From the Guidelines
Fluoride varnish should be initiated in infants and children as soon as the first tooth erupts, typically around 6 months of age. This recommendation is based on the most recent and highest quality study, which suggests that early application of fluoride varnish is crucial in preventing dental caries in children 1. The American Dental Association recommends applying fluoride varnish every 3-6 months for all children, continuing through childhood.
Key Points to Consider
- The standard concentration of fluoride varnish is 5% sodium fluoride (22,600 ppm) 1.
- Application is simple and can be performed by primary care providers or dental professionals.
- Fluoride varnish works by promoting remineralization of early carious lesions and inhibiting demineralization of healthy enamel.
- This preventive measure is particularly important for children at high risk for dental caries, including those with poor oral hygiene, limited access to dental care, or diets high in sugar.
Evidence-Based Recommendation
The study published in Pediatrics in 2021 1 provides the most recent and highest quality evidence on the use of fluoride varnish in preventing dental caries in children. Although the data on fluoride varnish are mixed for Indigenous populations, fluoride varnish is still recommended because the potential benefits far outweigh any risks.
Clinical Implications
- Primary care providers and dental professionals should apply fluoride varnish every 3-6 months for all children, starting from the eruption of the first tooth, typically around 6 months of age.
- Parents and caregivers should be educated on the importance of fluoride varnish in preventing dental caries and the need for regular applications.
- Children at high risk for dental caries should be prioritized for fluoride varnish applications.
From the FDA Drug Label
Safety and effectiveness below age 3 have not been established.
The most appropriate timing to initiate the use of fluoride varnish in infants and children to prevent dental caries is at or after 3 years of age, as the safety and effectiveness of the product have not been established below this age 2.
From the Research
Timing of Fluoride Varnish Initiation
The most appropriate timing to initiate the use of fluoride varnish in infants and children to prevent dental caries is:
- At the age of primary tooth eruption, as recommended by the US Preventive Services Task Force (USPSTF) 3
- This recommendation is based on the evidence that fluoride varnish application has a moderate net benefit in preventing future dental caries in all children younger than 5 years 3
Key Considerations
- The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption 3
- Fluoride varnishes have been shown to be effective in preventing dental caries, with caries incidence reduction ranging from 18% to 70% in clinical trials 4
- The application of fluoride varnish is a useful tool in caries prevention, and its efficacy is acknowledged in clinical practice guidelines globally 5
Evidence Summary
- Multiple studies have demonstrated the effectiveness of fluoride varnish in preventing dental caries in children, including a systematic review by the USPSTF 3 and other studies published in various journals 6, 7, 4, 5
- The evidence suggests that fluoride varnish application is a valuable preventive measure that can be initiated at the age of primary tooth eruption to prevent dental caries in infants and children 3, 5