From the Guidelines
Fluoride varnish is indicated for infants once their 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 applications of fluoride varnish to newly erupted teeth, beginning at the eruption of the first primary tooth, is paramount to achieve maximal benefit in preventing early childhood caries (ECC) 1. The American Dental Association still recommends fluoride varnish for all children, as the potential benefits far outweigh any risks.
Some key points to consider when applying fluoride varnish to infants include:
- The procedure is quick, painless, and can be performed by pediatricians or dental professionals during routine well-child visits
- The standard application involves a small amount of 5% sodium fluoride varnish painted directly onto all tooth surfaces
- Fluoride varnish works by promoting remineralization of tooth enamel and inhibiting bacterial metabolism in dental plaque
- Parents should be advised that the child can eat and drink immediately after application, though avoiding hot beverages and hard foods for several hours is recommended
It is essential to note that fluoride varnish is not effective in arresting and remineralizing more advanced lesions that have cavitated through the enamel, which are known to be more prevalent in young Indigenous children 1. However, early applications of fluoride varnish can help to enhance both the mineralization of healthy enamel and the remineralization of early incipient caries lesions.
The benefits of fluoride varnish in infants include:
- Strengthening developing teeth
- Helping to prevent early childhood caries
- Reducing the risk of pain, infection, and difficulties with eating and speaking
- Providing a concentrated, temporary dose of fluoride that promotes remineralization of tooth enamel and inhibits bacterial metabolism in dental plaque 1
From the Research
Indications for Fluoride Varnish in Infants
- Fluoride varnish is indicated for all infants and children starting at the age of primary tooth eruption, as recommended by the US Preventive Services Task Force (USPSTF) 2.
- The application of fluoride varnish to the primary teeth of all infants and children is recommended by the USPSTF, with moderate certainty of a moderate net benefit in preventing future dental caries 2.
- The evidence suggests that fluoride varnish has a substantial caries-inhibiting effect in both primary and permanent teeth, although the quality of the evidence is assessed as moderate due to the inclusion of mainly high-risk-of-bias studies with considerable heterogeneity 3.
Factors Influencing the Effectiveness of Fluoride Varnish
- The effectiveness of fluoride varnish is not significantly associated with factors such as baseline caries severity, background exposure to fluorides, application features, concentration of fluoride, or frequency of application 3.
- The use of fluoride varnish in combination with other topical fluoride interventions, such as toothpaste or mouthrinse, may achieve a modest reduction in caries compared to a single topical fluoride intervention 4.
Comparison with Other Topical Fluoride Interventions
- Fluoride varnish has been compared to other topical fluoride interventions, such as toothpaste, mouthrinse, and gel, with varying results 5, 4, 3.
- The evidence suggests that fluoride varnish is effective in preventing dental caries, but the relative value of different topical fluoride interventions is uncertain 5.