Editor’s note: Originally published in 2020 and updated regularly
The effectiveness of fluoride in preventing tooth decay and dental hypersensitivity is well known. Fluoride treatments are supported by the World Health Organization, the Centers for Disease Control and Prevention (CDC), and many other agencies. Public water fluoridation is considered one of the most successful public health actions in fighting tooth decay, according to the CDC.1 There are many types of professional fluoride applications that can be provided in the dental office as a treatment for adults and children. The American Dental Association recognizes 5% sodium fluoride (NaF) or 2.26% fluoride varnish treatment for the benefit of caries prevention when administered at least twice a year to children up to 18 years of age.2 Sodium fluoride varnishes are also recommended for the prevention of root caries in adults when administered at least twice a year at preventive patient appointments. It is easily interpreted that fluoride varnishes are beneficial for all age groups, especially children and people at high risk of caries.3 So what is the best type of nail polish and what are the differences between the various topical fluoride treatments?
Currently, we have no studies to support the clinical benefits of one type of occupational fluoride treatment over another. It has been shown that the frequency and duration of tooth contact with fluoride are the biggest factors contributing to the success of a treatment method. When comparing fluoride carriers such as nail polish to toothpaste and mouthwash, there are no proven benefits of any particular delivery system.4 So, why a polish, and what should we look for in one?5
Why varnishes?
As a delivery system, varnish is preferred for its ease of use, prolonged fluoride exposure time, and relative safety. A concern with other carrier methods is that there is an increased risk of swallowing, as well as reduced tooth contact time. Most varnishes on the market contain 5% NaF with an alcohol and resin based solution. The evaporation of the alcohol causes the system to dry quickly and the resin works to allow the fluoride to adhere to the teeth. The most common resin additive is colophony, a rosin derived from pine sap. The carrier is the cause of the main complaint about the varnish, as it is “sticky” and leaves a noticeable film on the teeth.2
You may also be interested in: 3 ways hygienists can boost acceptance of fluoride varnish
Product comparison
Not all products are created equal, as science has developed different additives to put into polishes in an attempt to increase their effectiveness. Here is a comparison of some of the most common polishes on the market.
Duraphat (Colgate) was the first varnish on the market in 1964. This varnish contains 5% NaF suspended in an alcohol-based solution of natural resins. Duraphat varnish is tinted. This is stated to be for easy visualization. The product has a high viscosity.
MI Varnish (GC America) it’s like no other polish. Contains 5% NaF + Recaldent (CPP-ACP). Recaldent is a new combination of casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP). Casein peptide occurs naturally in milk and binds to oral cavity teeth, mucosa, and even biofilm, which allows ACP to stabilize until it reaches the teeth to recalcify tooth structures.7 MI paste and Recaldent have been extensively studied and proven to be an effective way to remineralize teeth.
Fluor Protector S (Ivoclar Vivadent) differs in that it contains 1.5% ammonium fluoride (NH4FA). This varnish uses ethanol and water as solvents to allow reduced viscosity and increased wetting and flow. After evaporation of the solvent, the fluoride concentration is up to four times higher on the tooth surface, providing a local fluoride content of 3%. To increase effectiveness, a polymer additive helps the varnish adhere to the teeth. Its transparency, homogeneity and fine viscosity provide a high level of patient acceptance and satisfaction.8
Kolorz ClearShield (DMG America) contains 5% NaF. This polish, as it’s called, goes on completely clear for an aesthetic look. This product enhances the polish experience with its many different flavor options, including watermelon, bubblegum, peppermint, cookie dough and caramel, making every polish treatment more enjoyable.
Vanish Varnish (3M) is a unique product in that it has been shown to release fluoride over the course of 24 hours. As we have read, one of the biggest indicators of the effectiveness of a fluoride treatment is its duration. The longer the exposure to fluoride, the greater the effect it can have on the teeth. Another unique ingredient in this product is that it has calcium phosphate, in addition to NaF, to help remineralize teeth. This varnish is a suspension of modified alcohol-based rosin. The product reports increased fluidity and reduced film thickness.9 Another important advantage of this varnish is its effectiveness on polished and unpolished teeth, as well as in wet or dry environments. The extended release of the product is also a big plus.
bibliographical references
1. Water fluoridation basics. Oral Health Sector. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention website. https://www.cdc.gov/fluoridation/basics/index.htm. Updated January 24, 2020. Accessed February 17, 2020.
2. Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc. 2006, 137(8):1151-1159. doi:10.14219/jada.archive.2006.0356
3. Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention: Summary of updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013;144(11):1279-1291. doi:10.14219/jada.archive.2013.0057
4. Marinho VCC, Higgins JPT, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthwashes, or gels, or varnishes) versus another for the prevention of dental caries in children and adolescents. Cochrane Database Syst Rev. 2004(1): CD002780. doi:10.1002/14651858.CD002780.pub2
5. Carlinsey KL. Fluorine varnishes: Why they work and what to look out for. EC Dent Sci. 2016? 5 (6): 1220-1223.
6. Martel S. A new generation of fluoride varnish is coming to you. Oral Health Group website. https://www.oralhealthgroup.com/features/new-generation-fluoride-varnish-coming/. Published September 14, 2017.
7. GC America proudly presents MI Paste & MI Paste Plus. Frequent questions. GC America MI Paste Family Website. http://www.mi-paste.com/FAQ_MIP.php.
8. Fluor Protector S. Ivoclar Vivadent website. https://www.ivoclarvivadent.com/en/p/all/fluor-protector-s.
9. White varnish 3M Vanish 5% sodium fluoride with calcium phosphate. 3M website. https://www.3m.com/3M/en_US/company-us/all-3m-products/~/3M-Vanish-5-Sodium-Fluoride-White-Varnish-with-Tri-Calcium-Phosphate/?N =5002385+8710872+8713393+3290273727&preselect=8747108&rt=rud.
