Lite

ratu

re H

igh

ligh

ts

Shield against caries

Fluor Protector

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

3

Hypersensitivity

Depot effect

Plaque reduction

Bacterial metabolism

Remineralisation / Reduced demineralisation

Aesthetics

Suitable for all age groups

Pre-school children

Adolescents

Elderly

Easy handling

Under field conditions

Targeted caries control

Approximal caries

Fissure caries

Statement

5

7

11

11

13

16

17

17

18

19

20

20

22

23

25

25

Contents

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

4

Professional caries prophylaxis - long-term

To remain healthy, teeth need to be supplied regularly with small amounts of fluoride.

Fluor Protector, a varnish containing 0.1% fluoride,offers professional protection from caries.

The protective varnish is quick and easy to apply andadheres well to tooth surfaces. Fluor Protector is suitable for patients of all age groups and is profess-ionally applied by dentists or skilled personnel.Generally a twice yearly application is sufficient.

Fluor Protector is highly effective for the treatment of hypersensitive cervicals and long-term caries prophylaxis.

Over two decades of experience document the effect-iveness of this product.

The sound protection provided by FluorProtector is based on:

– Tight blockage of the dentin tubuli– Control of remineralisation processes– Incorporation of fluoride into the lower

layers of the enamel– Repair of initial caries lesions

Fluor Protector

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

5

J. Arends, H. Duschner, J.L. Ruben: Penetrationof varnishes into demineralised root dentine invitro; Caries Res. 31, 1997: 201-205.

The sealing of open dentin tubuli helps to prevent or reduce hypersensitivity. Varnishes that penetrate the tooth structure and seal the dentin tubuli are therefore very useful. Investigations carried out witha confocal laser scanning microscope (CLSM) haveshown that Fluor Protector penetrates the dentintubuli efficiently.

Hypersensitivity

B. Rudhart, E. Rompola, W. Hopfenmüller, J.P.Bernimoulin: Effectiveness of Cervitec and Fluor Protector in patients with dentin hyper-sensitivity; J Dent Res 77, 1998: 746.

Recession of the gingiva is often associated withhypersensitive dentin. Both Fluor Protector andCervitec varnishes are suitable for this indication. In a clinical study, no significant difference betweenthe varnishes was found – both significantly reducedthe sensitivity of all 20 patients over the study period of one month.

Penetration of varnishesinto demineralised dentin(Arends 1997).

05

10

35

Penetration depth [µm] Varnish D

Dentin

Dentin tubule

Fluor Protector

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

6

B. Collaert, G. Söderholm, G. Bratthall, H. DeBruyn: Evaluation of a fluoride varnish for thetreatment of dentine hypersensitivity;Dissertation B. Collaert, University of LundMalmö, 1990.

Fluor Protector was applied on hypersensitive cervicals at Baseline 1 and at Week 1. After thesetwo applications, the level of sensitivity to hot andcold sensations was clearly lower than that atBaseline 0.

100

80

60

40

20

0

Pain sensation

Baseline 0 Baseline 1 Week 1 Week 4

Severepain

No pain

Cold Hot

Reduction of pain after two applications of FluorProtector on hypersensitive cervicals.

FP FP

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

7

G. Rølla, E. Saxegaard: Critical evaluation of thecomposition and use of topical fluorides, withemphasis on the role of calcium fluoride in cariesinhibition; J Dent Res 69, 1990: 780-785.

A major part of the fluoride retained on tooth surfaces after topical application is calcium fluoride or calcium-fluoride-like material. A pH dependent fluoridedepot is formed, i.e. fluoride is released when the pHvalue sinks.

A.G. Dijkman, J. Tak, J. Arends: Fluoride depos-ited by topical applications in enamel. KOH-soluble and acquired fluoride; Caries Res 16,1982: 147-155.

Fluor Protector induces a comparatively substantialcalcium fluoride layer. Fluor Protector deposited moreKOH removable fluoride both on and in the enamelcompared to an APF gel and a resinous Na F varnish.

Fluoride deposited onand penetrated into theenamel after differentfluoride treatments.

70

60

50

40

30

20

10

0

Resinous NaFAPF Fluor Protector

Mean fluoride in and on the enamel [µg/cm2]

Depot effect

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

8

B. Øgaard: Effects of fluoride on caries develop-ment and progression in vivo; J Dent Res 69,1990: 813-819.

Proteins and phosphate stabilize the calcium fluoridelayer, which enhances its retention.

D.G.A. Nelson, W.L. Jongebloed, J. Arends:Morphology of enamel surfaces treated withtopical fluoride agents: SEM considerations; J Dent Res 62, 1983: 1201-1208.

Calcium fluoride particles adhere particularly well toporous surfaces, such as demineralized areas. Inaddition, they are retained on such areas for compar-atively long periods.

B. Øgaard, L. Seppä, G. Rølla: Professional topical fluoride applications - clinical efficacyand mechanism of action; Adv Dent Res 8, 1994: 190-201.

With fluoride varnishes, fluoride exposure can bebetter controlled, and less chair-time is required,compared with conventional solutions and gels.

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

9

Saliva

Ca2+

pH<5,5

HPO42– OH–

Saliva

CaF

pH 7

DemineralisationAt acidic pH levels, the enamel is demineralisedwithout fluoride protection

Protective calcium fluoride layerAfter the application of Fluor Protector, a protectivecalcium fluoride layer forms over the tooth surface

Bioavailability of fluorideWhen the pH level drops, calcium and fluoride ionsare released. The tooth structure is no longer directlyattacked. The calcium fluoride layer is tight andhomogenous forming a reliable depot that releasesfluoride over an extended period of time

Saliva

pH<5,5

Ca2+

Ca2+

F–

F–

2

CaF2

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

10

E. Hellwig, J. Klimek, G. Albert: In-vivo-Retention angelagerten und festgebundenenFluorids in demineralisiertem Zahnschmelz;Dtsch Zahnärztl Z 3, 1989: 173-176.

After the application of Fluor Protector, the uptakeof KOH-soluble and permanently bound fluorideclearly increased compared to cases in which FluorProtector was not applied. Three consecutive enamellayers that were treated with Fluor Protector exhib-ited a significantly higher fluoride content comparedto those that had been treated with a comparisonvarnish.

2000

1500

1000

500

0

1 2 3 Layer

Varnish D Fluor Protector

Mean fluoride concentration in three consecutiveenamel layers after the application of varnishes containing fluoride.

Fluoride content [ppm]

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

11

A.G. Dijkmann, D.G.A. Nelson, W.L. Jongebloed,A.H. Weerkamp, J. Arends: In vivo plaque form-ation on enamel surfaces treated with topicalfluoride agents. Caries Res 19, 1985: 547-557.

One month after the application of Fluor Protectoron enamel surfaces a significant inhibition of plaqueformation was noticeable. Additionally SEM studiesshowed dispersion and reduced density of the plaque matrix.

S. Balzar Ekenbäck, E.L. Linder, M.-L. Sund, H. Lönnies: Effect of fluoride on glucose incorporation and metabolism in biofilm cells of Streptococcus mutans; Eur J Oral Sci 109,2001: 182-186.

Bacterial biofilms or dental plaque are a prerequisitefor the development of caries and periodontal disease. Fluoride is able to reduce acid formation insome bacterial species of dental plaque. E.g. Mutansstreptococci by impairing glycolysis so inhibiting sugaruptake and in turn lactic acid production. In order toevaluate the effect of fluoride-bound hydroxyapatiteon lactic acid formation, in vitro – hydroxyapatitediscs were coated with a Strep. mutans biofilm. The discs were either left untreated or pre-treatedwith one of the following: 0% placebo varnish, FluorProtector, 0.2% NaF or 0.05% NaF. Discs were incubated in growth medium at ph 7.0 with glucosefor 3 hours. The discs pre-treated with fluoride reduced lactate production compared to untreatedcontrols or placebo discs. Fluor Protector and 0.2%NaF had a statistically significant inhibitory effect onlactate production.

Plaque reduction

Bacterial metabolism

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

12

3

2,5

2

1,5

1

0,5

0

Fluor ProtectorPlacebo 0,05% NaF 0,2% NaF

Lactic acid production in biofilms. Comparison of fluoride pre-treated discs and placebo. (BalzarEkenbäck 2001).

Mean Lactic acid in growth medium [mM]

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

13

S. Tranaeus, S. Al-Khateeb, S. Björkman, S.Twetman, B. Angmar-Månsson: Application ofquantitative light-induced fluorescence to mon-itor incipient lesions in caries-active children. A comparative study of remineralisation by fluoride varnish and professional cleaning; Eur J Oral Sci 109, 2001: 71-75.

This randomised controlled study compared the treat-ment of white spot lesions in caries active adolescents.Fluor Protector plus professional tooth cleaning (n=13)was compared with professional tooth cleaning (PTC)alone (n=18). In the FP group, PTC was followed byan application of FP, at baseline, after 1 week andevery 6 weeks for 6 months. In the control group PTCwas carried out once every 6 weeks for 6 months.Enamel fluorescence using quantitative light fluores-cence (QLF) techniques was measured at baseline andat each visit. In the FP group there was a significantchange over time for both lesion area and averagechange in fluorescence. These changes were not seenin the control group. There was a significant differencein average change in fluorescence between the twotest groups. For lesion area, there was no significantdifference, but a tendency towards a difference bet-ween the test groups. It was concluded that repeatedfluoride applications had a favourable effect on theremineralisation of white spot lesions as measuredafter 6 months.

Remineralisation/Reduced demineralisation

Initial situation: White spot appears dark

After six months: Size of white spot isreduced and fluores-cence is increased

Note regarding QLF: Mineralised healthy enamel exhibits high fluorescence i.e. a light colourDemineralised areas appear darker i.e. show low fluorescence.

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

14

R. Schmeiser, U. Schiffner: Der Einfluss vonCervitec und Fluor Protector auf dieDentindemineralisation in vitro; DZG 1995,Berlin.

The treatment with both Fluor Protector and Cervitecled to significantly shallower dentin lesions comp-ared to the control group. A mixture of both varn-ishes had no inhibiting effect on the demineralisation process.

W. Binus, M. Grube, A. Stiefel: Remineralisationof initial caries lesions by fluor silane. J DentRes 61, 4, 1982: 569.

Children aged 7-13 were repeatedly treated withFluor Protector over 12 months. 72 labial enamelopacities in the permanent teeth were treated.Clinical findings showed an improvement of the surface quality of the enamel lesions - some appearedto be fully mineralised.

C. Van Loveren, J.F. Buijs, M.J. Buijs, J.M. TenCate: Protection of bovine enamel and dentineby chlorhexidine and fluoride varnishes in abacterial demineralization model; Caries Res 30, 1996: 45-51.

An in vitro demineralisation model compared theprotective effect of two chlorhexidine varnishes andFluor Protector. On enamel Fluor Protector providedbetter protection from demineralisation due toMutans streptococci compared to Cervitec or anotherCHX varnish. However the dentin specimens werebest protected by Cervitec. For the optimal pro-tection of both enamel and dentin the application of both varnishes could prove optimal.

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

15

H. De Bruyn, L.J. Van Rijn, D.J. Purdell-Lewis, J.Arends: Influence of various fluoride varnisheson mineral loss under plaque; Caries Res 22,1988: 76-83.

Fluor Protector protects the enamel from mineralloss. After a single application of Fluor Protector, themean lesion depth after four months was signif-icantly shallower than that of the control groupwhich had been treated with a placebo varnish.

160

140

120

100

80

60

40

20

0

Mean lesion depth four months after a single application of various varnishes.

Varnish DControl group Fluor Protector

Mean lesion depth [µm]

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

16

T. Debner, D. Warren, J.M. Powers: Color stability of restorative materials exposed to fluoride varnishes; J Dent Res 78, (IADRAbstracts No. 1659) 1999: 313.

The colour stability of a compomer, hybrid ionomerand a composite were tested with the fluoride varnishes Durafluor (DF), Duraphat (DP), and FluorProtector (FP). Five discs per varnish were treated andthen brushed. Water was used as a control. Colourwas compared with a spectrophotometer at baselineafter staining (treatment) and after brushing. Dura-fluor and Duraphat both caused a perceptible colourchange after staining in all restoratives. Durafluorcaused a lasting colour change (i.e. after brushing)with the composite material. Fluor Protector did notaffect the colour of any of the restorative materials.

Aesthetics

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

17

L.G. Petersson, S. Twetman, G.N. Pakhomov:Fluoride varnish for community-based caries prevention in children; WHO, 1997.

The treatment with Fluor Protector is safe and can beused for children of preschool age.

L.G. Petersson: Fluoride mouthrinses and fluoridevarnishes; Caries Res 27, (Suppl. 1 1993) 35-42.

The average application time of fluoride varnishes is 3-5 minutes per patient. The acceptance even by smallchildren is very positive.

S. Twetman, L.G. Petersson, G. N. Pakhomov:Caries incidence in relation to salivary Mutansstreptococci and fluoride varnish applications inpre-school children from low and optimal fluoride areas; Caries Res 30, 1996: 347-353.

The application of Fluor Protector at 6 month inter-vals demonstrated a cariostatic effect on the primary dentition, even with today’s low caries incidence. Over the course of the two-year study, all the 648 preschool children accepted the Fluor Protector treat-ment very well.

L. G. Petersson, S. Twetman, G. Pakhomov: Theefficiency of biannual silane fluoride varnish in pre-school children; J Dent Res 74, 1995: 410(Abstr. 80).

A cost/benefit assessment indicated the advantage of a fluoride varnish program for children showingdental caries at baseline. Biannual application of FluorProtector on preschool children with active caries isbeneficial and should be recommended.

Suitable for all age groups:

Pre-school children

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

18

P. Axelsson, J. Paulander, K. Nordkvist, R.Karlsson: Effect of fluoride containing dentifrice,mouthrinsing, and varnish on approximal dental caries in a 3-year clinical trial; CommunityDent Oral Epidemiol 15, 1987: 177-180.

The differential effect of a fluoride dentifrice (2 x day), a fluoride mouth-rinse (1 x week) and afluoride varnish (4 x year) on approximal caries was examined in 252 adolescents aged between 13 and14 years. Fluor Protector was applied by a dentalprofessional; the dentifrice and mouth-rinse wereapplied at home. Fluor Protector reduced cariesmore significantly than the fluoride mouth-rinse.

Adolescents

2,5

2

1,5

1

0,5

0

Group 1 Group 2 Group 3 Group 4

Average number of new carious lesions

F-Paste andF-Rinse

F-Paste andPlaceboRinse

F-Paste and FluorProtector

PlaceboPaste andF-Rinse

Average number of new carious lesions after variouscombinations of fluoride therapy for 3 years.

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

19

S.R. Brailsford, J. Fiske, S. Gilbert, D. Clark, D.Beighton: The effects of the combination of chlor-hexidine/thymol and fluoride-containing varn-ishes on the severity of root caries lesions in frailinstitutionalised elderly people; J Dent 30, 2002:319-324.

The combination of Fluor Protector and Cervitec is asimple, quick, non-invasive highly useful method ofmanaging and controlling root-caries. Treatment canbe carried out by dental hygienists and is equally usefulfor high risk groups such as patients suffering fromParkinson’s disease and neuro-muscular disorders.

This study of 103 patients aged between 78 and 87,showed that a combination of Fluor Protector (appliedfirst) and Cervitec (applied second) improved the clinical status of active root caries. The combination ofCervitec and Fluor Protector was significantly moreeffective than Fluor Protector alone.

Elderly

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

20

B. Øgaard, L. Seppä, G. Rølla: Professional topicalapplications – clinical efficacy and mechanism ofaction; Adv Dent Res 8, 1994: 190-201.

Given their easy application technique and reliability of use, varnishes containing fluoride have becomewidely accepted. The time patients spend in the dentalchair is shorter than that required to conduct convent-ional prophylactic measures.

E.D. Beltrán-Aguilar, J.W. Goldstein, S.A.Lockwood: Fluoride Varnishes - A review of theirclinical use, cariostatic mechanism, efficacy andsafety; JADA 131, 2000: 589-596.

Fluoride varnishes are safe and easy to apply and are able to set in contact with intra-oral moisture. Compared with other topical fluoride vehicles, varnishes have advantages in terms of safety and ease of application.

L.W. Ripa: Need for prior tooth cleaning when performing a professional topical fluoride applic-ation: review and recommendations for change; J Am Dent Assoc 109, 1984: 281-285.

In school-based programs, children can be treatedwithout prior prophylaxis from the hygienist. Toothbrushing is sufficient in such cases as the pellicle doesnot act as a barrier to fluoride uptake by the enamel.

Easy handling

Under field conditions

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

21

J.W. Bawden: Fluoride varnish: a useful newtool for public health dentistry; J Public HealthDent 58 (4), 1998: 266-269.

Fluoride varnishes are quicker, more convenient andless messy to apply. Uncomfortable trays the bittertaste and potential swallowing problems of gels areavoided. Fluoride varnish is a superior topical fluor-ide agent for use in children and would seem to bemost useful in public health settings.

B. Monse-Schneider, R. Heinrich-Weltzien:Preventive oral health care programme forFilipino children; FDI Developing Dentistry, 12-15.

In a school based preventive oral health care pro-gramme in the Philippines, children were treated both preventively (tooth-brushing and fluoride varnish)and therapeutically (ART Atraumatic restorative treat-ment whereby teeth could be filled with amalgamusing hand instruments). Fluor Protector was appliedevery 4 months by trained parents. 1600 7 year oldswere recruited for the pilot project. For the primarydentition mean caries prevalence was 7.2 dmft andfor the permanent dentition 1.2 DMFT. Only 8.8%were entirely caries free. After 3 years the childrenhad an average age of 10.2 and 16.2% were cariesfree. Caries prevalence was 1.6 DMFT, the smallincrease of 0.4 DMFT within 3 years reflected theeffectiveness of the comprehensive dental careapproach.

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

22

J. W. Bawden: Changing pattern of fluoride intake; J Dent Res 71, 1992: 1212-1265.

Patients demonstrating either active caries or a medium/high caries risk, should be treated with pro-fessionally applied fluoride to control caries.

B. Øgaard, L. Seppä, G. Rølla: Professional top-ical applications - clinical efficacy and mech-anism of action; Adv Dent Res 8, 1994: 190-201.

The fissures and proximal surfaces of premolars andmolars may exhibit sub-clinical initial lesions. In thecourse of regular check-ups by the dental professional,fluoride varnish can be selectively applied onto theseareas to promote the remineralization of the toothstructure.

Targeted cariescontrol

Areas particularly susceptible to caries

Pits and fissures

Interdental surfaces

Dentinoenamel junction

Exposed cervicals

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

23

L. Petersson, K. Magnusson, H. Andersson, B.Almquist, S. Twetman: Effect of quarterly treat-ments with a chlorhexidine and a fluoride varnish on approximal caries in caries-susceptibleteenagers: a 3-year clinical study; Caries Res 34,2000: 140-143.

A study of 180 13 to 14 year olds with at least twoapproximal enamel caries lesions. One group was treated with Fluor Protector and the other withCervitec every 3 months. Overall each subject wastreated 12 times. Treatments with either of the varn-ishes showed promising effects with a low approximalcaries incidence and progression in teenagers withproven caries susceptibility.

ApproximalCaries

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

24

L.G. Petersson, S. Twetman, G.N. Pakhomov: The efficiency of semiannual silane fluoride var-nish applications: a two year clinical study in pre-school children; J Public Health Dent 58 (1),1998: 57-60.

5137 preschool children (4-5 years) attending one of 24 public dental health clinics in Halland, Swedenwere treated with Fluor Protector or a placebo var-nish. Treatment took place once every six monthswith all children receiving counselling with regard totooth brushing and diet. Caries prevalence data wascollected at baseline and after 1 and 2 years. Theincidence of approximal lesions (dfsa) was signif-icantly lower in the fluoride group than in the placebogroup. In children with clinical caries at the outseti.e. dfs scores of 1-4 or ≥ 5 approximal caries wasreduced 19 and 25% respectively compared to theplacebo group.

30

25

20

15

10

5

0≥ 5

dfs at baseline

Reduction in approximal caries after 2 years treatmentwith Fluor Protector in children with clinical caries atbaseline.

1to 4

Reduction in approximal caries [%]

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

25

P. Hahn, N. Mirnaghyan, E. Hellwig: Cariostaticefficacy of Cervitec and Fluor Protector on de-mineralized fissures; ConsEuro 2000, Bologna.

Fluor Protector and Cervitec reduced bacterial demineralisation deep within artificial fissures in vitro.

P. Hahn, S. Brüning, E. Hellwig: Effect of Cervitecand Fluor Protector on bovine enamel demin-eralization in artificial fissures; Caries Res 34,2000: 308-360.

Cervitec und Fluor Protector either alone or in comb-ination are able to reduce demineralisation within fissures.

FDI policy statement on fluorides and fluorid-ation for the prevention of dental caries; FDIDental World, May/June 1993: 11-17.

According to the FDI, the professional application oftopical fluoride is a safe and effective procedure toreduce dental caries.

Fissure Caries

Statement

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

26

Notes

Flu

or

Pro

tect

or

Lite

ratu

re H

igh

ligh

ts

Production and Distribution:

Ivoclar Vivadent AGBendererstrasse 2FL-9494 SchaanPrincipality of LiechtensteinTel. +423 / 235 35 35Fax +423 / 235 33 60www.ivoclarvivadent.com

Descriptions and data constitute no warranty ofattributes and are not binding

Printed in Switzerland© Ivoclar Vivadent AG, Schaan/Liechtenstein592368/0904/1/e/RDV