ADA Scientific Panel Issues Evidence-Based Clinical Recommendations: Patients at elevated risk for developing cavities benefit from applying topical fluoride

Patients at elevated risk for developing cavities benefit from applying prescription fluoride directly to their teeth at home or having their dentist apply it in the office, according to new clinical recommendations from a multi-disciplinary expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. Topical fluoride, used in conjunction with drinking optimally fluoridated water and using toothpaste with fluoride, is helpful to prevent tooth decay in these particular patients.

The summary of these updated clinical recommendations, “Topical Fluoride for Caries Prevention: Executive Summary of the Updated Clinical Recommendations and Supporting Systematic Review,” is published in the November issue of The Journal of the American Dental Association (JADA) and will be available to the public Nov. 1 on the ADA’s Center for Evidence-Based Dentistry (EBD) website and ADA members on the JADA website.

These clinical recommendations cover professionally applied and prescription-strength, home-use topical fluoride agents for cavity prevention. This marks the first time that these evidence-based recommendations were updated based on a systematic review of clinical studies. The authors reviewed clinical studies on fluoride mouth rinses, varnishes, gels, foams and pastes.

Evidence-based clinical recommendations are intended to provide dentists and other health professionals with a review of the latest scientific evidence on particular topics and are not considered a standard of care. Rather, health care professionals can consider clinical recommendations, patient preference and their own clinical judgment when diagnosing and treating patients.

The panel concluded that additional research is needed, but recommended the following for patients at elevated risk of developing cavities:

  • professionally-applied 2.26 percent fluoride varnish or a 1.23 percent fluoride gel every 3-6 months
  • home-use prescription-strength 0.5 percent fluoride gel or paste or 0.09 percent fluoride mouth rinse (for patients 6 years old or older)
  • A 2.26 percent professionally-applied fluoride varnish every 3-6 months is recommended for children younger than 6 years old

In addition, the recommendations specify the fluoride concentrations that provide the best benefit and indicate that APF foam not be used in children younger than 6 years old due to the potential of swallowing the foam.  Foam is also not recommended for children older than 6 years old and adults due to a lack of evidence for benefit. In addition, the panel recommended that clinicians determine a patient’s risk for developing cavities by conducting a caries risk assessment. 

The ADA recommends the following oral hygiene habits to fight tooth decay:  brushing twice a day with fluoride toothpaste, flossing daily, eating a balanced diet and visiting your dentist regularly for checkups.

The full report of the clinical recommendations, a chairside guide for dentists to use to talk to their patients and an audio podcast summary of the recommendations will be available Nov. 1 on the EBD website.

November issue of JADA

 The following select papers are scheduled to run in the November issue of JADA.

  • COVER STORY: “Dental Treatment Intensity in Frail Older Adults in the Last Year of Life”
  • CLINICAL PRACTICE: “Pain Catastrophizing in Dental Patients: Implications for Treatment Management” 
  • RESEARCH: “The Effect of Ceramic Primer on Shear Bond Strength of Resin Composite Cement to Zirconia: A Function of Water Storage and Thermal Cycling”
  • TRENDS: “Reimbursement Rates and Policies for Primary Molar Pit-and-Fissure Sealants Across State Medicaid Programs”

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About the American Dental Association
The not-for-profit ADA is the nation’s largest dental association, representing 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public’s health and promoted the art and science of dentistry since 1859. The ADA’s state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA’s flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA’s consumer website