Best practices for non dental professionals providing fluoride varnish
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Best practices for non dental professionals providing fluoride varnish



May 16th 2012

May 16th 2012



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Best practices for non dental professionals providing fluoride varnish Best practices for non dental professionals providing fluoride varnish Presentation Transcript

  • Best Practices for Non-Dental Professionals Providing Fluoride Varnish Presented by Vidya Shanmugam 1
  • 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 2
  • 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 3
  • 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. 4
  • 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 5
  • 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 6
  • 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 7
  • Who are the Non-Dental Professionals?    Primary care providers Public health nurses Oral health aides 8
  • 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. 9
  • 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. 10
  • 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 11
  • Primary Care Providers Training is provided in 3 forms:    In-person, In-office training Webinar training Web-based training 12
  • 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)  13
  • 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 14
  • 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. 15
  • 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. 16
  • Recommendations  Primary Care Providers Health Region Government Collaboration   Public Health Nurses Oral Health Aide 17
  • 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. 18
  • 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. 19
  • 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. 20
  • Thank You 21