CDA Update Magazine Vol 19 issue 7 page 7 July 2007

Four-minute fluoride gels are best for cavity reduction

CDA policy staff recently attended the National Oral Health Conference in Denver, where on topic of discussion was the use of topical fluoride.

“The presentation reviewed the evidence for the benefits of topical fluoride including gel, foam and varnish. One surprise was that one-minute gels, which are very popular, do not have the same level of clinically proven effectiveness as four minute gels,” said Gayle Mathe, CDA policy development manager.

The ADA published the results of its systematic review of professionally applied topical fluoride in 2006. The CDA is providing the following summary of ADA’s evidence-based clinical recommendations to reiterate the most current fluoride information.

Data supports the caries reduction benefits of four-minute gels. In contrast, one-minute gels have laboratory data, but no clinical equivalency on effectiveness.
Fluoride varnish is effective in preventing caries. High-risk patients should receive varnish at three- to six-month intervals. Low- or moderate-risk patients should receive varnish every six months.
Varnish creates less patient discomfort and achieves greater patient acceptability than gels, especially in preschool-aged children.
Low-risk individuals may not receive additional benefits from professional topical fluorides – fluoridated water and toothpaste may be enough.
There is insufficient evidence to address the efficacy of NaF versus APF gels.
- Varnish typically contains 5 percent NaF – equivalent to 2.26 percent or 22,600 ppm fluoride.
- APF contains 1.23 percent or 12,300 ppm fluoride.
- 2 percent NaF contains 0.90 percent or 9,050 ppm fluoride.
Dentists should perform a risk assessment on patients. The risk of developing caries exists on a continuum and changes over time as risk factors change. Risk status should be re-evaluated periodically.
Knowing the patient’s health history and vulnerability to oral disease is key to making treatment decisions.

The full text of the recommendations is available online at jada.ada.org in the Vol. 137, August 2006 issue, Page 1151 of the Journal of the American Dental Association.

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