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Effective Fluoride Mouthwash Delivery Methods as an Alternative to Rinsing

Rattanawiboon, Chayanit; Chaweewannakorn, Chayanit; Saisakphong, Tanyamai; Kasevayuth, Kasekarn; Trairatvorakul, Chutima

doi: 10.1097/NNR.0000000000000131

Background Special-needs patients with high caries risk cannot benefit from the proven caries-reducing effect of fluoride mouthrinse because of poor rinsing compliance and a lack of home-use fluoride application recommendations.

Objectives This study aimed to evaluate whether two modified delivery methods—spray or swab application—could raise the salivary fluoride to levels similar to that of rinsing.

Methods Five healthy men and 16 healthy women, ages 18–22 years, participated in this crossover study. The subjects performed a standardized brushing routine twice a day with 1,000-ppm fluoride dentifrice 1 week before and during the experimental period. The three fluoride mouthwash (0.05% NaF; 226-ppm fluoride) administration methods consisted of rinsing, spray, and cotton swab application. Each application was separated by at least 1 week. Unstimulated whole saliva was sampled for 2 minutes at baseline and at 0, 5, 10, 20, 30, 60, and 120 minutes after each fluoride mouthwash application. Salivary fluoride level (ppm) was measured by a blinded investigator using an ion-specific electrode (ORION EA940). The differences in salivary fluoride concentration for each application method were analyzed by repeated measures ANOVA at a nominal significance level of .05.

Results The newly designed fluoride mouthwash delivery methods yielded a similar fluoride level in whole saliva compared to that of rinsing at all time points (p > .05). The t half-life of fluoride concentration ranged from 1.62 minutes (SD = 0.53) in the spray group to 2.08 minutes (SD = 0.87) in the cotton swab group; the values were not significantly different.

Discussion Our results indicate that the spray and cotton swab fluoride delivery methods were effective alternatives to conventional mouth rinsing. Caregivers of individuals with acute and chronic illness, including developmental disabilities affecting cognitive or physical abilities, may consider using these alternative fluoride delivery methods to help promote dental hygiene.

Chayanit Rattanawiboon, DDS, is Research Associate; Chayanit Chaweewannakorn, DDS, is Research Associate; and Tanyamai Saisakphong, DDS, is Research Associate, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.

Kasekarn Kasevayuth, PhD, is Lecturer, Department of Biochemistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.

Chutima Trairatvorakul, M.S., is Associate Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.

Accepted for publication August 31, 2015.

The authors want to thank Dr. Kevin A. Tompkins (International Staff, Office of Research Affairs, Faculty of Dentistry, Chulalongkorn University) for assistance in revising themanuscript and Assistant Professor Tewarit Somkotra (Lecturer, the Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University) and Ms. Pariyawit Nurash (Statistician) for statistical advice.

The authors acknowledge that the project was supported by the Dental Research Fund, Faculty of Dentistry, Chulalongkorn University. Facilities, equipment, and technical support were from the Department of Biochemistry and Department of Pediatric Dentistry, Chulalongkorn University. All the commercial materials identified in this study were to describe the experimental procedures—not for any recommendation.

The authors have no conflicts of interest to report.

Corresponding author: Chutima Trairatvorakul, M.S., Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand (e-mail:

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