Tuesday, August 25, 2009

Fluoride Varnish

Remember when your dentist put that sour gel stuff in a giant foam tray put a straw suction tip in your outh and let you sit like that for 5 minutes? That flouride treatment was to help prevent tooth decay. Now there are some better options than that aweful gel. Fluoride Varnish is the most elegant version of office applied Fluoride.

Now there are a hundred different kinds of fluoride and many ways to apply fluoride. There is the fluoride in the drinking water, which you might drink every day which has been statistically proven to prevent tooth decay in large academic studies. That concentration is about one part per million of fluoride ion (ppm). The oral rinses you get in the grocery store are about 200 ppm. Toothpaste has about 1000 ppm. Once you get into those kinds of ranges you really don't want to swallow large amounts of fluoride. That's why we do not recommend regular toothpaste for very young children (under two) and we ask older children and adults to rinse and spit after brushing. The kinds of fluoride we apply in the office are much higher concentrations, usually of a version called APF or Acidualted Phosphate Fluoride (the sour stuff) or sodium fluoride. There has always been a concern for children that you don't want them to swallow too much fluoride during an in office delivery-those concentrations can be around 22,600 ppm! Foam systems were developed and we use that from time to time as you can get the fluoride on the teeth more easily without such a large total dosage.
Now there is an even better way-especially for children-Fluoride Varnish. It's sort of a thick liquid you paint on the teeth coating a concentrated dose of fluoride right up against the teeth, but in total dosage it is quite small. Better yet, long after the patient has left the office, it bathes the teeth in fluoride. It lasts for a few hours or until the patient brushes. It actually tastes pretty good, kind of like bananas I think. The first version thay had was called Duraphat. It was good, but was yellow colored and although very good, it always bothered patients to leave the dental office with goopy yellow looking teeth even if it was just for a few hours. Now they have improved the color. It's a sort of clear/white colored material. It is painted on and once it gets wet, it hardens up a little. Pretty cool, huh.

ADA on Fluoride

More info and video:
Vanish brand varnish from 3M
CDC on fluoride products

24 comments:

nyscof said...

Fluoride varnish contains a hugely toxic 26,600 parts per million fluoride - some of which invariable gets absorbed or involuntarily swallowed - spiking blood fluoride levels.

Your patients need to be told about fluoride's side effects

http://www.FluorideAction.Net/health

Dr. Dean Brandon said...

There are always folks that are what are someitmes called "anti-fluoridationists" who are convinced that Fluoride in any form is dangerous. Yes, too much fluoride over a long time is not good for developing teeth and can lead to fluorosis. You also don't want too much swallowed fouoride either-can give you a tummy ache and other things. Professionals, Universities and Scientists over many years have researched this stuff and the links I provided from the ADA should be some information on peer reviewed long term scientific studies of larger populations to reassure the public as to safety and effectiveness. BTW,the doses in varnish are just as high as gels-always have been, but in varnish the "total" dose/quantity is much lower and it is located where you need it. That is one reason why the ADA recommends it in children.

For future reference, I am not going to get into all the fluoride controversy here on this blog. I suggest further reading through the American Dental Association and American Academy of Pediatric Dentistry.

john said...

This is nice one... It may be cure the dental issues...

john korner

Dentist in chennai

Houston Dentist said...

I read your blog vey carefully .i think it is very knoledegable information for everyone.

Anonymous said...

Can to much Fluoride cause cavities?

Dr. Dean Brandon said...

No. A bacterial process causes cavities through decalcification of tooth enamel. Too much fluoride can cause fluorosis-(the enamel forms improperly), but is actually very resistant to tooth decay.

Anonymous said...

Nice information on what is available for patients.
I would like to respond to the incomplete comments made by Nyscof, “some of which invariable gets absorbed or involuntarily swallowed - spiking blood fluoride levels.”
Varnish is a great choice, the ppm are higher but only a small amount is applied. The varnish holds fluoride close to the tooth surface for a longer period of time than other concentrated fluoride products. This provides for fluoride uptake into the tooth enamel (making the teeth stronger) and fluoride which is available in the saliva (to take on acid attacks when drop in pH in the mouth). The picture you show of the varnish even has calcium and phosphate in the ingredients, so any extra fluoride is actually calcium-fluoride ion which does NOT get absorb or is it adsorb(or both) into the bloodstream or attach to bone but leaves the body as waste. I understand Nyscof passion on “anti-fluoride” and the never ending debate, but caries are preventable and any option to assist people with good oral health which in turn provides good overall systemic health is essential. I am not a doctor, nurse, dentist or hygienist but just someone who has been exposed to people from all levels of demographics and poor oral hygiene is epidemic. Good Luck.

Laura K. said...

Here in Holland they do not do flouride treatments. Do they do them in America still? I will never forget the orange one.. oh, no not ever..ewwwww. They also do not put flouride in the drinking water I'm told.

We were surprised at our last checkup (hadn't been 2 yrs.. yes spank us!) that I had 6 cavities (and I've had 3 before in my entire freaking life.. so 6 shocked me half to death!), my husband had 5 and our 6 yr old had 3. I expected some kind of "most cavities in a visit for a family" award.

When we were making our fillings appointments the desk lady commented that it seems since they stopped doing fluride treatments (I don't remember how many years ago they did) that they seem more and more people with more and more cavities than usual.

Is there something we can do to help ourselves? I have such a fear of the dentist and just getting tne novocaine to be numbed is a big issues for me so I would like to prevent myself from getting more and to insure we do the best for our children.

I do notice that my teeth seem awfully 'thin'? I'm not sure how to describe it but they don't feel strong at all. I didn't have this problem before I moved to Holland.

thanks again for your time,
Laura

laurasnow@home.nl

Dr. Dean Brandon said...

I have observed in Europe they are a little different as far as things like Fluoride. If there is no fluiride in the drinking water, you can expect more cavities. Not necessarily a particular person, but as a statistical group. I find your experience there is consistant with that. I always advise using fluoridated toothpaste at home (for children over the age of two). There are also oral rinses you can buy (at least here) like "ACT" fluoride rinse that you could use at home. It is good to get advice of a dentist so you are doing these things correctly.

Anonymous said...

Hi Dr. Dean...

My family lives in a small city in Oregon that doesn't have flouride in the water (which we just learned about recently). My baby is 11 months old and has 6 (almost 8) teeth that have never had any flouride. I noticed today that her top teeth (just came in a couple weeks ago) are starting to turn kind of gray. It's not gray on the outside of her tooth, but on the inside. The two bottom edges of each tooth are still white, though. Her other teeth look white and fine.

Do you think this could have to do with the lack of flouride? I can't remember any trauma to the teeth that would cause anything like this. I am worried that she will always have gray teeth!

Any information you could provide would be fabulous.

Sincerely,
Concerned Mommy

Dr. Dean Brandon said...

I cannot diagnose here, but you may want to read this:

Spots on teeth

Also, sometimes I see (usually on little babies) a grey stain from vitamines that is easily cleaned off by the detnist. Could be something else too. Get you pediatric dentist to check it out.

Joanneke said...

Hi Dr. Dean Brandon,
i am very happy to read your blog. I am originally from Europe and my teeth are a disaster because of a lack of fluoride ( and poor skills of my former dentist...) I was happy to have had a fluoride varnish done at my dentist, and now my family members who still live in Europe would like some as well. unfortunately, I could not order any online for them, since I am not a dentist myself. Do you have any idea how I can get some for my family as well?
Thank you so much!

Dr. Dean Brandon said...

The prescription strength fluoride varnish I am talking about in this post is well, by prescription only. To my knowledge only a dentist can apply this in office. It is not for daily use at home. Home fluoride is generally in the form of a mouth rinse.

Anonymous said...

My child received the floride varnish treatment and is complaining to the point of tears about the taste. (Literally, she's crying.) She refuses to eat (because it tastes so bad) and greatly desires to brush it off. She is spitting every two minutes. We have been told not to brush it off prior to eating and to brush only at bedtime: not before. (My child now thinks a 6:30PM bedtime is more than acceptable.) What damage will be done to her teeth if we go ahead and brush it off prior to her eating and well before the standard 9:00 PM bedtime? Please advise quickly. It'll be greatly appreciated by a concerned mom and an upset/anxious child. Thank you.

Dr. Dean Brandon said...

The more time it is on the teeth the fluoride has more of a chance to work. It naturally goes away/wears off with brushing and or eating. It's up to you. More time, better cavity protection, less time, more peace in the house.

I have personally tasted the stuff and it's pretty pleasant and mild. I have never heard of kids complaining. However, I do see some kids who are averse to toothpaste--any flavor.

Anonymous said...

i am from the philippines...and i would like to ask if my 2 y/o baby is safe to try the flouride varnish....thanks so much!

Dr. Dean Brandon said...

In most cases fluoride varnish is appropriate for young children. The amounts of total fluoride are far less than previous formulations.

Anonymous said...

My daughter is turning three next month, I noticed white spot leasions on her teeth three months ago. Went to the dentist right away, her diet consisted hugely of fresh fruit, no juice no, candy but then bad habit of ice cream at night. Went to dentist and got Florid Varnish. Varnish seems to have helped but white spots ate through enable on canine and now you can see dentine, varnish has now hardened dentine on canine and we now brush three times a day with electric tooth brush for children but her rear molar teeth seem to keep getting worse. No fruit now, no sugar nothing but they just get worse. I can now see two black cavities in her molars that were not there three months ago. We have used Varnish three times in four months and dentine is now hardening but white spots still present, better on front side but worse on rear secondary molars, its like the white spots were so bad that it took weeks if not months for them to take away the enamel. In any case, wondering how much varnish is too much? Once a week? Once a month? Once every three months? Tried everything but nothing is making them better, her diet is great, added calc salts, brush three times a day, xylital and so on. Just getting worried that there might be an underlying issue. If white spot lesions are sever is it just no going back? Im confused as when we were at dentist three months ago they said I was over reacting and she was going to do fine with the lesions, fronts side are pushing new healthy growth up from gum line raising the lesions up but second molars seem soft and like they are eating away. Any suggestion would be great as I have read all your blogs, you are incredible insightful and it is much appreciated that you provide this blog as it seems to be the most knowledgable straight forward I have found in three months of research. Thank you. Also her front teeth are perfect top and bottom, canine and back is the problem.

Dr. Dean Brandon said...

Well, it sure sounds like the teeth are gettign cavities. Fluoride varnish helps prevent caries (cavities), but once they start the best you can hope for is to slow them down. It will get worse if it is cavities. A pediatric dentist can evaluate what can be done. -Basically, fillings or some kind of restorations. We remove the bacteria/decay and repair whatever is left with fillings or crowns, etc. Also read on this blog about white spots/hypoplasia, which is not cavities, but can be a problem as well. I would not wait too long to get this looked at. Things can get worse pretty fast. I see it every day on very young children.

Anonymous said...

as I sit here with Fluoride varnish on my teeth for the very first time, btw, I'm 40. I went online to get more information on this white sticky goop on my teeth, and 95% of every thing I've read on multiple websites state this is very safe and effective.. I will admit I'm a bit gaggy from just letting my tongue touch my teeth,and I'm pretty much unable to eat due to the tongue touch teeth gag reflex, but I'll survive, and I am just over gaggy sensitive... I surly welcome this new treatment..

Anonymous said...

My 8 year old recently had a routine six month cleaning and was given his fluoride treatment as has been done in the past, they use a q-tip with the foam and dab it on. My concern this time was that the dental assistant put about five large gobs of fluoride in his mouth while she did his teeth and my son swallowed fluoride every time. I voiced my concerns while the treatment was being done and she continued saying she usually doesn't do fluoride but he will be fine and said he might just feel nauseous. I told her that they usually just dab it in his teeth and she ignored me and continued to put large amounts in his mouth. I asked her three more times why she used so much and is he going to be okay because he swallowed so much. She then said to the dentist that I was concerned and he said he will be fine but might have a stomach ache. I was very scared and I am still concerned about it. Please help ease my mind on this matter because I am so concerned and was told in past treatments that large amounts should not be swallowed.

Dr. Dean Brandon said...

Hi, just sitting here at the computer for a quick look when your comment came in. Firstly, I do not know what kind of fluoride they used, but one kind is a foam--kind of like whip cream. In the foam form there is not as much fluoride if they swallow it. Looks like a lot, but the foam is mostly air. The older gels were the same stuff but no air. If kids do swallow too much (hasn't happened in a long time) then I recommend drinking some milk or ice cream (something with calcium) it binds up the fluoride so no big problems. Even then it's just a temporary one day kind of thing.

The foam is effective as the most important part is the part touching the teeth, therefore the foam is good, but much lower dose is accidentally swallowed.

ianspradley said...

This is such a bullshit one-sided comment thread. Having a dentist tell you about fluoride is a good way to get a whole lot of bad info. and unsubstantiated crap. "Water fluoridation(sic)is statistically shown to reduce cavities..." Whose statistics? Point me in that direction and I'll show you an outdated, ghostwritten study with nobody actually willing to stand behind it and say they were involved. For future reference, Dr. Dean Brandon, why don't you save your breath and quit leading people astray. I know you probably don't even know better, I'll give you the benefit of the doubt!

Dr. Dean Brandon said...

Ha. Well, to each his own opinion. Here is a reference with 60 scientific studies statistics and real science:


Survey of Scientific Literature on Fluoride