FLUORIDE VARNISH APPLICATION CAN CHANGE THE COURSE OF A CHILD'S LIFE
3 minutes per patient. That's all it takes for a trained medical staff member to help prevent dental caries.
Our online Fluoride Varnish Application Training will teach you how to implement a Childhood Caries Prevention Program at your clinic. This course is:
- approximately one hour
- in video format
- eligible for one nursing CEU
The New Front Line in the Battle to Prevent Cavities
Who’s the first medical professional that pops to mind when you think of cavity prevention? A dentist, right? That’s perfectly logical; however, did you know that children of low socio-economic status have very limited access to dental care? And as a result of that limited access, there is a public health crisis for these high-risk children - a crisis of early onset dental caries that can lead to serious health problems. A public health crisis that could be averted if approached creatively.
Medical Clinics Can Fill a Void
One of the frustrations any medical professional must face is knowing many illnesses can only be treated after they emerge; but with intervention and proper training for caregivers, dental caries is a disease that can be prevented before it emerges. Cavities are 100% preventable!
Dental caries is the most common chronic disease of childhood. In fact, one in three children will already have tooth decay by their third birthday. But it is high-risk children - children of color who fall within federal poverty guidelines - who have 50% of their dental caries left untreated. And while this is alarming, there is also good news.
When medical clinics get involved, high-risk children can be helped. Medical providers can perform interventions to help safeguard these children’s teeth and then teach caregivers how to keep kids cavity-free.
Childhood Caries Prevention is as Important as Immunizations
So, how important is it to prevent a few cavities? After all, we’re talking about baby teeth that eventually fall out, not permanent teeth.
Don’t underestimate the consequences of poor dental care in small children; it can be, quite literally, a matter of life and death. Children with poor oral habits can experience infections and abscesses that may require expensive dental surgery while under anesthesia. This type of surgery is dicey for small children and in extreme cases can (and has) lead to death. But even in less severe circumstances, the consequences can be serious.
The Societal and Financial Costs of Poor Dental Care for Children
Children who do not receive proper dental care are at a disadvantage individually, but society as a whole also pays a cost for their lack of dental care.
It’s just cavities, right? But it’s actually so much more than that and left untreated cavities can lead to serious medical consequences. A child with severe dental caries may have problems chewing, leading to poor nutrition. The pain they suffer can lead to significant sleep issues, and if left untreated, abscessed teeth can cause a serious infection.
Possibly one of the least discussed consequences of bad teeth is social isolation. Imagine being afraid to smile at someone or being reluctant to talk because your poor teeth make it hard to speak clearly. You appear sullen or angry, when you are simply afraid of people’s reactions. It is unnecessary for a small child’s health or self-esteem to be damaged when simple steps can be taken to help them build healthy habits and a confident self-image.
Society also pays a price when young children suffer from dental caries. According to a North Carolina study, children with dental pain are three times more likely to miss school (https://www.ncbi.nlm.nih.gov/pubmed/21330579) and a Los Angeles study found that one third of elementary school absences among economically vulnerable children were due to dental problems (https://dentistry.usc.edu/2012/08/10/poor-oral-health-can-mean-missed-school-lower-grades/). It is just common sense that if you’re in pain you can’t concentrate on what’s being taught and you will perform more poorly.
Indeed, it’s not just oral pain that might keep you out of school. If you feel socially isolated from your peers because of an ugly smile or you’re teased for the way you pronounce words, why go to school? A child with poor dentition struggles more to reach her full potential. And it’s not only the child who suffers unintended consequences; if a caregiver is forced to miss work to look after a sick child, this can put their job and finances in a shaky position.
We all know Emergency Room visits are extremely expensive; however, a child who doesn’t receive regular oral care, can end up in the ER with severe pain and a dental infection. If a medical intervention becomes necessary, it can be costly and risky. And, unfortunately, the emergency room physician can’t treat the underlying dental issue, they can only treat the symptoms. A child under the age of five with a severe dental issue may need costly ambulatory surgery and anesthesia, raising the risk of complications and even death. If her family has public insurance or no insurance, a small issue that could have been resolved inexpensively with early intervention, becomes a costly burden for the family and society.
What Role Can Medical Clinics Play?
Because most at-risk children still see a physician periodically – even if they don’t see a dentist - clinics are in a unique position to help prevent childhood caries.
By implementing five-steps into their medical check-ups, clinics can help ensure young kids avoid many of the issues cause by poor oral health. We will review each of the following five steps in the remainder of this article:
- Conduct a gross oral evaluation
- Do a short risk assessment
- Provide anticipatory guidance so caregivers understand their role in prevention
- Apply fluoride varnish 4X/yr.
- Advise caregivers to find comprehensive dental care
1. Conduct a gross oral evaluation
The cause of cavities is simple: when we eat or drink foods with sugar, the sugar mixes with bacteria that are already present in our mouth and produces a sticky acid. That acid is deposited on our teeth, damages the enamel, and causes decay.
Medical providers are in a perfect position to intercede and help caregivers of babies and young children stop cavities. While medical doctors cannot diagnose or treat dental disease, they can spot the clues that indicate a need for intervention.
The first sign of the caries process is white spots where the tooth meets the gum of the upper four front teeth (maxillary central and lateral incisors). These white spots are evidence of demineralization where the tooth meets the gum. When a health provider observes the caries process at this early stage, fluoride will stop cavities from forming – if good oral care is taught to and adopted by the caregivers.
If the decay process is more advanced, then brown spots will be seen. Actual dental intervention is necessary at this point and should be recommended to the caregivers.
Advanced decay will be obvious, with dissolution or rotting of the outer surface of the enamel. A child with this level of decay is likely to be in pain and in danger of serious infection. The gravity of the situation must be impressed upon the caregiver and a referral to a dentist is needed for immediate urgent treatment.
2. Risk Assessment
When meeting with a caregiver and their child, it is helpful to conduct a brief dental risk assessment. By running through a set of predetermined questions, a clinic staffer or provider can ascertain if a child is at high risk for caries. For example, a questionnaire could include questions regarding whether the:
- Child has dental insurance
- Child has a dental home
- Child use a bottle at night
- Child’s teeth are brushed 2X/day
The Minnesota Oral Health Project has a Dental Risk Assessment Questionnaire (https://crushcavities.com/documents/dental-risk-assessment-questionaire.pdf) on its webpage that providers can adopt and modify without copyright infringement. Providers are encouraged to use it and make any changes that work for their practice.
3. Anticipatory Guidance
Anticipatory guidance is nothing more than the discussion the provider has with caregivers to teach them how to properly care for their child’s teeth. The provider can conduct this guidance while examining the child’s teeth or while applying fluoride varnish.
Anticipatory guidance usually consists of four main topics:
A. Avoid sugar
C. Dental home
Let’s examine each of these four topics a little more closely.
A. Avoid sugar
We’ve already discussed how sugary food and beverages mixed with bacteria create the conditions for cavities to form. But what are the best practices to help caregivers know how to avoid sugar?
- Mealtimes are the only time that milk, juice, or any sugary foods and beverages should be served.
- To reduce the risk of dental decay, these types of foods should not be served throughout the day or night.
- Serve milk in bottles and sippy cups at mealtimes only and offer water between meals.
- Avoid soda and juice (even diluted juice). These add sugar and acid to teeth and erode the enamel. These beverages should be avoided completely, but especially never put into a bottle or a sippy cup where the beverage just sits on the teeth when a child drinks them.
- Don’t put a baby to sleep at naptime or bedtime with a bottle. If it cannot be avoided, then the bottle should only contain water and never any sort of sugary beverage or milk.
The last recommendation helps avoid a child getting bottle mouth, a condition that can cause severe tooth decay because a baby’s teeth are bathed in sugars all night long. It cannot be emphasized strongly enough - water is the only appropriate fluid to put in a bottle for naps or bedtime.
B. The importance of fluoride
Fluoride is like a “magic” shield for teeth and actually prevents cavities. It enters the tooth’s enamel and helps it to remineralize, strengthens the tooth and helps to reverse any early tooth decay. Because of its protective benefits, caregivers need to know its sources in the environment so their child can reap its benefits.
Although fluoride occurs naturally in food and water, it’s usually not enough to make sure teeth receive its shielding benefits. That’s why many places add it to the public water supply. While that step has provided tremendous public health gains, not everyone gets their water from public drinking sources. If a child’s main source of water is from a private well, bottled water, or filtered water (including water marketed to parents for mixing formula), then that child may not be getting the defensive boost fluoride provides. Health providers who understand a child is not getting enough fluoride are able to recommend actions their caregiver can take to increase her intake of fluoride.
C. Dental home
As a health professional, you clearly understand the importance of young children receiving medical care and immunizations, preferably with a pediatrician who gets to know them, their health, and their family situation. It is equally important for children to have a dental home – for many of the same reasons.
But what is a dental home? A dental home is where a child visits a dentist twice yearly for preventative oral care and as often as necessary for restorative care. If a child only sees a dentist sporadically or for a problem, then the child does not have a dental home.
The ideal time for a child to establish a dental home is when their first tooth erupts, but definitely no later than their first birthday. This allows the dentist to note any issues early, to form a relationship with the caregiver, and to teach preventative care from the outset.
You are uniquely situated to help caregivers understand the importance of starting a relationship early with a dentist. Many caregivers don’t seek a dental home for their child because they are worried about the cost, but there is a tool the Minnesota Oral Health Directory (https://www.findadentistmn.org/) designed to locate providers who accept either public insurance or no insurance. The directory can be automatically translated into many different languages and is a wonderful resource for patients worried about the costs of dental care.
Oral care starts right from birth, dental care starts when a child’s first tooth emerges.
It is important that caregivers start oral care immediately by wiping their baby’s gums with a damp cloth after every feeding. In addition to getting the child used to having their mouth cleaned, it helps keep the mouth healthy.
As soon as a child’s first tooth erupts, the caregiver should begin dental care by brushing their child’s teeth. Brushing is the most important tool a caregiver can deploy to prevent cavities.
But it isn’t just the act of brushing that is important, it is how a child’s teeth are brushed. Teeth should be brushed twice a day with fluoridated toothpaste. The amount of toothpaste used will vary with the age of the child:
- Newborns shouldn’t use any toothpaste. Caregivers should wipe their gums with a moist cloth after each cleaning.
- Children between the ages of one and two should use an amount equal to a grain of rice.
- Children between the ages of three and six should use an amount equal to the size of a pea.
- Children ages seven and older should use a small smear of toothpaste.
Babies, toddlers, and young children lack the manual dexterity to care for their teeth adequately and they need adults to brush their teeth - especially the back teeth - until they are at least seven or eight years old. Good oral care and healthy baby teeth will lead to strong permanent teeth and can help avoid costly dental health-related issues later.
4. Fluoride Varnish
We already reviewed the importance of fluoride to a healthy mouth. Because it remineralizes the teeth and inhibits the growth of bacteria, it is key to keeping teeth strong. However, as a medical provider you can do more than just discuss its advantages with caregivers – you can apply a fluoride varnish to a child’s teeth four times per year (or twice per year if a child has a dental home). It is a quick process that takes 3 minutes or less and can be done by any trained clinic staff member. There is fluoride application training (https://crushcavities.com/fluoride-varnish-training/) available on the Minnesota Oral Health Project website along with links to information about manufacturers of fluoride varnish.
After receiving a varnish application, a child’s teeth will appear lightly discolored for two to three days, but that is normal. A child who has received a fluoride varnish application should not brush their teeth and they should only eat soft food for the remainder of that day; however, they can resume a normal diet and tooth brushing schedule the following day. Follow-up care instructions for caregivers is available in eight different languages and can be downloaded at crushcavities.com/clinics.
5. Find dental care
You can see that as a medical professional there are many things you can do to influence the oral health of the youngest children in your care: explain to caregivers the importance of fluoridated water and daily oral/dental care, emphasize the need for a child to have a dental home, and apply fluoride varnish. None of these things takes much time and their importance cannot be overemphasized.
Childhood caries prevention is easy to implement and should be part of every Child and Teen Checkup (C&TC) medical screening, other well-child assessments or even sporadic clinic visits. Parents can complete the Risk Assessment questions or they can be filled out by staff during the admission process. Dental care guidance can be part of the regular discussion during the examination, and application of fluoride varnish only takes 3 minutes and can be completed by a trained member of the clinic’s staff before immunizations or at another appropriate time during the examination.
The Minnesota Oral Health Project is here to help you with questions, training, resources, and implementation of a Childhood Caries Prevention program for your clinic. A fluoride varnish application program is available on our website and eligible personnel can earn one nursing CEU credit by completing the training. Check out crushcavities.com/fluoride-varnish-training/.