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How to Apply Fluoride Varnish. A Collaborative Effort between Indian Health Service (IHS) and the IHS Head Start Program. Course Objectives. Describe Early C hildhood C aries (ECC) List two ways to prevent ECC. Recognize the various stages of ECC. - PowerPoint PPT Presentation
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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.