Objective: To develop a scientifically current and evidence-based protocol for the use of fluoride varnish for the prevention of dental caries among high-risk children and adolescents.

Methods: Previous systematic reviews on this topic were used as the basis for the current review. Ovid MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007.

Results: A total of 105 articles were identified by the literature search; relevance was determined by examining the title, abstract and body of the article. Seven original research studies met the inclusion criteria. These articles were read and scored independently by 2 reviewers, and evidence was extracted for systematic review.

Recommendations: The following recommendations were developed on the basis of the evidence:

• For high-risk populations (e.g., people with low socioeconomic status, new immigrants and refugees, First Nations and Inuit children and adolescents), fluoride varnish should be applied twice a year, unless the individual has no risk of caries, as indicated by past and current caries history. This schedule of application would permit sealants to be checked biannually to ensure retention.
  


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  Single-dose packages of fluoride varnish should be used for children; the varnish in such packages should be stirred vigorously before application, to ensure that any precipitated fluoride is redissolved.
  


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  There is good evidence of the complementary efficacy of preventive strategies such as sealants and varnish, as well as toothbrushing and nutritional counselling; oral health care programs should therefore include as many complementary strategies as possible.