In-office treatments like fluoride varnishes and foams can help your patients keep their teeth healthy between visits. But which product is best when it comes to preventing cavities, gingivitis, enamel loss and periodontitis?

Studies show that when factors such as ease of application, immediate and long-term efficacy, and patient safety, tolerability and acceptance are considered, varnish comes out the clear winner. Here’s why:

Benefits of fluoride varnish

From the 1940s through the 1970s, clinical trials documented the benefits of professionally applied fluoride in reducing dental caries.1, 2, 3 As a result, fluoride varnish has been used as a caries preventive agent in Canada and Europe since the 1970s.4 In 1996, Health Canada changed the classification of fluoride from an element that is essential for growth and reproduction to an element that has a “beneficial effect on dental caries.”5

In the United States, the FDA has yet to approve varnish for the prevention of caries. However, it has been approved since 1994 as a Class II Medical Device (FDA 510k compliance) for use as a cavity liner. However, the use of topical fluorides is now recognized as effective by leading oral health organizations, including both the American Dental Association8 and the Canadian Dental Association,6, 7 and many dental professionals across U.S. the choose to use fluoride varnish “off-label” because of its proven effectiveness in preventing dental caries.9, 10

Whereas there is abundant evidence to support the efficacy of fluoride varnish, the opposite is true for fluoride foam.

Efficacy

When it comes to efficacy, research has shown that fluoride varnish far outweighs fluoride foam. In fact, studies have found that whereas, on average, foam reduces caries by approximately 25% in adults and adolescents11 and around 40% in children, varnish reduces the incidence of caries by between 50% to 70% across the board.12

In addition to being more efficacious than foam upon application, studies have proven that the protective effects of fluoride varnish last longer. In a head-to-head study,13 researchers used computer imaging to compare the effects of fluoride varnish and fluoride foam over several weeks. Although no significant difference was found one week following application, after the second week, the study found that the effects of fluoride varnish last significantly longer than those of fluoride foam.

Ease of Application

Another benefit of fluoride varnish is how quickly and easily it can be applied to teeth. For dental professionals, this means that learning proper application requires minimal training and that application requires minimal chair time. This leaves more time for scaling, reviewing proper oral hygiene techniques, taking x-rays and performing all other tasks within the allotted appointment time. For patients, fast and easy application means shorter and more comfortable treatments.

Conversely, fluoride foams must be dispensed into individual applicator trays for upper a lower teeth. Because upper and lower teeth are generally treated separately, fluoride foam treatments require longer chair time and longer periods of potential discomfort for patients. In addition, trays are easy to overfill, causing overflow, mess and waste, not to mention a higher risk of ingestion by the patient.

Superior Safety and Tolerability

Because fluoride varnish is applied directly to teeth, it sets very quickly and adheres to the teeth. This means that not only do you need to use less substance, but the minimal amount used is less likely to be swallowed than fluoride foam.

In addition to being safer than fluoride foams, fluoride varnish is easier for dental professionals to apply to children’s teeth and more comfortable for the pediatric patients because fluoride varnish comes in a variety of flavors. This is especially helpful given that the American Academy of Pediatrics recommends that fluoride varnish treatments begin as early as initial tooth eruption. In fact, the ADA recommends fluoride varnish over foam for children under six years of age, not only due to its superior efficacy but also due to the fact that the risks of ingestion posed by foams outweighs its potential benefits.

Less likely to trigger gag reflex

In addition to being safer and more comfortable than foams for application in children, fluoride varnish is also more comfortable for older patients who have a strong gag reflex. Whereas fluoride foam application requires the use of a tray that can trigger a gag reflex, fluoride varnish can be applied directly to the teeth, ensuring a more comfortable experience for the patient.

Bioavailability

Aside from their potential to trigger a patient’s gag reflex, dental fluoride foams can cause dental fluorosis and other unwanted side effects. This potential for harm depends on bioavailability, i.e., the amount of a substance introduced into a patient’s circulation when applied to any part of the body. Whereas the bioavailability of fluoride varnish is minimal, meaning that it will have little or no effect on the rest of the body, fluoride foams can have a significantly higher level of bioavailability. In other words, even though the concentration of fluoride is higher in varnish, less is swallowed than with foam, making varnish safer for both children and adults.

Cost-Effectiveness

Although safety and efficacy are critical, cost-effectiveness must also be considered. In addition to fluoride varnish taking significantly less time to apply and requiring less training to apply than foam, its cost-effectiveness is further increased when comparing how fluoride varnish is packaged versus how fluoride foam is packaged.

Fluoride foam is nearly always packaged in a single, large foam-dispensing bottle, allowing dental professionals to dispense as much foam as they see fit. However, trays are often overfilled in an effort to ensure that every tooth is properly coated for the duration of the treatment. As a result, too much foam is often used, resulting in overflow that goes to waste. Conversely, most fluoride varnish treatments are available in unit-dose package. This ensures that exactly the right amount of product is used, resulting in less waste and significant savings.

Conclusion

Whereas there is little evidence to support the efficacy of fluoride foams, the opposite is true for fluoride varnish. Fluoride varnish has been proven to have greater efficacy when it comes both treating sensitive teeth and reducing caries. Fluoride varnish is also more cost-effective and safer to use.

Choosing a fluoride varnish

Despite their clear superiority over fluoride foams, not all fluoride varnishes are created equal. Here are several factors to consider when choosing a fluoride varnish:

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  • Formula
  • Potential allergens:
  • Texture
  • Available flavors
  • Color
  • Packaging

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  • Look for a varnish formulated with 5% sodium fluoride and an adhesion agent to ensure adherence to teeth. A formula sweetened with xylitol and that leaves only a very thin film on teeth is appreciated by patients.
  • Many dental varnishes contain ingredients with the potential to cause serious or even fatal reactions. It is therefore safest to choose a formulation that does not contain tree nuts, peanuts, sesame, corn, shellfish, egg, soy, dairy products or gluten.
  • A smoother texture makes varnish faster and easier to apply and provides better coverage.
  • Because individual preferences vary, offering a range of flavors is appreciated by patients of all ages.
  • A varnish that dries nearly invisible/natural enamel color is preferable to one that leaves a yellow tint on teeth.
  • Individual dose cups are convenient to use and help reduce the risk of cross-contamination.
Formula
Look for a varnish formulated with 5% sodium fluoride and an adhesion agent to ensure adherence to teeth. A formula sweetened with xylitol and that leaves only a very thin film on teeth is appreciated by patients.
Potential allergens:
Many dental varnishes contain ingredients with the potential to cause serious or even fatal reactions. It is therefore safest to choose a formulation that does not contain tree nuts, peanuts, sesame, corn, shellfish, egg, soy, dairy products or gluten.
Texture
A smoother texture makes varnish faster and easier to apply and provides better coverage.
Available flavors
Because individual preferences vary, offering a range of flavors is appreciated by patients of all ages.
Color
A varnish that dries nearly invisible/natural enamel color is preferable to one that leaves a yellow tint on teeth.
Packaging
Individual dose cups are convenient to use and help reduce the risk of cross-contamination.

Medicom offers several dental varnishes that meet all of these criteria. Our latest formula, Duraflor® Ultra ™ white 5% sodium fluoride varnish, delivers our fastest fluoride release*.
Duraflor Ultra’s advanced formula quickly releases fluoride within 2-4 hours, so patients receive the maximum fluoride benefit while the varnish is still on their teeth. Duraflor Ultra
Does not contain gluten, peanuts, tree nuts, soy, sesame, corn, shellfish, eggs or dairy**.
Sweetened with xylitol, it does not contain saccharin or aspartame. Easy to open unit doses of 0.4 ml are available in 30-count and 200-count boxes.

Duraflor® Halo™ 5% Sodium Fluoride Varnish contains the highest allowable fluoride concentration. Convenient “peel and apply” package minimize mess and risk of cross-contamination. Dries to a natural white color for increased patient compliance. Duraflor Halo does not contain gluten, peanuts, tree nuts, soy, sesame, corn, shellfish, eggs or dairy Patients will enjoy all of the great tasting flavors sweetened with xylitol.

* Data on file
** IMPORTANT: Caramel flavor contains milk butter acids.

View our complete selection of dental preventives at Medicom.com.

References

  1. Horowitz, H.S., Ismail, A.I.: Topical fluorides in caries prevention. In: Fejerskov, O., Ekstrand J., Burt B.A., eds. Fluoride in dentistry. 2nd ed. Copenhagen: Munksgaard, Chapter 17, 1996.
  2. Johnston, D.W.: Current status of professionally applied topical fluorides. Community Dent Oral Epidemiol 22(3): pp. 159–163, 1994.
  3. Stookey, G.K., Beiswanger, B.B.: Topical fluoride therapy. In: Harris, N.O., Christen, A.G., eds. Primary preventive dentistry. 4th ed. Norwalk, CT: Appleton and Lange, pp. 193–233, 1995.
  4. Centers for Disease Control and Prevention: Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR Recommendations and Reports 50(RR14): pp 1-42, August 17, 2001.
  5. Canada. Health Canada: Fluoride. Ottawa: Health Canada, pp. 1–19, August 1996, edited February 1997.
  6. Canadian Dental Association: Fluorides: current information for dental personnel. Ottawa: CDA, 1992.
  7. Canadian Dental Association: Patient information sheet on fluoride and dentistry. Op. cit.
  8. Stookey, G.K.: Critical evaluation of the composition and use of topical fluorides. J Dent Res 69: pp. 805–812, 1990.
  9. Beltran-Aguilar ED, Goldstein JW. Fluoride varnishes: A review of their clinical use, cariostatic mechanism, efficacy and safety. JADA 2000; 131:589-594.
  10. Vaikuntam J. Fluoride varnishes: Should we be using them? Pediatr Dent 2000; 22:513-516.
  11. Hercules DM, Craig NL. Fluorine and tin uptake by enamel studied by x-ray photoelectron spectroscopy (ESCA). J Dent Res. 1978 Feb;57(2):296-305. doi: 10.1177/00220345780570022601. PMID: 277526.
  12. Clark DC. A review on fluoride varnishes: an alternative topical fluoride treatment. Community Dent Oral Epidemiol. 1982 Jun;10(3):117-23. doi: 10.1111/j.1600-0528.1982.tb01334.x. PMID: 6955115.
  13. Khattak MF, Conry JP, Ko CC. Comparison of three topical fluorides using computer imaging. J Clin Pediatr Dent. 2005 Winter;30(2):139-44. doi: 10.17796/jcpd.30.2.04746702m229p556. PMID: 16491969.
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