The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children

The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children
Tariq A. Alsahafi Mohammed A. alzunaydi nd 2 year students, Collage of dentistry. Qassim University

luoride varnish has been used widely as effective caries preventing agent in children, this paper discuss the rule

disproportionate number of low-income and minority children (2). Many researches and clinical trials have reviewed many ways in prevention of dental caries and that include topical applications of fluoride specially fluoride varnish. Fluoride varnishes have been described as the most convenient means of having preschoolers topical also use professionally-applied (3), to especially be among in fluoride

of fluoride varnish in the prevention of dental caries among children and to which degree it's effective. Previous systemic reviews and primary researches were used as basis for the current review. Application protocols and technique are demonstrated .Recommendations were established based on the developed knowledge.

children at high risk for tooth decay. It has Key words: fluoride varnish 'Dental caries 'Children been found effective preventing caries in permanent teeth. It is easy to apply and can be applied by oral health professionals as well as nonoralhealth professionals (4) . The purpose of this review is to assess the rule of fluoride varnish in prevention of dental decay among children.

Introduction
Early childhood caries is a worldwide health problem effecting most of the children especially in developing countries where the awareness of importance of selfprotecting and teeth brushing habits are not of that expansion (1). And it's also considered as the most common chronic disease of childhood and affects a

The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children

Fluoride varnish
Fluoride is most commonly associated with dental hygiene products and tooth protection. Most people are exposed to fluoride through treated drinking water or products such as toothpaste and mouthwash (5) . Fluoride also considered as the most scientifically proven method for avoiding the appearance of new lesions and curbing the progression of existing lesions and preventing the appearance of new ones (6). Fluoride varnish is a professionally applied, highly concentrated (22 600 ppm) fluoride product that has been widely used in Europe and Canada as a caries prevention agent for >20 years (2). Fluoride varnishes were developed more than thirty years (7). In the past decade, it has become more widely available in the United States. Fluoride varnish is an attractive option for the primary care setting because it can be easily applied by ancillary staff in <5 minutes, is generally acceptable to patients, and does not require special preparation of the teeth or expensive equipment. Fluoride varnish can also reverse early caries lesions (white spot lesions). Applications 2 to 4 times a year have been shown to decrease caries in the permanent dentition by 38%. (2)

Most

fluoride 5%

varnishes sodium

are

lacquers in a

containing

fluoride

colophony/resin base (see Table 1) (8).

Table I Fluoride Varnish Products

FDA approved (510k) as a medical device/desensitizing agent Duraphat Durafluor/duraflor Flour protector Cavity shield All solution fluoride varnish DuraShield Fluoridex Fluorilaq Flor-opal Enamel Pro Varnish

Fluoride agent

Primary base

5% NaF 5% NaF 1% difluorsilan 5% NaF 5% NaF 5% NaF 5% NaF 5% NaF 5% NaF 5% NaF

resin resin polyurethane resin resin resin resin resin resin resin

Depending preparations,

on

the

brand,

there

are

significant differences in fluoride varnish making comparisons difficult. Fluoride varnish provides a highly concentrated, temporary dose of fluoride to the tooth surface (9). The varnish holds fluoride close to the tooth surface for a longer period of time than other (10). concentrated fluoride products

Unlike low-dose fluorides available over the counter such as fluoride toothpaste, highly concentrated fluoride products such as fluoride varnish must be applied by a healthcare professional in most states. (11)

The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children

Fluoride

varnish

in

the

Steps (10): a) Prophylaxis prior (tooth brush or professional) prior to varnish application. b)Dry and Isolate quadrant that is ready to receive the varnish using cotton rolls. c) Dispense fluoride varnish as per manufacturers instruction. Usually 0.5-1 ml is more than adequate for the entire dentition. d) Apply varnish on tooth surfaces using a disposable brush or cotton applicator. The entire surface of the tooth must be treated. Avoid getting varnish on the soft tissue. The varnish then leaves fluoride rich layer adjacent to the tooth surface. e) The entire process takes 3-4 minutes. The general method of application is demonstrated in figure 1 (9).
Figure I. Fluoride varnish application

prevention of dental caries

All tooth surfaces undergo a cycle of demineralization and remineralization . Dental caries or dental decay is irreversible infection occur in demenarlized tooth surface caused by acid-producing bacteria that dissolve tooth surface resulting in greater demineralization (8). Topically Fluorides work in different ways to protect the teeth. Fluoride becomes concentrated in the outer enamel surfaces when applied over erupted tooth. Dental plaque and saliva act as fluoride reservoirs to enhance the remineralization process (8). In addition, fluorides interfere with the decay-causing bacteria colonizing on teeth and reduce their acid production, thus slowing demineralization. Fluoride also works by reversing noncavitated fissure carious lesions (5) .

Technique for application

One of the primary advantages of fluoride varnishes is their ease of application. There is considerable confusion as to whether a thorough prophylaxis is essential prior to varnish application. This may be advantageous who are afraid of the hand piece. from a behavioral standpoint in young patients (a) Areas of demineralized enamel on the primary incisors. (b) Teeth are dried with gauze square. (c) Varnish is applied to the tooth surface with a small brush. (d) After application ,a yellow film remains on the teeth

The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children

Duraflor and Duraphat set to cause a yellowish-brown temporal discoloration in tooth color. A tube of varnish of Duraflor or Duraphat should last for about 10-20 applications at an average cost of $0.80-$1.00 per application (12) Varnish will set on contact with saliva. It is alright for the child to eat or drink right away. Patients should avoid brushing their teeth for the rest of the day (10).

The use of one fluoride varnish product is contraindicated Known in patients or with: to - Ulcerative gingivitis and stomatitis (15). allergies reactions colophony (colophonium) or similar agents (16). Avoid ingestion during application. - Not to be used as a systemic treatment (10).

Advantages of fluoride varnish over other forms of Topical fluoride of

General Advantages of professional topical fluoride application include the ability to treat patients starting from a very young age, immediately teeth after the deciduous is anterior erupted. Application

Frequency

for

the

use

fluoride varnish
There are many application frequencies been used: 1. One application every six months (13); 2. One application four times a year; 3. Three application over a one week period; (10) But the most often used regimen is the semi-annual application for at least two years in moderate and high risk patients and annual application in low risk patients (9). Reapplication is necessary. How often it depends on the childs caries risk (14). Contraindication to the use of fluoride The commercially available fluoride varnishes have a fluoride content of 22.6 mg/ml (2). So the potential for ingestion and toxicity does exist.

necessary only two to four times a year. Providers and researchers find fluoride varnish easy to use and fast to apply (10). It can be swabbed directly on the teeth in less than 3minutes and sits within a minute of contact with saliva (8). Gels and foams require use of suction, air drying the teeth, trays that may trigger gag reflexes and several minutes of contact with the teeth (7). Fluoride varnish is safe and poses less risk of an adverse reaction since only a small amount is used (8). It can be applied in any setting and does not require the use of dental equipment or instruments. 4

The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children

Conclusion
Fluoride varnishes are considered as the most effective form of topical fluoride and the safer one. They prevent dental caries by prolonged contact with tooth surface and releasing fluoride and that inhabit enhance demineralization

Acknowledgment
The authors thank and appreciate Dr. Ramy Elmoazen lecturer of community dentistry for his assistance in preparing this review.

References
1. J.A. Weintraub, F. Ramos-Gomez, B. Jue, S. Shain, C.I. Hoover, J.D.B. Featherstone, and S.A. Gansky. Fluoride Varnish Efficacy in Preventing Early Childhood Caries. Journal of Dental Research. 2006, Vol. 85, 2. 2. Charlotte Lewis, Heather Lynch ,laura richardson. Flouride Varnish Use in Primary Care: What do Providers Think? Pediatrics. 2005, Vol. 115. 3. Denise Martins CarvalhoI,Mariana SalazarII,Branca Helosa de OliveiraIII, Evandro Silva Freire CoutinhoIV. Fluoride varnishes and caries incidence decrease in preschool children: a systematic review. Rev. bras. epidemiol. 2010, Vol. 13, 1. 4. flouride varnish: a Resource guide. Bertness J, Holt K,. Washington : National Maternal and Child Oral Health Resource Center, 2010. 5. Ernest Newbrun, D.M.D., Ph. Topical fluoride in caries preventing and management :A North American Perspective. Journal of Dental Education. 2001, Vol. 65, 10. 6. Joseph L. Riley, Joshua S. Richman, D. Brad Rindal,Jeffrey L. Fellows,Vibeke Qvist,and Valeria V. Gordan. Use of Caries Prevention Agents in Children: Findings from the Dental Practice-based Research Network. Community Dentistry and Oral Epidemiology. 2011, Vol. 39, 1. 7. R. Gary Rozier, D.D.S., M.P.H. Effectiveness of methods used by dental professionals for the primary prevention of dental caries. Journal of Dental Education. 2001, Vol. 65, 10. 8. Judith Feinstein Chair , Steven Geierman. Fluoride Varnish: an Evidence-Based Approach. U.S.A : Association of State and Territorial Dental Directors, 2007. 5

remineralization and it's important to note that fluoride varnishes are also effective on early white spots lesion.

Recommendations
The authors recommend the following strategies to be followed: 1- Community and schools programs should be provided by the government to make people aware of the importance of fluoride varnish and its efficacy in preventing dental decay in their children. 2- Fluoride varnish alone does not prevent dental caries. Oral hygiene still very important so parents must help their children and teaching them how to keep their teeth clean to maintain good oral hygiene. 3- Fluoride varnish should be applied based on the child risk of caries . 4- It's unnecessary to apply fluoride varnish for Children with no risk of caries

The Rule of Fluoride Varnish in the Prevention of Dental Caries among Children

9. Azarpazhoo. Fluoride Varnish in the Prevention of Dental Caries in Children and Adolescents: A Systematic Review. Journal of the Canadian Dental Association. 2008, Vol. 74, 1. 10. J., Vaikuntam. Flouride varnish:should we be using them? Pediatric Dentistry. 2000, Vol. 22, 6. 11. association, American dental. professionally applied topical flouride. USA : s.n., 2006. 12. Beltran-Aguilar ED, Goldstein JW, Lockwood SA. Fluoride varnishes. A review of their clinical use, cariostatic mechanism, efficacy and safety. JADA. 2000, Vol. 131, 5. 13. Bravo M, Baca P, Llodra JC, Osorio E. A 24month study comparing sealants and fluoride varnish in caries reduction. Journal of Public Health Dentistry. 1997, Vol. 57, 3. 14. P. Weinstein, a C. Spiekerman,a and P. Milgromb. Randomized Equivalence Trial of Intensive and Semiannual Applications of Fluoride Varnish in the Primary Dentition. caries research. 2009, Vol. 43, 6. 15. Isaksson M, Bruze M, Bjrkner B, Niklasson B. Contact allergy to Duraphat. Scand J Dent Res journal. 1993, Vol. 101, 1. 16. Sharma, PR. Allergic contact stomatitis from colophony. Dent Update . 2006, Vol. 33, 7.