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Clinical Resources

Topical Fluoride Treatments

Topical fluoride treatments help prevent decay in the teeth by promoting remineralization and reducing demineralization of tooth structure. The direct contact of topical fluorides to the tooth structure on a regular basis is important for caries prevention.

Topical fluoride comes in various forms and is available as self-applied and professionally applied formulations.

Self-applied Fluoride Treatments

Self-applied treatments can be found as over-the-counter items or through a prescription. Both can be used at home.

Fluoride toothpaste
Fluoride toothpaste is the most commonly used form of self-applied fluoride that comes over the counter and prescription strengths.

When using over-the-counter toothpastes, adults and children should brush twice daily with varying amounts of toothpaste, depending on age. For children younger than 3 years old, it is now recommended that parents brush their child’s teeth with fluoride toothpaste no more than the size of a grain of rice. Children between the ages of 3 and 6 years old who can spit should use a pea sized amount. Children should be monitored and encouraged to spit after brushing.

Prescription strength toothpaste is recommended for children and adults who are at a high caries risk level. Current guidance recommends children 6 and old should use prescription toothpaste only once per day compared to over-the-counter toothpaste (twice per day). Children should rinse their mouths after brushing while adults are directed to expectorate and not rinse.

Mouth rinses
Fluoride mouth rinse is mainly found as an over-the-counter treatment. It is not recommended for children under 6 years of age due to risk of swallowing repeatedly, which can lead to fluorosis. A higher concentration of fluoride mouth rinse is available for use in supervised school fluoride programs.

Prescription fluoride gels
Prescription fluoride gels are used as a supplement to brushing with regular toothpaste for children ages 6 and older and adults. Gels should be used once daily by brushing onto the teeth directly or placed into a mouth tray that is worn for at least one minute. Similar to prescription strength toothpaste, children should rinse mouth thoroughly while adults should expectorate and not rinse.

Professionally Applied Fluoride Treatments

Professionally applied treatments are used in a healthcare provider office.

Fluoride varnish
Fluoride varnish is applied to teeth and will harden once it contacts saliva. The setting of the varnish allows a high concentration of fluoride to stay in contact with the teeth for a longer period to increase effectiveness. It is recommended to be applied from two and four times a year, depending on caries risk.

Because of the quickness and ease of application, fluoride varnishes can be applied in a variety of settings by medical and dental healthcare personnel depending on state regulations.

Primary care providers play an important role in caries prevention by providing topical fluoride varnish during well-child visits.

Fluoride foams and gels
Fluoride foams and gels should only be applied at the dental office. The foam or gel is placed in a mouth tray and worn between one and four minutes. It is recommended for twice a year treatment.

Silver Diamine Fluoride (SDF)
Silver Diamine Fluoride is a colorless liquid containing fluoride. While it has only been cleared for the treatment of tooth sensitivity, it is gaining popularity by dental professionals to be used for caries control. It is often used as an interim treatment for individuals who might be unable to tolerate more involved dental procedures.