What Happens When Schools Apply Fluoride to Kids’ Teeth?

by Mandy Morgan April 14, 2025

Fluoride is back in the news as the latest RFK boogieman. Yet the research is clear: tooth decay doesn’t just hurt—it holds kids back. It affects how they eat, speak, concentrate, and even how they perform in school. Yet in many communities, especially those hit hardest by poverty, dental care isn’t a given. For millions of children, regular dental visits are out of reach.

But what if the solution was as simple as bringing the dentist to them? Or more accurately, bringing fluoride varnish directly into schools?

That’s the big idea behind School Fluoride Varnish Delivery Programs (SFVDPs)—and a new CDC-supported systematic review shows they work.

Big time.

What Are SFVDPs, and Why Do They Matter?

SFVDPs are programs where trained providers—sometimes dental hygienists, sometimes medical staff—apply a thin layer of fluoride varnish to children’s teeth right at school. No dental chair. No time off work. No cost for the family. Just a quick, simple, effective way to protect against tooth decay.

And that protection is not minor.

Across 31 studies with over 60,000 students, researchers found that:

• Cavities in permanent teeth dropped by 32% on average.
• Cavities in baby teeth dropped by 25%.
• Early-stage decay was less likely to get worse.
• In low-income communities, the benefits were even stronger.

So why aren’t these programs everywhere?

A Powerful Tool, Still Underused

Despite their effectiveness, nearly 30% of U.S. states don’t have a single SFVDP. One reason: reimbursement rules. In many states, only dentists or advanced medical professionals (like nurse practitioners) can bill Medicaid for applying fluoride varnish. Some states won’t reimburse if the child is over age 6. Others don’t allow trained laypeople to apply it, even though programs like the Indian Health Service successfully use them.

These barriers are frustrating because they block access to an intervention that is:

• Proven safe (only minor side effects like temporary staining or nausea reported in <1% of cases)
• Inexpensive
• Easily scalable
• Equitable

In fact, studies showed students in school-based programs received fluoride 14 times more often than those without access to such programs.

That’s a big deal when less than 1 in 5 low-income kids receive fluoride treatment at a dentist’s office.

Think of It This Way…

If you’ve ever handed out sunscreen at summer camp, you’ve done something similar to an SFVDP. It’s not about replacing the dermatologist—it’s about protecting kids where they are, before problems arise.

And the stakes are real. In the U.S., over half of adolescents have had tooth decay in their permanent teeth. Rates are higher among Black and Mexican American teens, making fluoride varnish not just a public health win, but a tool for racial and socioeconomic equity.

Participation Works—If You Let It

In U.S. studies, school participation rates reached 83%—a massive leap from traditional dental care. And the benefits weren’t just in preventing new cavities. Some studies showed existing early-stage decay even reversed when fluoride varnish was applied consistently.

Plus, there are promising—but still unmeasured—benefits. We know that kids with untreated cavities miss more school and do worse academically. SFVDPs might help change that trajectory.

Progression Slowed. Equity Gained.

One of the most encouraging findings? SFVDPs work better in more deprived communities.

In Scotland and Sweden, programs in low-income areas reduced tooth decay dramatically more than in wealthier areas. In the U.S., most of the studies in the review focused on low-income schools, further suggesting that this approach reaches—and helps—the kids who need it most.

What’s Still Missing?

Despite the strong results, some gaps remain:

• We don’t yet have strong U.S.-based data on racial and rural disparities in SFVDP effectiveness.
• We need better research on long-term outcomes—not just dental, but school performance and healthcare savings.
• We lack policy support in states that don’t reimburse non-dental providers or limit coverage by age.

But one thing is clear: fluoride varnish doesn’t need fancy tech or big money. It just needs smart policy and local champions.

What’s Next for Public Health?

If you’re in public health, education, or Medicaid policy, this study should serve as both a proof point and a call to action. SFVDPs check every box: cost-effective, equity-focused, and scalable.

Let’s not wait another decade to make them universal.

Join the Conversation

• Does your community have a school-based fluoride program?
• What policy barriers have you seen to expanding preventive dental care?
• How can we make these programs more accessible to rural and under-resourced schools?

Act Now – Public Health Can’t Wait!

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