BEST METHODS FOR TOPICAL FLUORIDE APPLICATION

• Question:   What is the best method for applying topical fluoride?

Answer:    In 2013, the American Dental Association (ADA) updated its recommendations on the use of professional and home-use prescription topical fluorides.  The executive summary and chairside guide is available at the ADA Center for Evidence-Based Dentistry’s website:  ebd.ada.org/ClinicalRecommendations.asp.

The new recommendations are based on a systematic review of the literature that looked at 5% neutral sodium fluoride (NaF) varnish and 1.23% acidulated phosphate fluoride (APF) gel.  The table below provides a comparison of both products.  For children younger than 6, varnish is the only recommended method for topical fluoride application.  Either varnish or gel is recommended at 3-month to 6-month intervals for patients older than 6 who are at increased risk of dental caries (cavities).  Many systems are available to ascertain caries risk.  Individual risk factors include poor oral hygiene, cariogenic diet, and suboptimal fluoride exposure (the level of fluoride in Albuquerque’s water is low).  Active dental caries in the previous 12 months, however, is the greatest predictor of future caries risk.

The panel concluded with low certainty that there was an anti-caries benefit to primary teeth with a twice-annual application of 1.23% APF foam and no benefit to the permanent dentition; therefore, foam was not included in the recommendations.  The panel identified no studies on the effects of 2% NaF gel that met the review’s criteria, so it was not included in the recommendations.

Because the use of 5% NaF varnish and 1.23% APF gel demonstrate the most significant anti-caries effects, we use either of these products.  Based on fluoride varnish’s ease of application and caries-prevention benefits in primary and permanent teeth, as well as in root caries, it is our application of choice.  Varnish is also very effective around orthodontic brackets and is easy to place where it is needed most.

TABLE 1:  Porfessionally-Applied Topical Fluoride Agents for Patients at Elevated Risk of Caries

1.23% Acidulated Phosphate Fluoride Gel     pH:  3.5        Concentration: 12,300 ppm fluoride 1.23% fluoride ion      4-minute tray application      At least every 3-6 months.

5% Neutral Sodium Fluoride Varnish             pH:  7.0        Concentration: 22,600 ppm fluoride 2.26% fluoride ion         Apply thin layer with soft applicator brush (1 minute to 2 minute application time)       At least every 3-6 months.

Please call Dr. Michael Armijo’s office at 505-797-1000 if you have any questions or concerns about Topical Fluoride and the safety of using it once and/or twice per year.