AAPHD RESOLUTION ON FLUORIDE VARNISH FOR CARIES PREVENTION
Adopted January 2008
WHEREAS: Dental caries affects individuals of all ages. One in five of all children aged 2 – 5 years
have untreated dental caries, and 33.5% of children aged 2 – 11 years living at less than 100% of
Federal Poverty Level have untreated dental caries.1 In 2005, 4.7 million children aged 2-17 years had
unmet dental needs because their families could not afford dental care.2 It is important that those at
high risk, regardless of age, receive the oral health care necessary to maintain a healthy life. Persons
from some racial and ethnic minority groups, those with less than a high school education, living in
poverty, and/or having some medically compromised conditions have a higher prevalence of dental
caries.3 Institutionalized elderly patients are more likely to experience dental caries than those living in
their own homes.4
WHEREAS: Fluoride varnish is a lacquer containing a high concentration of fluoride that is painted on
teeth to prevent dental caries. Most fluoride varnish products contain 5 percent sodium fluoride.
Fluoride varnish inhibits demineralization and promotes remineralization of tooth enamel reversing early
pre-cavitation. It also decreases tooth sensitivity. Fluoride varnish sets on contact with teeth in the
presence of saliva giving it some advantage for use in populations where it is difficult to maintain a dry,
oral environment, and where other topical fluorides might be ingested, such as persons with
neurodevelopmental/intellectual disabilities and young children.5
WHEREAS: Fluoride varnish is efficacious in permanent teeth of school-age children 6-8 and in primary
teeth of young preschool children.9-10 Appropriately trained health professionals may use fluoride
varnish as FDA off-label use to prevent dental caries in high-risk populations, especially high-risk
populations that have difficulty accessing dental care.
THEREFORE BE IT RESOLVED THAT THE AMERICAN ASSOCIATION OF PUBLIC HEALTH
DENTISTRY RECOMMENDS THAT:
Fluoride varnish is applied 2-4 times a year 10 to those deemed at moderate or high caries risk in
various public health settings by appropriately trained health professionals. These include but are not
limited to immunization clinics, physicians’ offices, WIC clinics, Early Head Start and Head Start
programs, schools and day care institutions, extended and/or long-term care facilities such as nursing
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and assisted-living homes, and private homes of medically compromised homebound to decrease and
arrest the development of dental caries for high risk populations;
Public health authorities ensure the appropriate assessments to determine a population’s risk for dental
caries and offer fluoride varnish application through organized programs. Examples of populations
considered to be at high risk for dental caries are low-income families, children and adult
Medicaid/SCHIP recipients including infants, toddlers and school-age children, those with little or no
access to routine dental care, those exhibiting high caries risk behaviors (i.e., cariogenic diet, poor oral
hygiene, medications or conditions that reduce salivary flow), persons with disabilities, and those in
nursing or assisted-living homes. Individuals with specific caries risk indicators such as active caries,
frequent use of fermentable carbohydrates, high cariogenic bacterial levels or low salivary fluoride
levels may also be targeted; 7, 10, 11
Individuals considered for fluoride varnish application and their parents or caregivers receive the
appropriate level of oral health counseling and education. Education about caries etiology and disease
prevention should be included whenever possible;
Persons administering the topical fluoride treatment undergo the necessary training to apply the varnish
properly to patients and are working within the scope of practice allowed in their jurisdiction;
Parents and caregivers be advised that topical fluoride varnish in young children is not a substitute for
community water fluoridation programs, dietary fluoride supplements, or dental care but a complement (
i.e., every child should have a dental home by age one for the beginning of comprehensive infant oral
care); and
Federal and state government and foundations provide financial support and incentives for fluoride
varnish research in different populations and delivery settings (i.e. children, adults and elderly, including
those with special health care needs, and different public health settings) to better understand efficacy,
effectiveness, applicability, program adoption, reach, and cost-effectiveness compared to other topical
fluoride and caries preventive regimens.
References
1. Beltran-Aguilar ED, Barker LK, Canto MT, Dye BA, Gooch BF, Griffin SO, Hyman J, Jaramillo F,
Kingman A, Nowjack-Raymer R, Selwitz RH, Wu T; Centers for Disease Control and Prevention (CDC).
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Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United
States, 1988-1994 and 1999-2002. MMWR Surveill Summ. 2005 Aug 26;54(3):1-43.
2. Bloom B, Dey AN, Freeman G. Summary Health Statistics for U.S. Children: National Health
Interview Survey, 2005. National Center for Health Statistics. Vital Health Stat. 2006 Series 10(231):6.
3. U.S. Department of Health and Human Services. Oral Health in America: A report of the Surgeon
General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental
and Craniofacial Research, National Institutes of Health, 2000.
4. Longhurst RH. Availability of domiciliary dental care for the elderly. Prim Dent Care. 2002
Oct;9(4):147-50.
5. Beltran-Aguilar ED, Goldstein JW, Lockwood SA. Fluoride varnishes. A review of their clinical use,
cariostatic mechanism, efficacy and safety. J Am Dent Assoc. 2000 May;131(5):589-96.
6. Rozier RG. Effectiveness of Methods Used by Dental Professionals for the Primary Prevention of
Dental Caries. J Dent Educ. 2001 Oct;65(10):1063-72.
7. National Institutes of Health (U.S.). Diagnosis and management of dental caries throughout life. NIH
Consensus Statement. 2001 Mar 26-28;18(1):1-23.
8. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in
children and adolescents. Cochrane Database of Systematic Reviews 2002, issue 1.
9. Weintraub JA, Ramos-Gomez F, Jue B, Shain S, Hoover CI, Featherstone JD, Gansky SA. Fluoride
varnish efficacy in preventing early childhood caries. J Dent Res. 2006 Feb;85(2):172-6.
10. American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride:
Evidence-based clinical recommendations. J Am Dent Assoc. 2006;137: 1151–1159.
11. Featherstone JD. Caries prevention and reversal based on the caries balance. Pediatr Dent. 2006
Mar-Apr;28(2):128-32; discussion 192-8.
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