ࡱ> egd%` $bjbj .H̟̟\j,H2(B %H'H'H'H'H'H'H$Ih@LKH@ @ @ KH`H###@ %H#@ %H##:9),) -h!e) H$vH0Ho)RMX"lM))xM9*>E,#q$KHKH#H@ @ @ @ D * *  Duraphat- Safety Issues Introduction Fluoride varnishes are generally considered safe and well accepted. A Cochrane review1 identified no evidence of adverse effects and recommended that future studies should actively record adverse effects. The safety information provided by Colgate (see Panel) indicates that their use is contraindicated in patients with ulcerative gingivitis or known sensitivity to colophony. However concerns have been raised regarding their use in allergic individuals2. This short paper summarises the available published literature on adverse effects related to fluoride varnishes. Safety information provided on Colgate professional website at:-  HYPERLINK "https://secure.colgateprofessional.com/app/ColgateProfessional/US/EN/Products/ProductItems/ColgateDuraphat/ProductSpecifics.cvsp" https://secure.colgateprofessional.com/app/ColgateProfessional/US/EN/Products/ProductItems/ColgateDuraphat/ProductSpecifics.cvsp Contraindications: DURAPHAT is contraindicated in patients with ulcerative gingivitis or stomatitis or known sensitivity to colophony (kolophonium) or other ingredients. Not for ingestion during application (not for systemic treatment). Interactions with other substances: On the day of DURAPHAT application, other fluoride preparations, such as fluoride gels, should not be administered. Routine regimens of fluoride tablets should be suspended for several days after treatment. Adverse Reactions: In case of disposition to allergic reactions, edematous swellings have been reported only in rare instances, especially after application to extensive surfaces. In extremely rare instances, attacks of dyspnea have occurred in asthmatic children. Patients known for sensitive stomach may occasionally experience nausea with extensive applications. In any case of intolerance, the varnish layer can easily be removed by brushing and rinsing.  Method Searches of the Medline, Embase, Cochrane Library and TRIP database were undertaken using the following search terms:- Fluoride varnish Fluorides,Topical Duraphat Allergy Hypersensitivity Asthma Only four directly relevant articles were identified3-6 none of which involved children. The most recent paper3 involved in a 29-year old male being treated for hypersensitive teeth who suffered from swelling and redness of the tongue and lip within 24 hours of treatment, requiring treatment with antihistamines. Subsequent testing confirmed an allergy to colophony. Colophony is a known contact sensitiser being a complex mixture of over 100 compounds derived from pine trees and has countless applications eg Cosmetics (e.g. mascaras, lipsticks, eyeshadows, concealer creams, nail varnish) Adhesives (e.g. sticking plasters and tapes, glues) Medicines (e.g. wart removers, cold sore creams, ostomy products, nappy creams, haemorrhoid creams, sprays) Toiletries (e.g.. transparent soaps, hair removing wax, dental floss, sunscreens, blister creams and first-aid ointments) Household items (e.g. grease removers for clothes, shoe wax, polish for floors, cars and furniture, laundry soaps, fly strips) Recreational (e.g. sport racket handles, athletic grip aids, golf club grips, bows for stringed instruments, fireworks, ski wax) Chewing gum Firewood and pine trees in the garden Paper products: one of the largest single uses of colophony is in the manufacture of paper and paperboard** A review by Downs and Sanson7 found prevalence rates for colophony allergy to range from 1-7% with a paper by Husain8 indicating a rate of 6.3% in the West of Scotland. The Scottish study was conducted in the 1970s and a recent paper from Sweden9 has shown falls in the prevalence of colophony allergy which may be linked to decreased exposure. To date there have been no published reports linking the use of fluoride varnishes to asthma episodes. Weintraub in a 2-years study10 of fluoride varnish applications involving 376 children which specifically recorded adverse events only noted 1 (a cheek ulcer) with no adverse events being recorded in known asthmatic children. A recent adverse event was recorded within the Childsmile programme11 during which a child (with a reported elastoplast allergy) was inadvertently provided with a durphat varnish application and suffered an allergic contact dermatitis type response. Conclusions There is clear evidence of allergic reactions to Duraphat in patients with known colophony allergy so it is important to follow the manufacturers recommendations regarding this. As there are no published reports linking the use of fluoride varnishes with asthma attacks there is no obvious reason to avoid using fluoride varnishes in this group of patients. However, in view of the number of ingredients in duraphat varnish and the fact that Colophony is a complex mixture of over 100 compounds derived from pine trees, the current advice not to apply fluoride varnishes to those patients who have been hospitalized with an asthma attack seems justified as these are potentially the most atopic children. It is also worth noting that the most common allergic reponse reported in the literature is the allergic contact dermatitis type response and that dentists assessing childrens medical histories should take this into account when making recommendations for duraphat use. Following that recent adverse event recorded within the Childsmile programme it is recommended that formal recording of all adverse events should be maintained Derek Richards Director, Centre for Evidence-based Dentistry References Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 1. Blinkhorn A, Davies R. Using fluoride varnish in the practice. Br Dent J. 1998; 185(6):280-1. Sharma PR. Allergic contact stomatitis from colophony. Dent Update. 2006 Sep; 33(7):440-2. Hensten-Pettersen A, Jacobsen N. Possible side effects related to dental hygienists' treatment. Acta Odontol Scand. 1994 Jun;52(3):157-61. Isaksson M, Bruze M, Bjorkner B, Niklasson B. Contact allergy to Duraphat. Scand J Dent Res. 1993 Feb;101(1):49-51. Lokken P, Borchgrevink CF. [Raported adverse effects in caries-preventive use of fluorides in Norway. Review and 2 cases] Nor Tannlaegeforen Tid. 1977 May;87(5):248-54. Norwegian. Downs AM, Sansom JE. Colophony allergy: a review. Contact Dermatitis. 1999 Dec;41(6):305-10. Review. Husain SL. Contact dermatitis in the West of Scotland. Contact Dermatitis. 1977 Dec;3(6):327-32. Lindberg M, Edman B, Fischer T, Stenberg B. Time trends in Swedish patch test data from 1992 to 2000. A multi-centre study based on age- and sex-adjusted results of the Swedish standard series. Contact Dermatitis. 2007 Apr;56(4):205-10. Weintraub JA, Ramos-Gomez F, Jue B, Shain S, Hoover CI, Featherstone JD, Gansky SA. 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