To review the scientific evidence and develop clinical recommendations on professionally applied topical fluoride. Medline and the Cochrane Database of Systematic Reviews were searched for systematic reviews published in the English language that dealt with professionally applied topical fluoride, including gel, foam or varnish, at any time up to October 2005. Seventeen systematic reviews were identified. Clinical studies published after January 2004 and thus not included in the systematic reviews were also identified through Medline. The American Dental Association (ADA) Council on Scientific Affairs formed a panel of experts to evaluate the identified systematic reviews and clinical trials. The panellists were provided with the identified publications and asked to identify any additional systematic reviews or other relevant published trials. One additional publication was included that had been accepted for publication. The individual studies were assessed at a workshop and a draft document was submitted for review to scientists with expertise in fluoride and caries, relevant ADA agencies and the external reviewers. The comments received were considered by the expert panel and the clinical recommendations were approved by the ADA Council on Scientific Affairs. The evidence (Table 1) and strength of recommendations (Table 2) were graded as shown. A date for the review of the recommendation is not provided. The panel produced a number of evidence statements (Table 3) and recommend planning topical fluoride applications based on an assessment of a patient's clinical risk (Table 4): a summary of the main clinical recommendations is shown in Table 5. The full document and an executive summary can be downloaded ( www.ada.org/prof/resources/topics/evidencebased.asp ). A number of areas were identified as requiring additional research: