Hussein Hassanali assesses the effectiveness and value of four preventive fluoride varnish applications for children.
I don’t need to lay out the benefits of fluoride; we all know its importance in maintaining oral health and its role in preventive dentistry.
With the shift towards minimally invasive dentistry, the evidence base for fluoride and remineralisation continues to grow. In the motivated patient, fluoride can even lessen the need for operative dentistry.
What I’ve discovered is that acceptance of preventive applications for children isn’t easy. Many return for check-ups asking whether they ‘have to have that yucky stuff on their teeth again’. Most, at best, tolerate it, but it’s definitely not their favourite part of coming to the dentist.
As an adult, I can understand the reasons of short-lived application for long-term gain. To children, it’s tricky to explain. So, I tested some myself to see what there was to dislike about them.
The main process involves applying fluoride varnish to dry teeth with a brush. It’s advised to avoid eating, drinking, or rinsing for 30 minutes, then stick to only soft foods for four hours after application.
I don’t think there are many children out there willing to hold out that long, especially when most want to gulp down the first thing in sight to take away the taste. Then, limiting what they can eat for the remaining time requires a police negotiator!
Fluoride varnish put to the test
Colgate Duraphat is a licensed product for caries prevention that’s mentioned in Delivering better oral health: an evidence-based toolkit for prevention. While it clearly states other products are available, it’s up to us as prescribers to ensure they are suitable.
Duraphat comes in a single flavour, which I found to be sweet and very sticky. There is a tacky coating and the teeth are visibly discoloured. I felt it took a couple of weeks to get some stubborn bits off. It’s also contraindicated in those that have a history of allergic episodes requiring hospital admission.
We provide Voco Profluorid varnish in our practice. The variety of flavours is helpful for fussy children, but I believe caramel and bubblegum send out the wrong message. For me – as someone with a sweet tooth – the caramel flavour was extremely sweet, but children love it.
The ability to apply this to wet surfaces makes it easy with wriggly kids. However, the strange, bland aftertaste and film-like coating that sloughs away isn’t pleasant.
Ivoclar Fluor Protector S claims to have the highest fluoride content. While the others start at an optimum concentration of 22,600ppm, which decreases over time, Fluor Protector S claims to start at 7,700ppm, but increases fourfold over a one-hour setting period to 30,800ppm. Does this really offer a statistically significant benefit? I feel that a fluoride varnish that increases in concentration offers more benefit. It’s easy to apply because of its low viscosity and applicator brush, leaving a nice thin layer that you can hardly taste or tell is there.
3M Clinpro White fluoride varnish comes in three flavours, and straight out of the pouch you can smell how fruity they are.
In terms of taste, they have a sweetness that gives it likability without making it sickening. It’s also easier to distinguish the flavours, which makes them quite tasty and preferable to younger patients.
There’s a creamy consistency that still leaves a noticeable coating on the teeth, but not to the same extent as a couple of the others.
To keep costs down Duraphat, Profluorid and Fluor Protector S is purchased as tubes. This can make it tricky to measure out, even though Colgate does have a dosing pad for Duraphat and Fluor Protector S has applicator brushes. Profluorid and Fluor Protector S are available in single-dose measures, but at greater costs. Clinpro White is only available in single-dose packets. This means you are certain of applying the correct amount as recommended unless you are willing to measure it out on microscales each time.
Taking prices into account, it’s easy to see why Duraphat and Profluorid are market-leaders and first choice of most practices. This is especially true of NHS practices that don’t get a choice in fee setting.
While tubes may look economical on paper, this doesn’t mean it will cost less in practice. Accidentally squeezing too much out causes unintended waste. Suddenly, it might not be such a great price after all, as you can’t push it back in.
Based on my experiences, I prefer Fluor Protector S for both patient and clinical reasons. From a patient viewpoint, it’s clear and colourless, and doesn’t leave a claggy coating over the teeth; it’s far more pleasing in the mouth. The shorter waiting time of only one hour compared with the others gives confidence of having the required benefit.
From a clinical point of view, it’s liquid, which makes it easy to apply and it flows well into fissures and pits – exactly where you want it to be. It may cost more, but I know I’m dosing correctly without waste and my youngest patients aren’t hating me, which keeps families happy, too.
I don’t remember fluoride varnish application when I was a child. But I hope it goes a long way towards reducing levels of dental caries for today’s and future generations. We can only hope to dream that, one day, this preventable disease and its debilitating effects on wellbeing is mitigated as much as possible.
Author: Hussein Hassanali qualified in 2009 from Liverpool University. He spends most of his time providing NHS dentistry
Published first in Dentistry magazine.
*Original article online at https://www.dentistry.co.uk/2019/11/26/fluoride-varnish-taste-test/