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What Is the Best Method for Applying Topical Fluoride?

What is the best method for applying topical fluoride?

QUESTION: What is the best method for applying topical fluoride? Do you prefer fluoride varnish and, if so, why?

ANSWER: As always, dental hygienists should look to the literature for guidance, while also incorporating their professional judgment and patient needs. In 2013, the American Dental Association (ADA) updated its recommendations on the use of professional and home-use prescription topical fluorides.1 The executive summary and chairside guide is available at the ADA Center for Evidence-Based Dentistry’s website:

Topical Fluoride Agents

The new recommendations are based on a systematic review of the literature that looked at 5% neutral sodium fluoride (NaF) varnish and 1.23% acidulated phosphate fluoride (APF) gel. Table 1 provides a comparison of both products. For children younger than 6, varnish is the only recommended method for topical fluoride application. Either varnish or gel is recommended at 3-month to 6-month intervals for patients older than 6 who are at increased risk of dental caries. Many systems are available to ascertain caries risk. Individual risk factors include poor oral hygiene, cariogenic diet, and suboptimal fluoride exposure. Active dental caries in the previous 12 months, however, is the greatest predictor of future caries risk.

The panel concluded with low certainty that there was an anticaries benefit to primary teeth with a twice-annual application of 1.23% APF foam and no benefit to the permanent dentition; therefore foam was not included in the recommendations. The panel identified no studies on the effects of 2% NaF gel that met the review’s criteria,
so it was not included in the recommendations.

Because the use of 5% NaF varnish and 1.23% APF gel demonstrate the most significant anti-caries effects, I would use either of these products. Based on fluoride varnish’s ease of application and caries-prevention benefits in primary and permanent teeth, as well as in root caries, it is my application of choice. Varnish is also very effective around orthodontic brackets and is easy to place where it is needed most. As some patients do not like varnish application, I would keep a 1.23% APF 4-minute gel product on hand, as well.


  1. Weyant RJ, Tracy SL, Anselmo T, Beltrán-Aguilar ED, et al. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systemic review. J Am Dent Assoc2013;144:1279–1291.
The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to to submit your question.

From Dimensions of Dental Hygiene. July 2014;12(7):74.


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