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Advances in Fluoride Varnish
Combining efficacy with patient comfort and convenience
The US Centers for Disease Control and Prevention called the addition of fluoride to public drinking water “one of the 10 great public health achievements of the 20th century.”1 Fluoride’s role as the single most important factor in preventing caries has truly revolutionized the quality of life for countless people all over the world, making tooth decay—one of the most widespread diseases in the world—avoidable and even preventable.
Today, fluoride can be found in numerous topical dental products, as well as in two thirds of America’s water supply. Topical fluorides on the market include toothpastes and mouthwashes. In a professional-care setting, fluorides have evolved from foam and gel treatments to present-day varnishes.
Although various formulations of fluoride varnish have been available to dentists for more than 40 years, only in the past decade has their popularity skyrocketed. Varnishes have earned the favor of dentists thanks to their ability to quickly set after being painted onto the surface of the tooth. However, many fluoride varnishes’ ability to both quickly set and adhere to the tooth for a long period of time have also too often proved to be their downfall.
In the author’s experience, the sometimes gritty residue of varnish frequently causes many patients to complain of leaving the dentist’s office with an uncomfortable texture on their teeth, a sensation some describe even as “dirty”—quite the opposite feeling one would hope to have after a visit to the dentist. In addition to a gritty texture, most varnishes leave a visible film on the teeth, often resembling plaque, rendering the patient not only uncomfortable, but also embarrassed to smile. The notoriously fuzzy feeling that varnishes leave on the teeth, in addition to their unsightly residue, often causes patients to prematurely wipe or brush the varnish off, thus reducing the treatment’s capacity for sustained fluoride release and uptake.
A recent survey showed that more than 80% of dental professionals feel that the product’s texture on the teeth is an important aspect to consider when choosing a fluoride varnish (Ultradent Products, Inc. data on file). This is because the more natural a varnish feels, the longer the patient will leave it on the teeth, allowing the varnish to deliver the maximum amount of fluoride ions to every tooth. In response to this demand, Ultradent Products, Inc., created Enamelast™ ( www.ultradent.com), a 5% sodium fluoride varnish that, in addition to its smooth texture upon setting, appears nearly invisible against the teeth, due to its translucent formulation (Figure 1 and Figure 2).
Adhesion and Fluoride Release
In addition to a varnish’s look and feel, which may influence the amount of time the patient leaves the product on the teeth, the varnish’s rate of fluoride release over time plays an important role in delivering the product’s maximum benefits. A recent study showed that over a 24-hour period, Enamelast not only delivered the highest overall amount of fluoride to the patient’s teeth, but also showed peak fluoride release at 4 hours’ wear time with sustained, higher fluoride release over a 24-hour period than its competitors (B.R. Schemehorn, unpublished data, 2013). For orthodontic patients, Enamelast facilitates longer sustained fluoride release when applied to teeth previously treated with a fluoride recharging primer.
The ability of a fluoride varnish to adhere to the teeth for an extended period of time is largely responsible for its rise in popularity among clinicians. In contrast, fluoride-containing mouthwashes and gels are easily washed away with liquid, saliva, or food. However, adhesion and subsequent fluoride uptake vary greatly among varnishes currently available on the market. For a fluoride varnish to provide the best results, it must adhere to the teeth for the entire recommended amount of time. Thus, the product’s adhesive capabilities play a direct role in the varnish’s ability to deliver the full benefits of fluoride to the patient. Enamelast features a patented adhesion-promoting agent that enhances retention and allows for higher fluoride uptake than any other fluoride varnish in its class, including the market leader (B.R. Schemehorn, unpublished data, 2013).
Fluoride varnishes that require premixing present the challenge of delivering consistent levels of fluoride from one patient to the next, as levels of the active ingredient can vary per application, depending upon the thoroughness with which the product is mixed. Enamelast’s no-mix formula ensures predictable outcomes, as the fluoride remains evenly distributed throughout the varnish at all times. Enamelast comes in two convenient delivery options: unit-dose blister packs (Figure 3), or multiple-dose packaging with Ultradent’s syringe and tip application (Figure 4). The Enamelast unit-dose blister packs are designed for clinicians who prefer the convenience of a one-time-use application, or for dental clinics in hospital settings that require the use of unit-dose treatments in which all materials are packaged together. Each blister pack includes a prefilled well and applicator brush, allowing the clinician to dip the brush in the well and paint the varnish on the teeth. Conversely, the syringe delivery method facilitates the ability to express the product through the tip directly onto the teeth for fast application. Clinicians can also choose to express the varnish onto the back of their glove before painting onto the teeth. Unlike the unit-dose blister packs, each syringe of Enamelast provides enough varnish for three to four patients.
Several factors contribute to the overall success of a fluoride varnish, including the product’s look, feel, rate of fluoride release, and amount of fluoride uptake, as well as the varnish’s consistency and fluoride distribution. Enamelast’s smooth, translucent texture and appearance work together to increase patient comfort and subsequent probable wear time. In addition to providing a more comfortable and esthetic patient experience, Enamelast also offers a patented adhesion-promoting agent that allows for the highest levels of fluoride release and uptake, when compared to market leaders. Enamelast’s no-mix formula ensures an even distribution of fluoride and consistent product delivery for every patient, regardless of delivery method.
1. “Ten Great Public Health Achievements, 1900-1999” www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm. April 2, 1999. Accessed March 5, 2014.
About the Author
Richard Tuttle, DDS
R&D Clinical and Laboratory Division Manager
Clinical Applications Advisor
Ultradent Products, Inc.
South Jordan, Utah
For more information, contact:
Ultradent Products, Inc.