Practice Tip #123: Myths About Fluoride Varnish

This Practice Tip is provided by the good folks at Pulpdent to help you distinguish the key features and myths about fluoride varnish, so you can best choose what meets your patient’s needs. American Dental is proud to support a growing number of popular Pulpdent products we know dental practitioners have come to rely on.

Four Myths About Fluoride Varnish

By Amber Auger RDH, MPH

As a practicing hygienist, I come across a lot of misconceptions about treatment options, especially fluoride varnish. Here are the top four myths I’ve heard about fluoride varnish and what you need to know:

Myth #1: It’s All About the Flavor

From salted caramel to tutti frutti, fluoride varnishes are available in a dizzying array of flavors. While great taste can help increase case acceptance, it is not the only factor to keep in mind when selecting a fluoride varnish. Consider the other ingredients in the varnish and the role they play in reducing the risk of dental decay.

Myth #2: Fluoride is the Key Ingredient

Fluoride is one of several important ingredients to look for in a fluoride varnish, including:

Calcium and Phosphate

During demineralization it is calcium and phosphate ions, not fluoride, that are released by the tooth. When the process of demineralization happens more quickly than remineralization, subsurface lesions develop, leaving the patient susceptible to tooth decay. The appearance of a white spot lesion indicates that, while subsurface mineral content has been lost, there is still potential for remineralization. The combination of calcium, phosphate, and fluoride help support remineralization and preserve tooth structure.


Xylitol promotes an increased salivary flow and a balanced pH, which helps to reduce the number of cariogenic and periodontopathic bacteria. The use of xylitol has been shown to lead to a reduction in the proportion of streptococci mutants in plaque, neutralize plaque acids, and help remineralize white-spot lesions.

Click here to learn about fluoride varnish with calcium, phosphate, fluoride, and xylitol.

Myth #3: More is Better

Counter-intuitive as it may seem, using more fluoride varnish is not necessarily better. Patients tend to be less compliant when they have multiple layers of fluoride varnish on their teeth.
Some may even chip away at a varnish treatment that feels “thick” or uncomfortable. To ensure patient compliance, the varnish should be uniformly mixed and placed in a thin, even layer, so that it can dry quickly.

Myth #4: Parts Per Million (PPM) Determines Efficacy

Many varnishes contain a high concentration of parts per million of fluoride (usually 22,600 PPM), in order to extend the contact time between fluoride and tooth surfaces. Research shows that it is the mechanism of action, rather than the parts per million of fluoride ions, that matters most. This mechanism involves interaction of fluoride from the varnish with saliva to form calcium fluoride (CaF2). The CaF2 deposits slowly release fluoride ions into the oral environment, supporting the natural remineralization process.

Interested in learning more about hygiene and prevention? Join the Embrace Prevention Facebook Group to engage with dental hygiene professionals from all over the world. Click here to join Embrace Prevention on Facebook.


  1. Collins, Fiona. The Development and Utilization of Fluoride Varnish. 2014. Available at:  Accessed October 23, 2018.
  2. Nordblad A, Suominen-Taipale L, Murtomaa H, Vartiainen E, Koskela K. Smart Habit xylitol campaign, a new approach in oral health promotion. Community Dent Health. 1995;12:230–234.[PubMed]
  3. A Maguire, A J Rugg-Gunn. Xylitol and caries prevention — is it a magic bullet? British Dental Journal volume194, pages429–436 (26 April 2003)
  4. Gold, J. Fluoride Varnish Products in the U.S. Market. J Res Development 2013. DOI: 104172/2311-3278.1000e102. Accessed November 6, 2018.


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