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Aims: To determine the efficacy of acidulated phosphate fluoride (APF) gel in reducing caries increment in a group of preschool children in Mosul City, and to compare between the anti-caries effect of two different concentrations (full strength-1.23% and half strength-0.4%) after one year of biannual application of the gel. Materials and Methods: The sample consisted of 363 kindergarten children [192 (52.89%) males and 171 (47.11%) females] aged 4 years-at the initial examinationfrom 10 randomly selected kindergartens in Mosul City Center. The sample was divided into two experimental groups and one control group. Children in the first group received biannual application of full strength (1.23%) APF gel; those in the second group received biannual application of half strength (0.4%) APF gel, whereas those in the third group did not receive any fluoride treatment. Dental examinations were done according to WHO criteria using dmft and dmfs indices: One before fluoride application and the other after one year. Results: A significant reduction in dental caries increment of the two experimental groups compared with the control group regarding dmft and dmfs indices. The percentage of caries reduction regarding dmft and dmfs indices were 97.25% and 101.15% for the first group, and 95.94% and 85.33% for the second group, respectively. However, the differences between the two concentrations were statistically not significant, although children in the first group who received the full strength fluoride application revealed slightly better reduction in caries increment than those in the second group who received the half strength fluoride application. Therefore, to decrease the risk of ingesting a highly concentrated fluoride gel, the use of the lower concentration APF gel is recommended. Conclusion: The use of such a program involving professional APF gel application for preschool children is advised especially for those with evidence of dental caries.