Do You Recommend Varnish and if so, why do you think it is better?
I work with several hygienists and we have a difference of opinion on what is the best method of applying topical fluoride. Do you recommend varnish and if so, why do you think it is better?
This sounds like a positive debate that will lead you all to find the best options for your patients. As always we look to the literature for guidance and also use our professional judgment. We are in luck in regard to current evidence because in 2013 the American Dental Association updated its recommendations on the use of professional and home-use prescription topical fluorides. You can access the executive summary and chairside guide from the ADA Center for Evidence-based Dentistry™ website at: http://ebd.ada.org/ClinicalRecommendations.aspx.
The recommendations which came out of a systematic review of the literature only include: 1) 5% neutral sodium fluoride (NaF) varnish and 2) 1.23% Acidulated Phosphate Fluoride (APF) gel. For children under the age of 6 years, only varnish is recommended. Either of these two regimens are recommended at 3-6 month intervals for patients with an elevated risk of dental caries. The panel concluded with low certainty that there was an anti-caries benefit to primary teeth with a twice annual application of 1.23% APF foam and no benefit to the permanent dentition therefore foam was not included in the recommendations. The panel identified no studies on the effect of 2.0% NaF gel that met the study criteria so it was also not included in the recommendations. Since 5% NaF varnish and 1.23% APF gel show the most anti-caries effect I would narrow my choices to either of them. Based on the ease of application and its benefits in the prevention of caries in primary and permanent teeth as well as root caries, varnish would be my application of choice. Varnish also shows great benefit around orthodontic brackets and is easy to place it where it is needed most. Because there are some patients that do not like a varnish application I would keep the 1.23% APF four-minute gel application on hand. Best of luck to you and your colleagues on deciding on a protocol in your office!
1. Weyant RJ, Tracy SL, Anselmo T, Beltrán-Aguilar ED, Donly KJ, Frese WA, Hujoel PP, Iafolla T, Kohn W, Kumar J, Levy SM, Tinanoff N, Wright JT, Zero D, Aravamudhan K, Frantsve-Hawley J, Meyer DM. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systemic review. J Am Dent Assoc. 2013 Nov;144(11):1279-1291.