Supplementary Material for: Fluoride formed on enamel by fluoride varnish or gel application: A randomized controlled clinical trial

Although fluoride varnish (FV) and acidulated phosphate fluoride gel (APF-gel) are considered clinically effective to reduce caries, in vitro studies have shown that FV reacts slowly with enamel because most NaF present in the formulation is not solubilized in the FV. Therefore, we conducted a clinical study to evaluate if the time that FV remains on dental surfaces could overcome its slower chemical reactivity when compared with APF-gel. Sixty-eight volunteers were randomly allocated into four groups: Negative control (Control, no treatment), APF -gel application (1.23% F applied for 4 min), and FV application (Duraphat®, 2.26 % F) for 4 h (FV-4h) or 24 h (FV-24h). To evaluate fluoride formed and retained on enamel, acid biopsies were made on the buccal surfaces of the maxillary central incisors before, at the end of the application of fluoride products (immediately after gel application, or after 4 or 24 h of varnish application) and after 7 and 28 days. Fluoride concentration in dental biofilm was also analyzed before and up to 28 days after initial application. The data were analyzed by 2-way ANOVA, considering treatment and time as factors. The APF-gel and FV-24h groups formed greater fluoride concentration on enamel than the FV-4h and the control group at the end of application (p=0.0001), with no difference from each other (p=0.99). The groups did not differ regarding fluoride in biofilm, fluid (p=0.73) and solids (0.40). In conclusion, fluoride varnish needs to remain in contact with the teeth for prolonged times (>4 h) to reach the same reactivity obtained by a 4-min application of APF-gel.