How to Apply Fluoride Varnish

A Collaborative Effort between Indian Health Service (IHS) and

the IHS Head Start Program

Course Objectives

1. Describe Early Childhood Caries (ECC)

2. List two ways to prevent ECC.

3. Recognize the various stages of ECC.

4. Discuss the benefits of topical fluoride.

5. List the 5 steps to applying fluoride varnish.

6. Demonstrate the appropriate application of fluoride

varnish.

7. List one key message for families to prevent ECC.

Why are Baby Teeth Important?

Eating and nutritionHolding space for the permanent teethTalkingSmiling

What is Early Childhood Caries? ECC is the presence of

any decayed, filled, or extracted (due to decay) teeth in the primary dentition (baby teeth).

Involves infectious bacteria, often passed from mothers to babies.

The teeth often decay very quickly.

Effects of ECCPain

Infection

Higher risk of new cavities

Missed school days and

difficulty concentrating in school

What Causes ECC? Pathological Factors Bacterial biofilm Ingestion of simple carbohydrates Reduced salivary function TOOTH DECAY

Protective Factors Fluoride Antibacterials Oral hygiene habits Flow and composition of saliva Structure of tooth minerals in each

individual Dental Sealants NO TOOTH DECAY

Demineralization and Remineralization

ECC and AI/AN Children• 76% of AI/AN children

ages 2-5 have experienced dental cavities.

• 68% have untreated decay.

• Over 50% have severe ECC.

1999 IHS Oral Health Survey

Two is Too Late!

Costs of ECCTraditional dental

treatment is largely ineffective at reducing the bacteria that cause ECC.

ECC can cost thousands of dollars to treat each child, even exceeding $8,000 when a child is hospitalized and treated under general anesthesia.

FluorideInhibits demineralization

Enhances remineralization

Inhibits plaque bacteria

Ways to Obtain Fluoride: SystemicWater

Prescription drops or tablets

Ways to Obtain Fluoride: Topical

Fluoride Toothpaste

Fluoride Varnish

Fluoride Mouthrinses

Fluoride ToothpasteRecommend cleaning the

teeth daily with a small smear of fluoride toothpaste as soon as the first tooth erupts.

At three years of age, brush daily with a pea-size dab of fluoride toothpaste

Topical Fluoride Recommendations for High-Risk Children. Development of Decision Support Matrix: Recommendations from MCHB Expert Panel, 2008

What is Fluoride Varnish?Highly concentrated

topical fluoride treatment

Can reverse white spot lesions.

Safe for young children

Easy to apply

Advantages of Fluoride VarnishSafe

Easy to Apply

Accepted by patients

No special requirements

Research with AIAN childrenMedical staff applied during

well-child visits.

Children who received four or more application of varnish between the ages of 9-24 months of age had 35% reduced decayed surfaces over children who received none.

Holve S, IHS Primary Care Provider, Oct 2006.

.

Due to the high prevalence of dental caries, most AI/AN children can be considered high-risk for dental caries unless a dental professional has classified them differently

Who does What in AI/AN Communities?

Age Staff Protocol

9-24 months Medical Staff 4 treatments

2-3 years CHRs, WIC, PHNs 3-4 treatments

3-5 years Head Start staff 3-4 treatments per year

Work together to prevent ECC!Fluoride varnish for

every infant and child

Dental screenings

Parent education

Caries Stabilization

5 Steps to Applying Fluoride Varnish

Step 1: Getting ReadySuppliesFluoride VarnishGauze squaresNon-latex glovesChild-size toothbrush (optional)

Principles of Infection Control1. Take action to stay healthy: wash hands or

use an alcohol-based hand rub before and after applying varnish on each child.

2. Avoid contact with blood and body fluids: wear gloves.

3. Make items safe for use: use all disposable items.

4. Limit contamination: set up on a paper towel and dispose of all items after each application.

Applying Infection Control Principles

Set Up Application Clean Up

Step 2: Oral Health Assessment• Use the knee to knee

position if you are working with babies and very young children.

• Children 3 and older can stand in front of you.

If you use a toothbrush…Show the

caregivers how to brush

Use the toothbrush as a mouth prop

Oral Health Assessment

First Sign of ECC: White Spot LesionsCan be remineralized with

Changes in diet

Fluoride varnish

Daily brushing with fluoride toothpaste.

Early and Moderate ECC

Caries Stabilization: ITRAsk your dental

clinic if they provide Caries Stabilization and ITR for young children.

Severe ECC

Step 3: Dry the teeth

Use the gauze squares

Step 4: Apply Fluoride Varnish

http://www.youtube.com/watch?v=cV5OmL7C8K4

Step 5: Take Home MessagesDon’t brush until

the next day for optimal benefit of the fluoride varnish.

Brush daily with a fluoride toothpaste.

5 Steps Review

Note: During all steps, be sure to follow the principles of infection control. All of the supplies are disposable and intended for single use only!

What can YOU do to prevent ECC?• Provide oral health

screenings and fluoride varnish for the children you work with.

• Provide oral health messages to families in your community.

Summary

Instructions for Course CompletionAfter completing the course and receiving a score

of at least 80% on the posttest, you will receive a certificate.

After demonstrating application of fluoride varnish on a child in the appropriate age group, have a medical or dental health professional sign your certificate.

Standing orders must be provided by a dentist or physician. Make sure he/she is licensed in the state you work in if you will be providing fluoride varnish treatments for non-native children.

Special Thanks

We want to thank California First Smiles for use of some of their

photos and Dr. Joanna Douglass for use of her video.