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Best practices for non dental professionals providing fluoride varnish
1. Best Practices for Non-Dental
Professionals Providing Fluoride
Varnish
Presented by
Vidya Shanmugam
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2. What is Fluoride Varnish?
Fluoride Varnish is defined as “a lacquer or
liquid, made from a natural or synthetic base, in
which fluoride salts are dissolved in a solvent
as ethanol.”
It acts as an anti-caries agent and also
aides in reduction on caries when applied
appropriately
It is a type of professional topical fluoride
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3. What is Fluoride Varnish?
Advantages:
Easy to apply
Does not require dental equipment
Does not require dental cleaning before application
Sets on contact with saliva
Is safe to use
Easily acceptable by infants, children and individuals with special
needs
Is not expensive
Frequency of application
According to American Dental Association (ADA) – every 6
months/ two or more times in high caries risk children
According to Saskatchewan Ministry of Health – once or twice a
year based on caries risk assessment
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4. Early Childhood Caries (ECC)
Early Childhood Caries (ECC) is defined as the “presence of 1 or more decayed
(noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any
primary tooth in a child under the age of 6.”
It is the most common chronic disease of children
Seen as white spots (initial stages) on the upper front teeth-- further develops into
yellow, brown or black areas --- crown fracture due to lack of tooth structure
Photo Source – Early Childhood Caries , California Dental Association.
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5. Link Between ECC and Fluoride Varnish
According to Canadian Dental
Association, a multifactorial approach
should be taken to reduce the risk of
ECC
Which includes:
Early dental visit
Risk assessment
Therapeutic interventions (fluoride varnish)
Preventive counseling
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6. First Dental Visit
Organizations
Recommendation for first dental visit
Canadian Dental Association (CDA)
By one year of age
American Dental Association (ADA)
Within 6 months of eruption of first tooth or no later
than 12 months of age
American
Academy
of
Pediatric
Dentistry As early as 6 months of age, 6 months after the first
(AAPD)
tooth erupts, and no later than 12 months of age
British Dental Association (BDA)
Eruption of first tooth (6 months of age)
Australian Dental Association* (ADA*)
12months of age or shortly after the eruption of first
baby teeth
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7. Establishment of a Dental Home
According to AAPD,
Dental home is “inclusive of all aspects of oral
health that result from the interaction of the
patient, parents, non-dental professionals and
dental professionals”.
Similar policy has also been put out by CDA
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8. Who are the Non-Dental
Professionals?
Primary care providers
Public health nurses
Oral health aides
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9. Attitudes and beliefs
1.
Health care providers indicate that do they play an important
role in oral health promotion.
2.
Majority of the health providers lacked the basic oral health
knowledge, which prevented them from providing oral health
counseling or preventive activities
3.
Majority of the health providers were not willing to provide
fluoride varnish as they conceived it to be time consuming,
occupy extra space and out of their scope of practice.
4.
After efficient training on oral health and fluoride varnish, it
was indicated that health providers were more willing to
provide anticipatory guidance and fluoride varnish application.
5.
Physicians found it difficult to refer children for dental
treatment, as they do not have a source of referral.
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10. Primary Care Providers (PCPs)
Include – pediatricians, family physicians, nurse
practitioners, and other staff in a medical office.
Best-practice:
In United States, a dental preventive initiative was
undertaken by Medicaid.
Under this program, primary care providers are
reimbursed for providing preventive dental
services for children.
The age up to which a child is eligible for the
service and the reimbursement rate varies for
different states.
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11. Primary Care Providers
Preventive services include:
Oral screening and risk assessment
Fluoride varnish application
Anticipatory guidance
To be eligible for reimbursement, it is
mandated for the PCPs to undertake a
training on the above three components.
Training is provided on:
Oral health and diseases common in children
Fluoride varnish
Standard protocols and procedures
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12. Primary Care Providers
Training is provided in 3 forms:
In-person, In-office training
Webinar training
Web-based training
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13. Public Health Nurse (PHN)
Best practice:
Paint-A-Smile fluoride varnish program was
developed by Saskatoon Health Region in 2001.
The main aim of the program is to prevent ECC in
children at high risk and arrest the progress of
ECC in children with the oral condition.
This was set out to be achieved by implementing
fluoride varnish program in Child Health Clinics
(CHCs).
Components of the program are :
Fluoride varnish application
Oral hygiene education and tobacco counseling
(provided to the parents/caregivers)
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14. Public Health Nurse (PHN)
As part of the program, rural PHNs are
trained in
Fluoride varnish policy
Basic oral health and diseases
Oral screening
Application of fluoride varnish
Referral recommendation and documentation
procedures
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15. Oral Health Aide
In communities where access to a dental
professional or a medical professional is
difficult, member of a community can act as an
Oral Health Aide.
Best practice:
Children’s Oral Health Initiative (COHI), is a
nationwide oral health program developed in
Canada.
It was developed to address the disparity in
oral health between First Nations and Inuit
population and the general Canadian
population.
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16. Oral Health Aide
The services offered by the program are:
COHI screening
Fluoride varnish application
Sealants
Alternative Restorative Treatment (ART)
One-on-one oral health information sessions
COHI Aide is a non-dental professional who
serves as a link between the dental
professional and the community .
The COHI aide is a community worker and
employed as a part-time staff.
The COHI aides undergo a 3 day training
provided by the dental professional.
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18. Recommendations
Fluoride Varnish Program Training
Three main components that of a training
program should include:
Risk assessment
Fluoride varnish application
Anticipatory guidance
This training should be provided by a dental
professional utilizing both audio and visual aides.
Along with the theoretical training, hands-on
demonstrations should also be provided.
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19. Recommendations
Establishment of Dental Home
As recommended by a number of organizations, a
dental home should be established for a child before
12 months of age.
Under circumstances where non-dental professionals
are not willing to provide fluoride varnish application,
it is recommended that they should be encouraged to
provide oral health anticipatory guidance and refer
the child to a dental professional.
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20. Recommendations
Long-Term Recommendations
Oral health education should be provided to the
physicians, pediatricians and nurses during their
university level.
For primary care providers who are interested in self
learning of oral health, continuing education courses
should be made available.
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