Fluoride treatments are professionally applied in a dental office. They are recommended for people with a moderate to high risk of tooth decay (e.g., people with a history of cavities, infrequent dental visits, poor dental hygiene, diet high in sugar). This may include children and adults.  

Professionally applied fluoride treatments provide extra protection against tooth decay. These treatments are safe and effective. It is typically recommended that they be performed twice a year, even if high risk patients already drink fluoridated water and use dental care products that contain fluoride. 

The fluoride used for these treatments has a higher concentration level and different chemical makeup than the flouride found in over-the-counter products. The types of fluoride used for professional fluoride treatments include:

• Acidulated phosphate fluoride (APF). This is the most commonly used type of fluoride. It is available in foam or gel form, at a fluoride concentration level of 1.23 percent. APF is slightly astringent and may irritate gum tissue in patients with dry mouth. It does not discolor teeth or restoratives (e.g., fillings, crowns), although it may cause scratches in porcelain or composite resins.
  
  
• Neutral sodium fluoride. This was the first fluoride used in topical applications. It is commonly available as a 2 percent concentrate foam or gel or a 5 percent concentrate varnish. It is nonirritating and does not discolor teeth. In children, it is typically used once a week for four weeks and recommended at ages 3, 7, 10 and 13 years. In adults, the gel or foam may be applied every six months and the varnish may be applied every four months. Neutral sodium fluoride may be used as an alternative to APF when porcelain or composite restorations are present, or in patients with dry mouth.
  
  
• Stannous fluoride. Available as a powder that can be mixed with water to make an 8 percent concentrate gel, just before application. It has a disagreeable taste, may irritate the gums, and may discolor the teeth and gums (due to tin in the solution, not fluoride). This type contains a high concentration of fluoride, and is recommended for people at high risk of tooth decay.

Before a fluoride treatment, a patient’s teeth will be cleaned. Teeth are then dried to avoid diluting the fluoride when it comes into contact with them. The fluoride is then applied to the teeth.

When fluoride is a gel or foam, a tray that looks like a mouth guard is filled with the fluoride then kept in the mouth (so the solution covers the teeth) for one to four minutes. Patients may be instructed to spit and the mouth area may be wiped with gauze. Patients are often advised to refrain from eating, drinking, rinsing or smoking for 30 minutes after a treatment. This maximizes fluoride’s contact with teeth and effectiveness of the treatment.

If fluoride is a varnish, it is painted onto the teeth (including any exposed tooth root) and quickly dries. Patients may be advised to spit and to avoid eating, drinking, smoking or rinsing the mouth for at least 30 minutes after application.

Fluoride varnish is not currently approved by the Food and Drug Administration (FDA) for use in cavity prevention. It has been approved for treatment of tooth sensitivity, although it is also commonly used to help prevent tooth decay. Fluoride varnish has been used in this capacity in Canada and Europe since the 1970s and is documented to be effective for this purpose.

The fluoride used in professionally applied treatments is frequently flavored to make the experience more palatable for patients, but it should never be swallowed.