Summary Guideline/Dental Caries

Evidence-Based Dentistry (2006) 7, 62–64. doi:10.1038/sj.ebd.6400422

Topical fluoride guidance

Address for correspondence: Professor P Speight, Department of Oral Pathology, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield S10 2TA, UK.

Derek Richards1

1Centre for Evidence-based Dentistry, Oxford, UK

American Dental Association. Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc 2006; 137:1151–1159



Scope and purpose


To review the scientific evidence and develop clinical recommendations on professionally applied topical fluoride.



Medline and the Cochrane Database of Systematic Reviews were searched for systematic reviews published in the English language that dealt with professionally applied topical fluoride, including gel, foam or varnish, at any time up to October 2005. Seventeen systematic reviews were identified. Clinical studies published after January 2004 and thus not included in the systematic reviews were also identified through Medline. The American Dental Association (ADA) Council on Scientific Affairs formed a panel of experts to evaluate the identified systematic reviews and clinical trials. The panellists were provided with the identified publications and asked to identify any additional systematic reviews or other relevant published trials. One additional publication was included that had been accepted for publication. The individual studies were assessed at a workshop and a draft document was submitted for review to scientists with expertise in fluoride and caries, relevant ADA agencies and the external reviewers. The comments received were considered by the expert panel and the clinical recommendations were approved by the ADA Council on Scientific Affairs. The evidence (Table 1) and strength of recommendations (Table 2) were graded as shown.

Review and Updating


A date for the review of the recommendation is not provided.



The panel produced a number of evidence statements (Table 3) and recommend planning topical fluoride applications based on an assessment of a patient's clinical risk (Table 4): a summary of the main clinical recommendations is shown in Table 5. The full document and an executive summary can be downloaded (

Research recommendations


A number of areas were identified as requiring additional research:

  • A systematic review on the effectiveness of fluoride varnish and gel in high-risk people and/ or groups and the effects of varied frequency
  • The effects of frequency and mode of application (varnish, gel and foam) of fluoride products in adults and especially in populations with special needs
  • The use of fluoride varnish and gel for the prevention of root caries and recurrent caries
  • Strategies, especially for appropriate intervals of fluoride varnish and gel in high-risk groups, including consideration of multiple applications over short time intervals
  • The best fluoride regimen to assist in the remineralisation of early carious lesions
  • Clinical trial on the effects of fluoride foam versus gel in various target populations
  • Clinical trial on the effectiveness of 1-min versus 4-min gels in various target populations
  • Development of slow-release fluoride systems that are responsive to changing pH levels in plaque fluid and/ or saliva
  • Methods of assessing caries risk
  • The safety and effectiveness of chewable topical fluoride supplements or troches for adults
  • Evaluation of whether the caries-prevention effect of topical fluoride treatments is influenced by fluoridated water and toothpastes



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