Caries Risk Assessment, Fluoride Varnish, and Counseling

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Fluoride Varnish Standard of Care

Caries Risk Assessment, Fluoride Varnish, and Counseling Fluoride Varnish Fluoride Varnish Standard of Care
  • The United States Preventive Services Task Force (USPSTF) recommended first in 2014 that primary care clinicians apply fluoride varnish to the teeth of all infants and children, starting with the appearance of the first primary tooth through age 5, at least every 6 months. USPSTF recommendations were reaffirmed in 2021.
    • Recommendation applies to ALL children; no longer a risk-based recommendation
    • Assigned a "B" grade recommendation
  • All children should receive a professional fluoride treatment at least every 6 months in the primary care medical home.
  • Higher risk children should receive fluoride varnish application every 3 months.
  • Fluoride varnish application by a PCP is cost-savings intervention, especially in children 3 years and under. One study in Virginia found that, accounting for averted restoration cost, PCP fluoride varnish application would save $75.32 per child, or a total population savings of almost $2 million/year for VA Medicaid.
  • Though helpful in reducing caries, varnish is not a replacement for appropriate diet, regular brushing, indicated systemic fluoride supplements, or routine dental care.

References

Chou R, Pappas M, Dana T, Selph S, Hart E, Schwarz E. Screening and Prevention of Dental Caries in Children Younger Than Five Years of Age: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 2102. AHRQ Publication No. 21-05279-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021.

Clark MB, Keels MA, Slayton RL.SECTION ON ORAL HEALTH. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2020; 146 (6): e2020034637. 

U.S. Preventive Services Task Force Recommendation Statement. Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions. 2021. Click here

Scherrer CR, Naavaal S. Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia. J Pediatr. 2019; 212: 201-207.

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