Date post: | 23-Jan-2015 |
Category: |
Health & Medicine |
Upload: | saskohc |
View: | 304 times |
Download: | 0 times |
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
(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
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
Public Health Nurses
Oral Health Aide
Health Region Government
Collaboration
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