From the Guidelines
Fluoride varnish should be initiated in infants as soon as the first tooth erupts, typically around 6 months of age, to prevent dental caries. This recommendation is based on the most recent and highest quality study, which suggests that early applications of fluoride varnish to newly erupted teeth, beginning at the eruption of the first primary tooth at the 6‑month developmental age milestone, is paramount 1. The American Dental Association still recommends fluoride varnish for all children, as the potential benefits far outweigh any risks.
Key Points to Consider
- Fluoride varnish applications help to enhance both the mineralization of healthy enamel and the remineralization of early incipient caries lesions in primary and permanent teeth 1.
- The varnish contains a high concentration of fluoride that forms a protective layer on the tooth surface, slowly releasing fluoride over several hours after application.
- Early intervention is crucial because primary teeth are more susceptible to decay due to thinner enamel compared to permanent teeth.
- Fluoride varnish works by remineralizing early carious lesions, inhibiting bacterial metabolism, and making teeth more resistant to acid attacks.
Application Frequency
The recommended application frequency is every 3-6 months, with higher-risk children benefiting from more frequent applications (every 3 months) 1. However, the evidence of benefits from more than two applications per year remains inconclusive.
Importance of Early Initiation
Initiating fluoride varnish at the eruption of the first primary tooth is crucial to achieve maximal benefit, especially in high-risk populations such as Indigenous children 1. This approach is particularly important for children who may not yet have developed proper oral hygiene habits or who consume sugary foods and beverages regularly.
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 age 3, 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, or at 6 months of age, as recommended by the American Academy of Pediatrics 3
- The US Preventive Services Task Force (USPSTF) also recommends applying fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption 3
- A study published in BMJ open quality found that applying fluoride varnish to children starting at 6 months or the time of tooth eruption up to 3 years of age can increase the number of patients who receive fluoride varnish application 4
Key Findings
- The application of fluoride varnish can be effective in preventing dental caries in both primary and permanent dentitions 5
- Fluoride varnish application every 3-6 months can be beneficial in preventing caries lesions on the erupting first permanent molars of high-risk populations 6
- A study published in the Journal of international oral health found that applying fluoride varnish to children aged 3-6 years old can decrease the mean decayed, missed, and filled teeth (dmft) 7