Regarding Fluoride Varnish
Regarding fluoride varnish, the frequency for average or elevated caries risk is 3-6 month application. What is the minimal time frame of application, such as for a high risk patient? Would 72 hours-2 weeks be too much exposure to 5% neutral sodium varnish?
Thank you for bringing up this question regarding the frequency of 5% NaF varnish application. I am sure many other clinicians have been thinking about providing multiple applications within a short period of time, but are unsure if the additional applications will provide any increased benefit over the 3-6 month application regimen which is based on current evidence (ADA Review, 2013). The short answer to this question is that we do not have evidence to tell us if additional applications (beyond every 3-6 months) will be beneficial or not, but I believe this question can best be answered by using an evidence-based decision-making (EBDM) model. EBDM employs a patient-centered approach to treatment decisions and integrates: 1) the clinical evidence, 2) the clinician’s expertise, and 3) the patient’s wants and needs. While I can see no harm in more frequent applications this is something you want to carefully consider and have a discussion with your patient to learn more about their treatment goals, financial situation (to pay for additional applications), and ability to come to the office for multiple appointments. In other words, the decision is based on the specific patient situation. For example, if you were seeing a patient at an elevated caries risk who is living in another country where there is no access to dental care and this patient is only in the U.S. for three weeks, once per week applications may be a consideration. However, for the majority of patients with an elevated caries risk I recommend adhering to the 3-6 month application regimen unless specific and unique circumstances require consideration of more frequent applications.