Sir, I am a newly qualified dentist and despite my limited experience I have noticed different opinions on when to apply fluoride varnish. Delivering better oral health guidelines1 recommend that all children should have fluoride varnish applied at least twice yearly, including even those at low caries risk, whilst children with known caries risk factors are recommended additional applications. However, there are certain medical contraindications specified by SDCEP guidelines2 and manufacturers.
I have noticed two different approaches to application of fluoride varnish, the first in which every child that attended for an examination appointment had fluoride varnish applied providing there were no co-operation issues, a specific request by the patient or guardian requesting not to apply fluoride varnish or in the case of a medical contraindication (checked by asking the patient and their accompanying guardian). However, during my dental core training year in a community dental setting I was advised that fluoride varnish could not be applied to children under 16 unless parental consent is obtained prior. Fluoride varnish application was therefore much lower as many children attended regular dental examinations with grandparents or siblings etc.
I understand that there has been a documented case of a Type 1 hypersensitivity reaction to colophony which is present within Duraphat varnish in which the patient developed allergic contact stomatitis.3 However, the patient in question had a known allergy to sticking plasters and therefore had a known risk of having an allergy to colophony so wouldn't have had fluoride varnish applied under current SDCEP recommendations. A recent randomised controlled trial conducted in South Wales involving 1,016 children aged 6-7 years old recruited over 2011–13 followed up over a 36-month period by Chestnutt et al. concluded that six-monthly applications of fluoride varnish on all surfaces of caries-free first permanent molars resulted in a caries preventative effect that is not significantly different to placement and maintenance of fissure sealants on the occlusal surfaces of caries-free first permanent molars in children.4 Fluoride varnish also exhibits advantages such as being quick and easy to apply and a less complex intervention than fissure sealants whilst not requiring any maintenance. It is due to the above reasons I believe perhaps we should be considering the use of fluoride varnishes that are colophony free or booking patients in solely for application of fluoride varnish once clarification of medical history from a parent and parental consent has been obtained.
How many of these children are sick after their treatment. When my son had this treatment over 30 years ago he on both occasions became very ill. It is a poison.