# Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents
## 3 Results and Discussions
### Fluoride Varnishes
(2013) found that the caries protection benefit brought by fluoride varnish use is independent of baseline caries risk and severity, previous administration of fluorides, earlier prophylaxis, commonness of applications, and concentration of topical agent [44]. In their network meta-analysis, [PERSON] et al. (2019) concluded that a combination of sealants and 5% NaF varnish was the most effective in arresting or reversing lesions on occlusal surfaces versus non-treatment (RR, 3.35; 95% CI, 2.42 to 4.64, moderate certainty) [2]. For non-cavitated carious lesions on smooth surfaces, this network meta-analysis demonstrated that 5% NaF varnish application had a twice greater possibility of arresting or reversing enamel lesions vs. no treatment, while the association of the same fluoride varnish with resin infiltration increased this possibility to five times [2]. Many studies from the literature showed that professionally applied fluoride varnishes are effective for preventing dental caries in both dentitions (Table 2). All these RCT [39; 45; 46; 47; 48; 49; 50; 51] studies and meta-analyses concluded that fluoride varnishes exhibited an important caries-inhibiting effect in both permanent and primary dentitions, with reductions in caries ranging from 28 to 70%. Despite clinically proven efficacy, professionally applied fluoride varnish is not widely used in the world [52]. In countries with community water fluoridation, such as the USA and Australia, fluoride varnish is recommended only for patients with increased caries risk, but in those countries with no water fluoridation or a small concentration of fluoride in drinking water (e.g., England, Scotland) fluoride varnish is indicated for caries prevention in all children and adolescents [52]. Furthermore, a recent systematic review and meta-analysis performed by [PERSON] et al. (2021) showed that fluoride varnish did not add significant caries-preventive benefits for children under 8 years old using regular fluoride toothpaste with \(\geq\)1000 ppm (low to moderate certainty evidence) [53]  
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[PERSON] et al. conducted an RCT regarding the therapeutic effect of two fluoride varnishes on white spot lesions, finding a similar effect for both materials after four applications. A preventive fraction of 80% was found, associated with a reduction in the magnitude of WSL [54]. Another Brazilian study found an overall preventive fraction of 45.7% for three fluoride varnishes [55]. [PERSON] et al. underlined the importance of risk assessment for the application of fluoride varnish while confirming the effectiveness of these materials in preventing occlusal caries in moderate-high caries risk [56]. These authors recommend two to four applications per year of fluoride varnish [56]. Additonally, [PERSON] et al. could not establish which intervention (pit and fissure sealants vs. fluoride varnish) had better results, in agreement with [PERSON] et al. [57] and [PERSON] [58]. Among professionally applied fluoride products, fluoride varnish is the most adequate regarding safety and acceptability, as well as regarding caries prevention in high-risk children and adolescents, orthodontic patients, and the elderly [59]. Some studies proved that professionally applied fluorides (such as varnishes) are more effective in preventing caries on smooth surfaces than occlusal surfaces [23; 60]. According to the American Dental Association (ADA), professionally applied fluorides, depending on caries risk and age, are synthetized in Table 3.  
The EAPD moderately recommends 2-4 applications of fluoride varnishes for the prevention of caries in both dentitions, especially in children of increased risk of caries development, as well as in children with special oral health care needs, orthodontic patients, or during sensible periods such as tooth eruption [31]. According to the EAPD [31] and ADA [37], fluoride varnish is the only topical agent to be used in preschool.