Frequency Guidelines for Fluoride Varnish
Is the appropriate interval for fluoride varnish application among patients at average or slightly elevated caries risk every 3 months to 6 months? If so, what is the protocol for patients at high risk? Would applying varnish every 72 hours to 2 weeks be too much fluoride exposure?
I’m sure many oral health professionals have considered providing multiple fluoride varnish applications within a short period but are unsure if the additional exposure will provide further benefits. First, let’s look at the current recommendations for all patient age groups. As always, dental hygienists should look to the literature for guidance, while also incorporating their professional judgment and patient needs. In 2013, the American Dental Association (ADA) updated its recommendations on the use of professional and at-home prescription topical fluorides.1 The executive summary and chairside guide are available at the ADA Center for Evidence-Based Dentistry website:ebd.ada.org/ClinicalRecommendations.asp.
The ADA Council on Scientific Affairs recommendations are based on a systematic review of the literature that includes two types of professionally applied fluorides: 5% neutral sodium fluoride (NaF) varnish and 1.23% acidulated phosphate fluoride (APF) gel. The APF gel is administered in trays for at least 4 minutes. Children younger than 6, however, should only receive the 5% NaF varnish application due to the risk of adverse effects—particularly nausea and vomiting—associated with swallowing excess amounts of fluoride gel.
These recommendations are for individuals at increased risk of dental caries. No distinction is made between moderate- and high-caries risk. The current evidence-based recommendation is to apply fluoride varnish at least every 3 months to 6 months.2 There is no evidence that demonstrates additional applications (beyond every 3 months to 6 months) provide greater benefits. The best way to approach this question is to use an evidence-based decision-making model, which employs a patient-centered approach to treatment decisions and integrates:
- Clinical evidence
- Clinician’s expertise
- Patient’s wants and needs
While it’s unlikely that increased application of fluoride varnish will cause harm, it should be discussed with patients to learn more about their treatment goals, ability to pay for additional applications, and feasibility of returning to the office for multiple appointments. In other words, the decision is based on the patient. For example, for a patient at high caries risk who lives in another country where there is little access to dental care and the patient is only in the United States for 3 weeks, weekly fluoride applications may be indicated. For the majority of patients with an elevated caries risk, however, I recommend adhering to the 3-month to 6-month application regimen unless unique circumstances require consideration of more frequent use.
- Weyant RJ, Tracy SL, Anselmo T, et al. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systemic review. J Am Dent Assoc. 2013;144:1279–1291.
- Maguire A. ADA clinical recommendations on topical fluoride for caries prevention. Evid Based Dent. 2014;15:38–39.