Best Practices for Non-Dental

Professionals Providing Fluoride

Varnish

Presented by

Vidya Shanmugam

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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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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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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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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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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

(AAPD)

As early as 6 months of age, 6 months after the first

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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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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Who are the Non-Dental

Professionals?

Primary care providers

Public health nurses

Oral health aides

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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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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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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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Primary Care Providers

Training is provided in 3 forms:

In-person, In-office training

Webinar training

Web-based training

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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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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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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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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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Recommendations

Primary Care Providers

Public Health Nurses

Oral Health Aide

Health Region Government

Collaboration

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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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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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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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Thank You

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