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: 1. 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. 2. 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. 3. There is good evidence of the complementary efficacy of preventive strategies such as sealants and varnish, as well as toothbrushing and nutritional counselling; oral healthcare programs should therefore include as many complementary strategies as possible.