The 21st Century Method for Delivering Fluoride

1. The 21st Century Method for Delivering Fluoride Laurie Turner, RDH May 20th, 2010

2. Alarming Statics: Of the 4 million children born each year, more than half will have cavities by the time they reach second grade. While 9 million children in this nation do not have medical insurance, more than twice that number --� 23 million�-- do not have dental insurance.

3. Economic Consequences Untreated dental conditions among children also impose broader economic and health costs on American taxpayers and society. Between 2009 and 2018, annual spending for dental services in the United States is expected to increase 58 %, from $101.9 billion to $161.4 billion. Approximately one-third of the money will go to dental services for children.

4. Surgeon GeneralsCall to Action to promote Oral Health The Vision: To advance the general health and well-being of all Americans by creating critical partnerships at all levels of society to engage in programs to promote oral health and prevent disease.

5. The Goalsof the Call to Action reflect those of Healthy People 2010 To promote oral health To improve quality of life To eliminate oral health disparities

6. The 2009 Children�s Health Insurance Program Reauthorization Act (CHIPRA) Established a requirement that parents of newborns be informed of risks for ECC, its prevention, and the need for the child to have a dental visit by age one.

7. Early Intervention Provided by Primary Care Professionals The use of primary care providers as a first line of defense in children�s oral health is an innovative approach that provides an opportunity to facilitate a more cohesive working relationship between the dental and medical communities.

8. Tooth Decay Is the #1 chronic infectious disease in children that is not responsive to antibiotic treatment and does not heal itself, its progressive.

9. According to the CDC dental caries is the most prevalent infectious disease among US children. More than 40% of children have tooth decay by the time they reach kindergarten, and more than 52 million hours of school are lost each year because of dental problems, as cited by the US Department of Health and Human Services.

10. Early Childhood Caries-ECC The disease of ECC is the presence of one or more decayed(non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces, in any primary tooth of a child 71 months of age or younger.

12. Early Childhood Caries-ECC Infectious Transmissible Diet Dependent Fluoride Mediated Reversible

14. Oral Bacteria

15. Diet Dependent Caries is promoted by carbohydrates, which break down to acid. Acid causes demineralization of enamel. Frequent snacking promotes 20 minute acid attacks. Foods with complex carbohydrates (breads, cereals, pastas) are major sources of �hidden� sugars. High sugar content in sodas, Kool-aid, Hi-C, Snapple etc.

18. DemineralizationIt�s a COMPLEX SEQUENCE of events Start with that just cleaned smooth, shiny feeling. Within minutes, glycoproteins in saliva coat enamel for protection, but also create a �sticky� coating called the pellicle to which a bacterial biofilm, plaque, can adhere. Once you eat any carbohydrate, mainly simple sugars, amylase enzymes begin breaking down sucrose molecules. Bacteria sticking close to the enamel via the pellicle metabolize sucrose molecules, proliferate, and release acid as a byproduct. Acid then penetrates the porous mineral structure of the enamel and diffuses Calcium and Phosphorus out of the tooth, called demineralization.

19. Demineralization

20. AAP Recommendations for an Oral Health Risk Assessment Assess mothers�/caregiver�s oral health. Assess oral health risk of infants and children. Assess child�s exposure to fluoride. Recognize signs and symptoms of caries. Provide anticipatory guidance including oral hygiene instructions (brush/floss). Make timely referral to a dental home. The AAP, also realizing the important role that child health professionals need to play in children�s oral health, developed a policy statement in May 2003 titled, �Oral Health Risk Assessment Timing and Establishment of the Dental Home.� This policy states that every child should begin to receive an oral health risk assessment by 6 months of age by a qualified pediatrician or a qualified pediatric health care professional. When performing an oral health risk assessment, child health professionals should Assess mother�s/caregiver�s oral health. Assess oral health risk of infants and children. Perform oral health examination and recognize signs and symptoms of caries. Assess child�s exposure to fluoride. Provide parent education on oral hygiene and diet. Make timely referral to a dental home. The AAP policy statement can be accessed online at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/5/1113. The AAP, also realizing the important role that child health professionals need to play in children�s oral health, developed a policy statement in May 2003 titled, �Oral Health Risk Assessment Timing and Establishment of the Dental Home.� This policy states that every child should begin to receive an oral health risk assessment by 6 months of age by a qualified pediatrician or a qualified pediatric health care professional. When performing an oral health risk assessment, child health professionals should Assess mother�s/caregiver�s oral health. Assess oral health risk of infants and children. Perform oral health examination and recognize signs and symptoms of caries. Assess child�s exposure to fluoride. Provide parent education on oral hygiene and diet. Make timely referral to a dental home. The AAP policy statement can be accessed online at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/5/1113.

22. Caries Assessment Tool

24. National Call To Action To Promote Oral Health A Public-Private Partnership under the leadership ofThe Office of the Surgeon General National Call To Action To Promote Oral Health A Public-Private Partnership under the leadership ofThe Office of the Surgeon General

25. Prevention and Fluoride Varnish Fluoride Varnish Application: Effective October 1, 2009, a maximum of four(4) annual fluoride varnish applications from birth until age 7 years of age. Physicians, Dentists, NP, RN, RDH, LPN treating Medicaid beneficiaries will be reimburse up to $30.00 per application. Prior approval is NOT required under Medicaid fee-for-service. Fluoride Varnish code D1206 (topical application of fluoride [prophylaxis not included] � child). To enroll for reimbursement contact Computer Science Corp. at 800-343-9000. For questions concerning Medicaid manage care, please contact the Division of Managed Care at 518-473-0122.

27. Why recommend a fluoride varnish? To prevent dental caries and in many cases reverse early dental caries Baby teeth are in a child�s mouth until about age 11 or 12 No dental cleaning necessary prior to application No special equipment Quick, easy to apply (2 minutes) Sustainable service

28. How does the varnish work? The lacquer-based product adheres to the dental enamel forming a depot from which fluoride is slowly released Making the tooth more resistant to acid dissolution Saliva actually sets the varnish

30. Advantages fluoride varnish: Easy to apply Teeth do not need professional prophylaxis Children can eat and drink following applications Potential ingestion of fluoride is low Prevents ECC

33. Visual dental abscesses require immediate treatment/referral:

35. Care giver instructions: Child can eat and drink normally for the rest of the day Teeth will look dull, but will be back to normal once varnish is removed Brush the varnish off the next day Varnish is applied every 3 to 6 months depending on moderate to high risk status Referral to a dental home

40. The AAPD recommends that the following �Get it Done in Year One� Check list to keep infant mouths healthy and prevent infection: Clean infants� mouths and gums regularly with a soft infant toothbrush or cloth and water. �Once baby teeth appear, brush them at least twice daily with an age-appropriate sized toothbrush and a �smear� of fluoridated toothpaste. � Give children older than six months fluoride supplements if their drinking water does not contain enough fluoride. (Fluoride supplementation in infants has been shown to reduce tooth decay by as much as 50 percent). Wean infants from the bottle by 12-14 months of age.�Have infants drink from a cup as they approach their first birthday. Visit the pediatric dentist before children�s first birthday and twice annually following the first appointment. Avoid at-will breast feeding after the first baby tooth appears and other foods are introduced.

41. Implementation�. Questions to ask in setting up Who do you need to talk to and educate about oral health? Do you need to educate your administrators to gain their support? Medical billing personnel? What staff members will be involved? Do you want to involve other health professionals such as physician assistants and nurses? How will supplies be purchased and paid for? Identify who will need to budget for the cost of fluoride varnish supplies. Who will do oral health assessment/fluoride varnish application? The toolkit contains information about various companies that can supply fluoride varnish. It is generally very inexpensive, but you will need to designate a staff member to be responsible for ordering and supplying the fluoride varnish. How will this be documented and followed up? Every facility has different documentation standards and procedures. How and to whom will dental referrals be made? Try establishing and building relationships with dental providers. They are great resources for you. How will billing for fluoride varnish be completed? Identify who needs to be educated about the billing procedures, as well as what will be done for children who need fluoride varnish and are covered under a private health insurance that does not reimburse for fluoride varnish.

42. You Can Make a Difference! Review fluoride content in area water supply Add oral health risk assessments into well-child visits before the age of one Provide parent education regarding oral health and possibly give the child a toothbrush Provide a list of dentists (pediatric/general) in your area who accept Medicaid and Child Health Plus

43. Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it�s the only thing that ever has. Margaret Mead~