Dental caries is considered the most prevalent chronic disease affecting children and adolescents, though cavities are not a problem for only the young. Studies show that 90 percent of adults aged 20 to 64 years, and 96 percent of the elderly, suffer from dental cavities, as well.
Considering that cavities are a concern across all age groups, and fluoride is the single most effective tool to prevent dental cavities, then it means that anyone can benefit from fluoride treatments, including varnish.
According to Cochrane review, fluoride varnish is highly effective for children and adolescents at higher risk of dental caries due to limited access to fluoride from other sources. In fact, it can reduce the risk of cavities in primary teeth by 37% and in adult teeth by 43%.
Although fluoride varnish is mostly used for children between the ages of 3 and 14 years, it can be used in babies and toddlers, starting from the moment the first tooth erupts, and the treatment maintained at an interval of 3 to 6 months. Adults suffering from sensitive teeth, chronic tooth decay, or have thin tooth enamel can also benefit from fluoride varnish treatments.
So there’s no age limit to the use of fluoride varnish treatments, and is actually recommended for anyone at high risk of dental caries.
What are the risk factors of dental caries?
According to the American Dental Association (ADA), dental caries, also known as tooth decay or cavities, is a bacterial infection that causes demineralization and destruction of the hard tissues of the teeth. It is caused by the interaction between bacteria, food, and the production of acid, which can lead to the formation of holes or cavities in the teeth.
Dental caries can cause pain, tooth sensitivity, and even tooth loss if left untreated. It is one of the most common chronic diseases affecting both children and adults.
Risk factors for adults
Topical fluoride treatments through varnish can be beneficial for all age groups including adults who:
- Have dental sensitivity
- Have thin tooth enamel
- Have excess tooth wear due to grinding and clenching
- Suffer from chronic tooth decay
Fluoride varnish for toddlers and children
Fluoride varnish application is recommended for infants and children with a moderate to high risk of developing cavities. Children may be considered at risk if they:
- Had cavities in the past, or have white spot lesions and stained fissures
- Continue to use the bottle after their 12 months or sleep with a bottle containing sugary liquids
- Breastfeed on demand at night after teeth emerged
- Have a developmental disability or special needs
- Have a tendency of using high sugar oral medications
- Have visible plaque on teeth
- Regularly consume cariogenic drinks or snacks
- Have busy parents or caregivers who don’t monitor oral care at home
- Don’t have access to fluoridated water or fluoride supplementation
- Have family members with a history of caries
- Engage in ad lib use for extended periods with a bottle or sippy cup containing liquids other than water
Contraindications
Although fluoride varnish is generally safe for use, it is not recommended for children at low risk of cavities, especially if they have access to optimally fluoridated water or receive other kinds of fluoride treatments from a dental professional.
It is also not recommended for people with:
- Ulcerative gingivitis and stomatitis (trench mouth)
- Known allergies or reactions to colophony (Rosin) – a pine tree ingredient found in medicines, adhesives, chewing gum, and cosmetics
Reasons for varnish treatment for all age groups
The ADA recommends fluoride applications in high-risk patients at a 3-month interval to:
- Reduce hypersensitivity along the gum line
- Improve tooth enamel resistance to acid erosion
- Inhibit plaque formation and dental caries in the long-term
- Address sensitivity after teeth whitening
- Inhibit demineralization and promote remineralization to reduce caries incidence in high-risk patients
Fluoride varnish for caries management
The American Dental Association recommends the use of various fluoride treatments to prevent cavities in all age groups, including:
- Sealants + 5% sodium fluoride (NaF) on occlusal surfaces (biting surfaces of back teeth)
- 5% NaF on approximal surfaces (surfaces in-between adjacent teeth)
- 5% NaF or 1.23% APF gel on facial or lingual surfaces (front and back surfaces of teeth)
Modern fluoride varnish are conveniently packaged for easy and convenient use. They also have a pleasant taste, set quickly, and result in little to no discoloration. The common ones include:
- Duraphat, which is a 5% sodium fluoride formulation in a colophonium base, marketed by Colgate Oral Pharmaceuticals.
- Fluor Protector, which contains 1% difluorosilane in a polyurethane base, has a lower pH than Duraphat, and is supplied in vials by Ivoclar, North America.
- Duraflor, which is similar to Duraphat but also contains the artificial sweetening agent xylitol and is distributed by Medicom.
- CavityShield, which is a unit-dosed fluoride varnish containing 5% sodium fluoride in a resinous base, supplied in individual pouches by Omnii Products. The advantages of CavityShield are that it avoids waste, provides a controlled amount of fluoride, and reduces the chance of over-ingestion and fluoride toxicity.
Cost of fluoride varnish treatment
The cost of fluoride varnish application can vary depending on various factors, such as the location, the dentist or dental professional administering it, the type of varnish used, and the number of applications required.
The estimated cost per application for each of the varnishes is:
- Duraphat: $1.25-$2.50 – a tube has about 10ml for 10 applications
- Fluor Protector: $4.00 – one box has about 20 vials for 20 applications
- Duraflor: $1.00-$2.00
- CavityShield: $3.00-$3.75
That said, fluoride varnish treatment is covered by insurance for children and teens on Medicaid or CHIP, so they will get the treatment for free. It can also be provided free-of-charge by certain programs that run through schools.
If paying out of pocket, the cost could be included in your routine dental checkup, or paid separately from as little as $25 depending on the factors mentioned above.
Takeaway
Fluoride varnishes are effective and safe for delivering and retaining fluoride on tooth structure, promoting remineralization, and inhibiting demineralization.
They are most effective when used on early white spot lesions with an intact surface layer.
Fluoride varnishes are a useful alternative for caries control in special needs patients and those undergoing orthodontic treatment.
They are easy to apply and relatively safe, making them a suitable tool for prevention in community-based dental programs.
