Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review

J Am Dent Assoc. 2013 Nov;144(11):1279-91. doi: 10.14219/jada.archive.2013.0057.


Background: A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies.

Types of studies reviewed: The authors conducted a search of MEDLINE and the Cochrane Library for clinical trials of professionally applied and prescription-strength topical fluoride agents--including mouthrinses, varnishes, gels, foams and pastes--with caries increment outcomes published in English through October 2012.

Results: The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research.

Practical implications: The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.05 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from "in favor" to "expert opinion for." As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Keywords: Caries prevention; caries; evidence-based dentistry; fluoride; practice guidelines; preventive dentistry.

Publication types

  • Practice Guideline
  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Cariostatic Agents / administration & dosage
  • Cariostatic Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Dental Caries / prevention & control*
  • Fluorides, Topical / administration & dosage
  • Fluorides, Topical / therapeutic use*
  • Humans
  • Mouthwashes / therapeutic use
  • Young Adult


  • Cariostatic Agents
  • Fluorides, Topical
  • Mouthwashes