CPSTF Recommends School Fluoride Varnish Delivery Programs

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The Community Preventive Services Task Force (CPSTF) recommends school fluoride varnish delivery programs to prevent dental caries (tooth decay) among school-aged children (preschool through high school).

Evidence shows that these programs, implemented primarily in communities with lower incomes and high rates of tooth decay among children, achieve meaningful rates of student participation, increase the number of treatments received, reduce dental caries, and reduce disparities in onset of tooth decay by income and other social determinants of health.

What are School Fluoride Varnish Delivery Programs?

School fluoride varnish delivery programs apply fluoride varnish to the teeth of children attending preschools and schools (from tooth eruption at age 6 months through high school) either at school or at offsite locations. Depending on state regulations, fluoride varnish applications may be administered by:

  • Dental professionals: dentists, dental hygienists, dental therapists
  • Trained non-dental health professionals: physicians, nurses, medical assistants, community health workers
  • Trained lay workers: teachers, administrative staff, counselors, volunteers

Programs may also provide one or more of the following additional services:

  • Risk assessment for tooth decay
  • Oral hygiene instruction and supplies
  • Oral health education
  • Dental sealants
  • Referrals to dental care

Why is this important?

  • Untreated tooth decay, one of the most prevalent diseases among children, reduces a child’s ability to eat, speak, learn, and play.
  • Tooth decay is significantly higher among children from families with lower incomes as well as historically disadvantaged racial and ethnic populations.
  • While topical fluoride treatment prevents tooth decay, fewer than 18% of children from families with lower incomes received a topical fluoride treatment during an annual dental visit in 2013-2014.

References

Centers for Disease Control and Prevention. 2019. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. [accessed March 21, 2022]. Available at: https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html.

Chou R, Pappas M, Dana T, Selph S, Hart E, Fu RF, Schwarz E. 2021. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Screening and Interventions to Prevent Dental Caries in Children Younger Than Age Five Years: A Systematic Review for the US Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US).

Chou R, Bougatsos C, Griffin J, Selph SS, Ahmed A, Fu R, Nix C, Schwarz E. 2023. Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years A Systematic Review for the US Preventive Services Task Force. Am J Prev Med. 64(4):579−594.

Clark MB, Keels MA, Slayton RL, Section on Oral Health, Braun PA, Fisher-Owens SA, Huff QA, Karp JM, Tate AR. 2020. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 146 (6): e2020034637.

Marinho VC, Worthington HV, Walsh T, Clarkson JE. 2013. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013(7):Cd002279.

US Department of Health and Human Services. 2000. Oral Health in America: A Report of the Surgeon General. [accessed March 29, 2024]. Available at: https://www.nidcr.nih.gov/research/data-statistics/surgeon-general.

Wei L, Griffin SO, Robison VA. 2018. Disparities in Receipt of Preventive Dental Services in Children From Low-Income Families. Am J Prev Med. 55(3):e53–e60 e53.

Weyant RJ, Tracy SL, Anselmo TT, Beltrán-Aguilar ED, Donly KJ, Frese WA, Hujoel PP, Iafolla T, Kohn W, Kumar J et al. 2013. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 144(11):1279-1291