Table 3.

Evidence-based clinical recommendations for professionally applied topical fluoride
 The following table summarizes the evidence-based clinical recommendations for the use of professionally applied topical fluoride. The clinical recommendations are a resource for dentists to use. These clinical recommendations must be balanced with the practitioner’s professional judgment and the individual patient’s preferences.
 It is recommended that all age and risk groups use an appropriate amount of fluoride toothpaste when brushing twice a day and that the amount of toothpaste used for children younger than six years not exceed the size of a pea. For patients at moderate and high risk of caries, additional preventive interventions should be considered, including use of additional fluoride products at home, pit-and-fissure sealants, and antibacterial therapy.

Risk CategoryAge Category for Recall Patients
<6 Years6 to 18 Years18+ Years
RecommendationGrade of EvidenceStrength of RecommendationRecommendationGrade of EvidenceStrength of RecommendationRecommendationGrade of EvidenceStrength of
*Fluoridated water and fluoride toothpastes may provide adequate caries prevention in this risk category. Whether or not to apply topical fluoride in such cases is a decision that should balance this consideration with the practitioner’s professional judgment and the individual patient’s preferences.
†Emerging evidence indicates that applications more frequent than twice per year may be more effective in preventing caries.
‡Although there are no clinical trials, there is reason to believe that fluoride gels would work similarly in this age group.
§Although there are no clinical trials, there is reason to believe that fluoride varnish would work similarly in this age group.
Laboratory data demonstrate foam’s equivalence to gels in terms of fluoride release; however, only two clinical trials have been published evaluating its effectiveness.
Because of this, the recommendations for use of fluoride varnish and gel have not been extrapolated to foams. Because there is insufficient evidence to address whether or not there is a difference in the efficacy of sodium fluoride versus acidulated phosphate fluoride gels, the clinical recommendations do not specify between these two formulations of fluoride gels. Application time for fluoride gel and foam should be four minutes. A one-minute fluoride application is not endorsed.
LowMay not receive additional benefit from professional topical fluoride application*IaBMay not receive additional benefit from professional topical fluoride application*IaBMay not receive additional benefit from professional topical fluoride application*IVD
ModerateVarnish application at 6-month intervalsIaAVarnish application at 6-month intervalsIaAVarnish application at 6-month intervalsIV
OROR
Fluoride gel application at 6-month intervalsIaAFluoride gel application at 6-month intervalsIVD‡
HighVarnish application at 6-month intervalsIaAVarnish application at 6-month intervalsIaAVarnish application at 6-month intervalsIV
OROROR
Varnish application at 3-month intervalsIaD†Varnish application at 3-month intervalsIaA†Varnish application at 3-month intervalsIV
OROR
Fluoride gel application at 6-month intervalsIaAFluoride gel application at 6-month intervalsIVD‡
OROR
Fluoride gel application at 3-month intervalsIVD‡Fluoride gel application at 3-month intervalsIVD‡