This paper reviews fluoride varnish (FV) literature to develop a community-based protocol for people with special needs or those who are caries susceptible. Safety, personnel and cost issues are discussed and existing NIH, CDC and WHO recommendations are presented. FV studies are assessed with respect to type of FV to use and frequency of application. FV is compared with studies using other caries preventive agents: 0.2% NaF mouthrinse, acidulated phosphate fluoride (APF) gel, dental sealants, water fluoridation and chlorhexidine. Because there are few FV studies among special need populations, conclusions are based on available literature and public health principles. If personnel are available, FV use is preferred to APF gel and may be preferable to 0.2% NaF mouthrinse. FV is more effective in optimally fluoridated communities. If many occlusal surfaces are at risk, sealants should be applied. Additional combinations and frequencies of preventive agents should be tested, especially for people with special needs and high caries risk adults.