. Other preventative measures such as dietary advice and oral hygiene counselling should also be implemented. The team should ensure that they educate their patients on the benefits of fluoride varnish applications, which are recommended every 3 to 6 months depending on caries risk level. The potential benefits of topical fluoride applications should be explained, including cost-effectiveness by helping to prevent further interventions as a result of caries, such as restorations, or even extractions. Bi-annual application of fluoride varnish has been shown to be cost-effective.

Fluoride varnish can also be useful in adults in providing relief from dentin hypersensitivity, and to help prevent dental erosion.

Patients are likely to prefer a non-invasive technique to manage their caries risk and even treat early stage caries, and it is an easy preventive treatment for patients who may have difficulty tolerating dental care, for example patients who have disabilities or who are elderly. Fluoride varnish therefore offers a solution to manage patients of all ages and even those with additional dental challenges.