There is a discussion going on in my dental office regarding fluoride trays (1 min) vs. varnish with regard to decay prevention. I was absent on the day we had a 3M rep discuss varnish and apparently the office was told that the FDA has not approved varnish for decreasing or preventing decay. Therefore, the varnish is not being used anymore. I find this hard to believe since both are fluorides. Do you have any research-based evidence that proves there is prevention of decay whether it is a varnish or topical gel?
Thank you for asking for research-based evidence to guide your clinical decision-making in regard to fluoride delivery. You are justified in questioning the statement that fluoride varnish is not being used anymore. In fact, to the contrary, the use of fluoride varnish is expanding due to strong evidence to support its use for a variety of patients. The American Dental Association (ADA) Report, Professionally Applied Topical Fluoride: Evidence Based Clinical Recommendations, published in May 2006 provides a concise summary of the evidence to support tray and varnish applications. The executive summary of this report can be found online at: http://www.ada.org/prof/resources/pubs/jada/reports/report_fluoride_exec.pdf
The report recommends the use of fluoride gel in trays or varnish application for patients in all age categories with moderate to high risk for dental caries. The ADA recommends only varnish for patients under the age of six years (for up to four times per year) because an overall smaller quantity of varnish is used as compared to a gel tray application thus reducing the amount potentially ingested. The product representative is correct in stating that varnish is not FDA approved for the reduction of dental caries. However it is FDA approved as a cavity liner and a desensitizing agent. Its use as a caries-preventive agent is considered off-label, but is clinically acceptable as exhibited by its wide use in most U.S. dental schools and by the addition of the ADA-CDT procedure code, D1206 in 2007. The new code D1206 "Topical Fluoride Varnish: Therapeutic application for moderate to high caries risk patients" is used for the application of fluoride varnish to the entire dentition that may or may not be administered in combination with a prophylaxis for all ages. Fluoride varnish offers many advantages over tray applications in terms of patient acceptance, tooth coverage (especially for exposed root surfaces and around orthodontic brackets), and increased contact time with the tooth surface. I recommend reading the ADA report for additional information.