From the Guidelines
Fluoride varnish is indicated in infants as soon as the first tooth erupts, typically around 6 months of age, and should be applied regularly to achieve maximal benefit. This recommendation is based on the most recent and highest quality study available, which suggests that early applications of fluoride varnish to newly erupted teeth can help enhance mineralization of healthy enamel and remineralization of early incipient caries lesions 1. The American Dental Association still recommends fluoride varnish for all children, despite mixed data for Indigenous populations, as the potential benefits far outweigh any risks 1.
Key points to consider when applying fluoride varnish in infants include:
- Application should start with the eruption of the first primary tooth at the 6-month developmental age milestone
- Fluoride varnish helps to promote remineralization of tooth enamel and inhibit bacterial metabolism in dental plaque
- The procedure is quick, painless, and can be performed by pediatricians, family physicians, or dental professionals during routine well-child visits
- Parents should be advised not to brush the child's teeth for 4-6 hours after application and to offer soft foods during this period
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. Therefore, early and regular applications of fluoride varnish are crucial to achieve maximal benefit and prevent early childhood caries.
From the Research
Indications for Fluoride Varnish in Infants
- Fluoride varnish can be applied to infants as a safe and effective method for caries management, especially for those at risk for caries or with special needs 2.
- The US Preventive Services Task Force 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, 4.
- This recommendation is based on evidence that fluoride varnish application can prevent future dental caries in children younger than 5 years, with a moderate net benefit 3.
- Fluoride varnish can be easily applied and is a painless procedure, making it suitable for young children 2.
Age of Application
- The US Preventive Services Task Force recommends starting fluoride varnish application at the age of primary tooth eruption 3, 4.
- This typically occurs around 6 months of age, but may vary depending on the individual child's development.
Benefits and Risks
- Fluoride varnish has been shown to be effective in preventing dental caries in children, with a significant reduction in caries increment 5.
- However, the evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children younger than 5 years 3, 4.
- An intensive fluoride varnish treatment regimen may not be sufficient to prevent caries relapse in children at high risk for caries 6.