Cavities used to be a fact of life. But over the past few decades, tooth decay has been reduced dramatically. The key reason: fluoride. Research has shown that it reduces cavities between 20 - 40 percent in children, and 15 - 35 percent in adults. It also helps repair the early stages of tooth decay even before the decay becomes visible. Unfortunately, many people continue to be misleading about fluoride and water fluoridation. To help you learn more about the important oral health benefits of fluoride, the American Dental Association (ADA) has prepared some information.

Fluoride when added to community water supplies, is the single most effective public health measure we have to prevent tooth decay and improve oral health for a lifetime. Also, products containing fluoride stop the growth of newly formed cavities AND can prevent formation of cavities on the roots of teeth. The U.S. Public Health Service completed an extensive study of the benefits and risks of fluoride. Their report concluded that "optimal fluoridation of drinking water does not pose a detectable cancer risk to humans." The report went on to say that fluoride's "benefits are great and easy to detect."

It benefits people of all ages. For example, when children are young and their teeth are still forming, fluoride works by making tooth enamel harder and more resistant to the acid that causes tooth decay. In fact, studies indicate that people who drink optimally fluoridated water from birth will experience up to 40 percent less decay over their lifetimes. For adults, the benefits are just as great. Fluoride helps repair the early stages of tooth decay even before they become visible in the mouth, a process known as remineralization. And for older adults who experience problems with root caries (decay along the gumline), fluoride has been effective in decreasing this condition.

Fluoride Varnish 

This summer of the American Dental Association (ADA) Council on Scientific Affairs published new guidelines for professionally applied topical fluoride. A panel of experts reviewed published studies on fluoride gel, foams, and varnish, and issued recommendations.

A. Fluoride Varnishes – what are they? Typically 5% Na fluoride is rosin or resin base with alcohol solvent. They have been the standard of care for 30+ years in Western Europe, Scandinavia, and Canada. New ADA guidelines recommend varnished for moderate and high caries risk patients in all 3-age categories (<6 years, 6-18 years, and >18 years).

B. What are advantages and Considerations of 5% Na Fluoride Varnish?

Advantages:

1. High dose fluoride with a minimal volume applied
2. Potential for minimal volume swallowed
3. Keeps Fluoride in contact with tooth for many hours
4. Reduces Caries in primary and secondary dentition demonstrated in multiple studies
5. Lower plasma fluoride levels than after professional fluoride gel
6. Well tolerated by very young children
7. Acceptable flavor

Considerations

1. Patients are aware of varnish on teeth and describe it as fuzzy sticky, or uneven feel
2. Temporary change in tooth appearance. This appearance is diminished after brushing
3. Instructions to wait 4-6 hours after application before brushing
4. Patients must avoid crunchy or sticky foods for the remainder of the day following application
5. Patients must discontinue use of floured supplement until the day following treatment.

On demineralized areas	Under gum overgrowth	Over ageing sealants	Around brackets from braces	On exposed root surfaces

C. Who is at Risk for Caries?

1. 1. Poor Oral Hygiene
2. Prolonged Nursing (bottle or breast)
3. Enamel Defects
4. Many Restorations
5. Chemotherapy or Radiation therapy
6. Eating Disorders
7. High sugar Diet
8. Patients with Braces
9. Presence of expsed root surfaces
10. Physical or mental disability with inability or unavailability of performing proper oral care.

SCHOOL BASED FLUORIDE PROGRAMS

Many studies have demonstrated that school-based fluoride programs can reduce tooth decay by 30 to 40 percent. With parental permission, for best results the procedure should be started in kindergarten or first grade and be continued through at least the eighth grade. Fluoride is usually provided in a rinse form.

The school based programs are worthwhile because:

• The procedure is effective and inexpensive.
• Little time is required for the procedure--approximately 3 minutes per week for an average classroom.
• The procedure is easy for school children of all ages to learn and to do.
• With minimal training, non-dental personnel, such as classroom teachers, aides or volunteers, can adequately supervise the procedure.

Several million school children are now receiving the benefits of this preventive procedure. Yes, a fluoride program in school provides a unique opportunity to help all children have a healthier smile. A healthy smile is indeed a beautiful sight.