Evaluation of Clinical Evidence on the Efficacy and Safety of Fluoride Varnishes Compared to High-Concentration Topical Gels in Preventing Dental Caries in Preschool Children

Early Childhood Caries remains the most prevalent chronic condition globally in preschool children, necessitating effective preventive protocols. Among professional topical fluorides, fluoride varnishes (FV) and high-concentration gels (FG) are widely utilized, yet the optimal balance between efficacy and safety remains a critical clinical concern. This structured critical review aimed to compare the clinical evidence regarding the caries preventive efficacy (measured by DMFS/dmfs reduction) and safety profile (specifically the risk of systemic fluoride ingestion) between professionally applied fluoride varnishes and high-concentration fluoride gels in children under six years of age. A structured search was conducted across major electronic databases (e.g., PubMed, Scopus, Cochrane Library) for Randomized Controlled Trials (RCTs) and systematic reviews directly comparing or assessing FV and high-concentration FG in preschool children. Clinical evidence demonstrates that FV offers comparable, and often superior, caries reduction rates compared to FG (up to 75% reduction reported in some FV trials). Crucially, FV exhibits a significantly higher safety margin; due to its rapid adherence and sustained-release mechanism, the risk of acute ingestion and subsequent systemic fluoride exposure is markedly lower than with the tray-applied gel method. Additionally, FV demonstrates superior patient compliance and application efficiency in young children. Based on the synthesis of clinical data, Fluoride Varnish is the safer and preferred professional topical fluoride agent for children under six years. Its superior safety profile, coupled with strong evidence of efficacy and practicality, firmly establishes it as the recommended first-choice protocol for ECC prevention in pediatric dental practice.