Topical Fluoride for Children (TFC)

The percentage of persons 1–4 years of age who received at least two fluoride varnish applications during the measurement period.

Why It Matters

Topical fluoride plays an important role in preventing dental decay (cavities) caused by dental caries in children. Dental caries is the most common chronic disease in children in the United States. From 2015–2016, prevalence of total (untreated and treated) caries-related tooth decay was 46% for children 2–19 years 1. As children age, the prevalence increases from 21% (2–5 years) to 51% (6–11 years), to 54% (12–19 years). Overall, the prevalence of untreated caries was 13.0%. If untreated, dental caries can lead to difficulties with eating, speaking and learning 1.

There can be significant payoffs to investing in oral health. Persons in communities with fluoridated water have fewer cavities than persons in those without it 2. In one simulation study conducted in Virginia for Medicaid eligible children younger than 3 years, the authors estimated that receiving fluoride varnish would reduce the percentage of 7½-year-old children with tooth decay from 63% to 40%. Primary care physicians applying fluoride varnish would save Medicaid more than $75 per child, totaling almost $2M/year for Virginia Medicaid 3. It has been estimated that providing fluoridated water to communities for 1 year could save $6.5B in future dental treatment costs.

The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation for children younger than 5, starting at 6 months for those whose water supply is deficient in fluoride, and apply varnish to the primary teeth of all infants and children, starting at the age of primary tooth eruption 4. The AAPD recommends that topical fluoride treatments be provided every 6 months, or at an interval appropriate to the child’s needs, starting at 12–24 months and continuing into adolescence 4.

*This measure has been included in and/or adapted for HEDIS with the permission of the Dental Quality Alliance (DQA) and American Dental Association (ADA). © 2025 DQA on behalf of ADA, all rights reserved.

Historical Results – National Averages

Performance results for this measure are currently unavailable.

References

  1. Griffin, S.O. 2016. “Vital Signs: Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children.” MMWR. Morbidity and Mortality Weekly Report 65. https://doi.org/10.15585/mmwr.mm6541e1
  2. NIHCM. September 14, 2021. Oral Health & Health Equity. National Institute for Health Care Management (NIHCM) Foundation. https://nihcm.org/publications/oral-health-health-equity
  3. Scherrer, C.R., & S. Naavaal. 2019. “Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia.” The Journal of Pediatrics 212, 201-207.e1. https://doi.org/10.1016/j.jpeds.2019.05.026
  4. AAPD. 2018. “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescent.” The Reference Manual of Pediatric Dentistry, 232–242.

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