Fluoride’s predominant effect in caries prevention and management is post-eruptive and topical. However, as it relates to this statement, topical fluorides are those that are applied to erupted teeth, with the understanding that water fluoridation’s and dietary fluoride’s main effect is also topical. The American Association for Dental Research (AADR) strongly recommends twice daily use of fluoride-containing dentifrices as an effective means of reducing caries.

Furthermore, based on current evidence, the AADR also strongly recommends that fluoride-containing dentifrices should be used in small amounts in pre-school-aged children in order to reduce the risk of dental fluorosis through unintentional ingestion. It is important to note that professionally applied gels and varnishes also reduce caries incidence. Studies show that application at six-monthly intervals is appropriate for patients at increased caries risk, but application frequency may be decreased or increased according to risk status and degree of exposure to other sources of fluoride. Higher-risk patients should receive applications at three to six-month intervals. In addition, the AADR recommends the use of daily or weekly fluoride mouth rinses and gels for this group. The AADR makes the following caveat:  Because of their high fluoride concentration, mouthrinses and prescription gels are not recommended for pre-school-aged children. 


  1. Weyant RJ, et al., Topical fluoride for caries prevention, Executive summary of the updated clinical recommendations and supporting systematic review, J Am Dent Assoc 2013;144(11):1279-1291. (Recommended by Carey ,Gonzalez and Zhan)
  2. Am Dent Assoc, Center for Evidence-Based Dentistry, Topical fluoride for caries prevention, Council on Scientific Affairs, November 2013. 
  3. Fluoride varnishes for preventing dental caries in children and adolescents. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Cochrane Database Syst Rev. 2013 Jul 11;7:CD002279. doi: 10.1002/14651858.CD002279.pub2. 
  4. Cochrane reviews on the benefits/risks of fluoride toothpastes. Wong MC, Clarkson J, Glenny AM, Lo EC, Marinho VC, Tsang BW, Walsh T, Worthington HV. J Dent Res. 2011 May;90(5):573-9. doi: 10.1177/0022034510393346. Epub 2011 Jan 19.
  5. Guideline on fluoride therapy. Pediatr Dent. 2013 Sep-Oct;35(5):E165-8.
  6. Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, Zentz RR. Fluoride toothpaste efficacy and safety in children younger than 6 years. J Am Dent Assoc. 2014 Feb;145(2):182-9. doi: 10.14219/jada.2013.37.

(adopted 1996; revised 2009, revised 2015)