The use of fluoride varnish in children: a critical review with treatment recommendations.

This paper expands upon the recent report of the expert panel commissioned by the American Dental Association's Council on Scientific Affairs by offering evidence-based clinical recommendations for professionally applied topical fluoride. The authors strongly support the panel's recommendation that clinicians should rely upon caries risk criteria for determining those children who will receive a topical fluoride treatment. In this paper, the authors will take a position that when clinicians have made a decision to use topical fluoride therapy, fluoride varnish should be the only consideration for children ages 0-6 and children of all ages who have special health care needs that limit their attention span and/or cooperation. The authors offer an accompanying rationale based on dosage reduction and efficacy, that fluoride varnish should be the topical fluoride of choice for children ages 6-12. The authors expand upon the recent panel recommendations by examining published clinical trials to determine the best clinical techniques for varnish use. The authors offer clinicians the following recommendations prior to varnish use: a pre-application rubber cup or tooth brush prophylaxis, the application of varnish to dry teeth and post-operative instructions to include both no tooth brushing and a soft diet for 12 hours.