The Case for Fluoride Varnish Interventions

The Impact of Dental Caries

Caries is the most common chronic disease of childhood.1 Dental caries is the decay process, the end result of which is the cavity. It has reached silent epidemic proportions because no one writes about the problem, as compared to the frequent writings that appear in the lay press about mental health, heart disease, diabetes, Alzheimer's, etc.

Every year oral health problems (e.g. abscessed tooth, severe pain) result in the estimated loss of 51 million school hours.2From the morbidity perspective, caries can lead to poor nutrition because children with abscessed teeth do not eat well. As they learn to speak, they can't pronounce words that require pressing the tongue against the upper teeth (e.g. "thus"). Caries has even led to the death of at least two children, a 6-year old in Mississippi and a 12-year old in Maryland. This is something we never want to see in Minnesota. 3

Clinical Staff

Research on Fluoride Varnish Interventions

As far back as the 1970s, research performed in Scandinavia showed that fluoride varnish applied quarterly, together with caregiver education about caries prevention, will reduce the frequency of caries. Because caries is an infectious disease, it is preventable. A simple approach to curb the caries crisis is for primary care medical providers to:

  1. Apply fluoride varnish quarterly to the teeth of all children enrolled in Medicaid, starting with the eruption of the first tooth, the age of one at the latest.
  2. Educate caregivers about caries and their role in prevention.

Without a change in caregiver behavior, fluoride varnish alone cannot curb the crisis.

Easy Intervention with High Impact

A fluoride varnish application takes less than three minutes to perform, can be delegated to any trained member of the medical clinic staff, and is non-invasive.

Reduction of the incidence of caries will result in significant cost savings to the Medicaid program. There will be fewer visits to the emergency department (the clinic of last resort for Medicaid enrollees who do not have a dental home) for abscessed teeth. In Minnesota the median cost for an emergency department visit is approximately $1233, and results in incomplete care since emergency department physicians do not drill, fill, or pull teeth.6

The State of Minnesota will also see savings from a reduction in ambulatory surgery for restorations of carious teeth under general anesthesia. Not only is such treatment expensive (average charge of $10,000 - $20,000), but it runs the risk of an anesthetic death.7

Our Goal

Healthy People 2020 has as one of its expectations that by 2020, 75% of all children less than 6 years old are caries free.8 That can only happen if primary care medical providers are more strongly encouraged to provide caries prevention services as part of the Child and Teen Checkup (EPSDT) well-child examination.

Notes

  1. "Early Childhood Caries (ECC)", American Academy of Pediatric Dentistry
  2. Oral Health in America: A Report of the Surgeon General
  3. Deomonte Driver was a 12-year-old boy from Maryland who had an abscessed tooth in 2007. He died from a brain abscess, because his mother was unable to find a dentist who would treat him.
    "For Want of a Dentist", The Washington Post
  4. See, C&TC periodicity schedule. Children should be seen twelve times by their fifth birthday. https://edocs.dhs.state.mn.us/lfserver/Public/DHS-3379-ENG.
  5. See, https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Fluoride-Varnish-What-Parents- Need-to-Know.aspx.
  6. '"How Much Will I Get Charged for This?" Patient Charges for Top Ten Diagnoses in the Emergency Department', PLOS ONE
  7. Charge estimate based on data from Fairview Health Centerß. Estimate is based on the average charges for facility, anesthesiology, and professional components.
  8. "Reduce the proportion of children aged 3 to 5 years with dental caries experience in their primary teeth", Healthy People 2020