Patient Care

Fluoride Varnish vs. MI Paste: When to Know Which is Best for Your Patient

By Katie Melko, RDH, MSDH on June, 24 2019
Fluoride Varnish vs. MI Paste: When to Know Which is Best for Your Patient
Katie Melko, RDH, MSDH

Katie works as a public health hygienist and educator and as adjunct faculty at Lincoln College of New England. She is involved in ADHA and currently serves as Immediate Past President in Connecticut.

With so many products on the market, it can be overwhelming for patients and providers to know which product is best for them. Often, providers will start with the least-invasive product and if it doesn’t work, slowly move toward stronger products.

As providers, we often see this with patients who experience sensitivity, or have high caries risk or medically induced dry mouth. How do we know if MI Paste® or fluoride varnish treatments will be better?

What is MI Paste?

MI Paste is a product from GC America that is milk-derived and provides the teeth with calcium and phosphate – the essential minerals your teeth need to be strong. The sugar-free product is water-based and comes in multiple flavors. This product is great for children under the age of 6, pregnant patients, patients who whiten their teeth and need help with sensitivity, or patients who need help desensitizing their mouth.

MI Paste Plus® does all that is described above, plus offers 900ppm of fluoride. Both of these products are creams that are meant to be applied multiple times a day safely, but not to replace toothpaste. It is best used for desensitizing, sensitivity relief, before and after whitening and, best of all, is that is doesn’t irritate dry mouths, meaning no burning sensation after use. It is great for high caries risk, orthodontic patients, and special needs, high plaque and high biofilm patients.

MI Paste® ONE is a toothpaste and a treatment all in one. This product combines MI Paste Plus and toothpaste with fluoride to help patients with remineralization, white spot lesions, tooth erosion, and prevention of white spots and dental caries, plus all that is listed above. Instead of brushing and then using a cream, you can do it all in one step with MI Paste One.1

What is Fluoride Varnish?

Fluoride varnish provides 5% sodium fluoride to the tooth and can work up to six hours after application to strengthen the enamel, re-mineralize and desensitize the tooth. These applications can be applied to children, adults and geriatric patients to help with sensitivity, reduce caries and provide an extra layer of enamel protection.

Fluoride varnish can also be used as a cavity liner, and on the root surface to help block the dental tubules of the tooth. It can be applied every six months to help continuously reduce symptoms.

Fluoride varnish is made by many companies and comes in many flavors. The most important aspect to choosing a particular brand is ease of use and that is doesn’t temporarily turn teeth yellow and clump during application.

I generally use mint for adults and bubblegum for children – these flavors seem to be the favorites among others I’ve tried. It’s important to give proper instructions after applying this product. The patient typically can’t eat or drink for at least 30 minutes and should avoid hard, crunchy and sticky foods for the rest of the day to maximize the fluoride uptake to the tooth.

How do you know which one is best?

Every patient is unique based on their medical and dental history, and what the patient presents within their mouth. So it is never a clear-cut answer, and sometimes we have to try a few different products until we find the perfect fit for the patient and provider. Let’s do a couple of patient cases and discuss which one is best and why:

Case 1:

A 3-year-old boy presents with decay and is classified as a high caries risk due to age, number of carious lesions, socioeconomic status and diet. It is the patient’s first dental visit and he is very uncooperative during treatment. The provider does an exam and the hygienist does a toothbrush prophy.

Did the provider recommend MI Paste or Fluoride Varnish treatment? Was a prescription given? Was the parent compliant?

This is a real case – the provider ultimately recommended MI Paste Plus and gave a prescription for it. Providers can bill out for fluoride varnish when applying this product instead of a varnish treatment. The patient will receive this treatment every six months and use it at home daily until the caries risk is manageable and fluoride varnish will be more suitable. The parent agreed to this treatment, but didn’t agree with nutritional counseling that was given. This is still a work in progress.

Case 2:

A 35-year-old female presents with sensitivity from recession and abfraction. The patient has tried sensitivity toothpastes and MI Paste on and off for at least two weeks at a time with no significant relief. She has a low caries risk and good oral hygiene.

Did the provider recommend MI Paste or Fluoride Varnish treatment? Was a prescription given? Was the patient compliant?

Again, another real case – the provider recommended fluoride varnish treatments and wrote a prescription for Colgate® PreviDent® 5000 Sensitive because the over-the-counter sensitivity brands she tried provided minimal reduction of sensitivity.


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