Fluoride Varnish Application Training for Missouri Oral ... · As you can see from this photo, fl...
37
1 Fluoride Varnish Application Training for Missouri Oral Health Preventive Services Program State of Missouri Department of Health and Senior Services Office of Primary Care and Rural Health/Oral Health Program AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.
Transcript of Fluoride Varnish Application Training for Missouri Oral ... · As you can see from this photo, fl...
11
Fluoride Varnish Application Training for
Missouri Oral Health Preventive Services Program
State of Missouri Department of Health and Senior ServicesOffice of Primary Care and Rural Health/Oral Health ProgramAN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.
Presenter
Presentation Notes
Welcome to the Preventive Services Program Fluoride Varnish Training. By completing this training course you will be eligible to take part as a volunteer to apply fluoride varnish in a Preventive Services Program Event. Thank you for your interest and participation.
22
Course Instructions
• The course will take approximately 30 minutes to complete.
• To advance through the course press the right arrow on your keyboard or left click on your mouse.
• You may stop and start this course at any time.• Completion Code=VARNISH
Presenter
Presentation Notes
The course will take approximately 30 minutes to complete. To advance through the power point slides, press the right arrow on your keyboard or left click on your mouse. You may stop and start this course at any time. At the conclusion of the course you will be directed to complete a form which will register your completion of the training. Completing this form is essential to accurate accounting. You will be asked to insert a completion code when completing this form. The code is VARNISH.
33
Program ObjectivesAt the completion of this course the learner will be able to:
• Describe the four basic components of the Preventive Services Program (PSP).
• Understand why fluoride varnish is used as a decay-preventive agent.
• Explain the materials necessary to apply fluoride varnish.
• Describe methods of varnish application.
Presenter
Presentation Notes
This course will provide you with a basic overview of the Preventive Services Program, help you understand why we use fluoride varnish, assist you in assembling the materials for a varnish application and teach you to properly complete a fluoride varnish application on a child’s teeth. The Preventive Services Program will be referred to from this point on as P-S- P.
44
The Preventive Services Program
The Missouri Oral Health Preventive Services Program (PSP) is a community-based, systems approach to population-based prevention of oral disease.
Presenter
Presentation Notes
The intent of PSP is to mobilize a community toward protecting the oral health of its children. People across Missouri are gathering together for PSP events to “make a difference where they live!” Essential to the success of the PSP is the community-wide involvement of various groups toward this common goal of children’s oral health. Examples of these groups include schools, childcare facilities, dental professionals, hospitals and businesses.
55
PSP MethodologySURVEILLANCE
Annual screening by a licensed dentist or dental hygienist
EDUCATIONCurriculum materials availableToothbrushes, toothpaste and floss, too!
PREVENTIONFluoride varnish applied twice per year by volunteers
REFERRALChildren needing early or urgent dental care
Presenter
Presentation Notes
PSP has four components. The first component is surveillance, also known as a dental screening. A screening of the oral health of a community’s children is conducted once per year by a dentist or dental hygienist. Secondly, oral health educational materials and programs are built into the PSP structure. Your event coordinator will be arranging for some form of oral health education for the children involved in the program. Furthermore, toothbrushes, toothpaste and dental floss are being provided for the children participating in the program. Prevention is the third component of PSP. To prevent dental decay, fluoride varnish is applied twice per year by community volunteers. That’s where YOU fit in. The fourth component is referral. Children identified as needing early or urgent treatment are referred for care. PSP is designed for children of all ages-infants through high school.
66
People Involved in the Event
• You will be one of many involved in a PSP Event. • That is the purpose of PSP. “Many hands working
together for the oral health of the community.”• Your role is to provide an application of fluoride varnish
to the children's teeth. This will be done twice during the school year.
SCREENERDentist
orDental Hygienist
VARNISH VOLUNTEERParent, Nurse,
Teacher or any otherPerson Interested in
Applying Varnish
OTHER ASSISTANTParent, Nurse, Teacher or any
other Person interested inhelping with the details of
the Event
EVENT COORDINATORPerson coordinating the screenings, varnish, education and referrals for the school or agency.
Typically a School Nurse, Head Start Health Coordinator, County Nurse or Parent
Presenter
Presentation Notes
You will be one of many involved in a PSP Event. As you can see from this chart, it takes many hands working together to implement a PSP event. Dental professionals serve as the screeners. Parents, nurses, and others interested in assisting apply the varnish. And there is also room for others to do education, hand out materials and assist as recorders for the screeners.
Fluoride Varnish is….
• Safe for all ages
• Easy to apply
• Effective in reducing dental decay
Presenter
Presentation Notes
As you can see from this photo, fl varnish is a sticky substance applied with a small applicator brush to the surfaces of the teeth. The varnish will firm up on the teeth and remain until brushed away. While on the teeth the fluoride contained in the varnish aids in strengthening the enamel of the child’s teeth. Fluoride varnish is safe for children of all ages. It is easy to apply and effective in reducing tooth decay.
8
Fluoride Varnish is Endorsed by the Following Associations ….
• American Dental Association
• Association of State and Territorial Dental Directors
• Centers for Disease Control and Prevention
Presenter
Presentation Notes
The use of fluoride varnish as a decay preventive agent is recommended by many associations including the American Dental Association, the Association of State and Territorial Dental Directors and the Centers for Disease Control and Prevention.
9
How Fluoride Varnish Works
• Retards, arrests, and reverses the decay process
• Decreases the harmful effects of mouth acids
• Rebuilds tooth enamel
Presenter
Presentation Notes
With its ease of application and the relative safety of its use, fl v is an ideal prevention-oriented technique to be promoted in community-based health programs. In the state of Missouri, fluoride varnish may be applied by dental professionals, medical professionals or lay volunteers. Fluoride varnish strengthens the tooth by adding minerals to the structure of the enamel. This makes the teeth more resistant to the harmful attack of mouth acids by re-building soft tooth enamel.
Fluoride Varnish will be supplied in individual dose packs.
Presenter
Presentation Notes
You will not have to worry about how much fluoride varnish to use. It is supplied in individual dose packs.
1111
Other Items You May Need:
– Masks– Gloves (latex free)– Eye Wear (optional)– Gauze (optional)– Hand Sanitizer
These additional items will be at the site for your use.
Presenter
Presentation Notes
When you are preparing to do a fluoride varnish application you will need to gather supplies to use. These supplies include masks, gloves, eye wear, gauze and hand sanitizer. These items should be provided for you by the coordinator of the event.
1212
Remember, some children will have dental decay and poor oral hygiene.
Maintain the Child’s Privacy and Self-esteem
Apply fluoride varnish in such a way as to maintain some form of privacy and also keep his/her dignity intact.
Presenter
Presentation Notes
Some children will have dental decay and poor oral hygiene. Provide some form of privacy during the application process. If possible, position the varnish application station area away from waiting crowds of children.
1313
Infection Control
• Change gloves after each child.
• Wearing a face mask will decrease your chances of contracting colds/flu.
• Use hand sanitizer often.
Presenter
Presentation Notes
We suggest using routine infection control guidelines. This means changing gloves after varnishing each child. It is also essential that a new mouth mirror be used for each child. These gloves and mouth mirrors should be disposed of immediately after use. A trash can should be located nearby. Wearing a face mask will decrease your chances of contracting colds and flu. You do not need to change the face mask after each child, unless it becomes moist or soiled. It is recommended that you use a hand sanitizer frequently throughout the day.
1414
Application Tip #1
A table or desk top will keep all your supplies close at hand.
Presenter
Presentation Notes
Here are a few tips for applying the varnish. Look for a place with good lighting when you are setting up your area. A table or desk top near your work area will help keep all your supplies close at hand. A chair will be needed to provide the child a place to sit. Any type of chair will do. You may stand or sit to apply the varnish, whatever is most comfortable to you.
Application Tip #2
Position a chair near a wall so that the child can tilt his/her head back.
A knee to knee/lap position is helpful to use with infants and toddlers.
http://www.scdhec.gov/health/mch/oral/early.htm
Presenter
Presentation Notes
Tip #2. For young children, a knee to knee or lap position may be helpful. Notice this positioning in the upper left hand corner of this slide. The volunteer and the care-giver sit facing each other with knees close together. The child is held in the caregiver’s lap, facing the caregiver and then laid back into the lap of the varnish volunteer. This way the child can continue to see the caregiver and the caregiver is able to help in controlling the hands of the child. Sometimes a small child will cry when the varnish is being applied. No need to worry, this allows the mouth to be open and fl v can be quickly applied. For most children the application of fl varnish can take place with the child in a chair. It may be helpful to position the chair near a wall so that the child can lean back to steady his/her head.
Application Tip #3
Good light and retraction with mouth mirror make all the difference.
Presenter
Presentation Notes
Tip #3. Good light and a firm retraction with a mouth mirror or finger will make application much easier. Notice on the upper left hand slide how the mouth mirror is used to retract the cheek. The Mirror is used like a scoop and the face of the mirror is laying against the inside of the child’s cheek. To reach the very back teeth on the top, you may want to ask the child to close down slightly. This will loosen the cheek muscle and allow you to reach this area. Your hands will feel clumsy at first, but you will develop a routine as to how to manage the mouth and supplies. It may be helpful to have the child hold the varnish pack for you. This will free you up to use the applicator brush and retract the lips and cheeks.
Application Tip #4
Don’t be afraid to use your fingers to move the lips and cheeks.
Presenter
Presentation Notes
Tip #4. Don’t be afraid to use your fingers to move the lips and cheeks. These tissues are pliable. Also remember that the children may tend to drool and may want to “spit” into a nearby trash can. It is suggested that you NOT get this practice started. It is better to begin by explaining to the child that you will be applying the varnish and that once it is completed he or she may swallow. No worries about swallowing the varnish. It will adhere to the teeth.
18
Application Basics
• The teeth DO NOT need to be dry, professionally cleaned or freshly brushed prior to the application of fluoride varnish.
• Varnish is “painted”on all surfaces of all teeth with disposable applicator.
• Application takes approximately 1-2 minutes.
Presenter
Presentation Notes
Fluoride varnish is intended to put a fluoride layer in close contact with enamel for several hours. The addition of the fluoride strengthens the tooth and makes it more resistant to decay. The teeth do not need to be dry, freshly brushed or professionally cleaned prior to the application of fluoride varnish. However, a dry tooth brushing prior to application may be a good idea and a good chance to review the child's brushing skills. Your event coordinator may have arranged for the children to dry brush as part of an educational program prior to the application of fl varnish. The varnish is painted on all surfaces of the teeth with a disposable applicator. This takes about 1-2 minutes.
19
Application Process• Apply a thin layer of
varnish on all surfaces of all teeth with disposable applicator.
• The material will make the child’s teeth feel waxy or “fuzzy”.
• Keep up friendly chatter with the child to distract them and provide encouragement.
AVOID APPLYING THE VARNISHTO LARGE AREAS OF DECAY
Presenter
Presentation Notes
You will apply a thin layer of fluoride varnish with the disposable brush to all surfaces of the teeth. If the patient is uncooperative, apply varnish to the front teeth only. You want this to be a positive experience. Avoid forcing any child to comply. Keep up a friendly chatter with the child to distract them and provide encouragement Your conversation with the child may go something like this: Hi, my name is _________. I will be painting this fluoride on your teeth today. It will make your teeth strong and help prevent tooth decay and it will only take a minute. Your teeth will feel fuzzy when I get done. Don’t worry though, you will be brushing this away tomorrow morning” While you are varnishing the child’s teeth you can encourage them to keep up good home care habits by saying something like, “Remember to brush your teeth morning and night”. After applying the varnish you can say, “ there now, all done. You can swallow and remember, don’t brush this off until tomorrow morning” It’s as simple as that.
20
Suggested Application Sequence
• Start with the cheek surfaces of teeth…
• Apply a thin layer of fluoride varnish to the cheek and front surfaces of all the teeth,
• Upper and Lower,
• Front and Back.
Presenter
Presentation Notes
Suggested application sequence. This sequence for varnish application is only a suggestion, you may alter the sequence to suit your needs, as long as all tooth surfaces are covered with the varnish. It is suggested you begin by applying the fl v to the cheek and front surfaces of all teeth-upper and lower, front and back.
21
Suggested Application Sequence
• Now, Apply a thin layer of fluoride varnish to the inside of the mouth surfaces;
• Upper and Lower,
• Front and Back.
Presenter
Presentation Notes
Now move to the inside of the mouth. Apply a thin layer of fl v to the teeth surfaces on the inside of the mouth, Upper and Lower, front and back. For the top teeth, the mirror may be helpful for reflecting light to see certain areas of the mouth. You may also ask the child to tilt his or her head back in order to see better. For the lower teeth The mouth mirror is helpful to hold the tongue away from the teeth while applying the varnish. You may also ask the child to tilt his or her head downward slightly in order to see better.
22
Suggested Application Sequence
• Finish with the chewing surfaces of the teeth.
• Apply a thin layer of fluoride varnish to the chewing surfaces of all the teeth;
• Upper and Lower.
Presenter
Presentation Notes
Now finish by coating the chewing surfaces with a thin layer of the varnish. There is usually plenty of varnish left to do this. Cover the chewing surfaces on both the upper and lower teeth. The entire application process should take between 1-2 minutes. The process should be completed quickly, if too much time is taken the varnish may begin to thicken in the dose pack.
To Review the Sequence
• Outsides
• Insides
• Chewing Sides
Presenter
Presentation Notes
Now let’s review the sequence, Outsides of the teeth, (Upper and Lower). Insides of the teeth (Upper and Lower) and now the chewing sides (Upper and Lower). It’s as easy as that.
24
Application Appearance
The varnish thickens quickly after application and may appear as a yellow film.
Presenter
Presentation Notes
The varnish sets up quickly after application and may appear as a yellow film. This yellow film is temporary and can be brushed away. Instruct the child or the child’s care giver not to brush until the next morning.
25
Post Application
• Okay to eat and drink as usual, however avoid hard crunchy foods and hot beverages
• The child may not have the mouth mirror
• No brushing until tomorrow morning
Presenter
Presentation Notes
After the varnish is applied, It is okay for the child to eat and drink as normal, though some suggest avoiding hard crunchy foods or very hot liquids for the rest of the day. Some children may ask to keep the mouth mirror. This is not recommended. Doing so can spread germs from one child to another. Before the children leave your area, remind them not to brush until the next morning.
Fluoride Varnish-Twice Per Year
• Recommendations call for two applications per year.
• Two applications per year can help reduce decay dramatically.
• Preschool children who had no fluoride treatments were almost four times as likely to have decay as those who received fluoride varnish applications at six-month intervals. 26
Weintraub, JA, et al, Fluoride Varnish Efficacy in Preventing Early Childhood Caries, J Dent Res 85(2):172-176, 2006.
Presenter
Presentation Notes
Fluoride varnish needs to be reapplied to maintain a decay preventive effect. Various application schedules have been proposed. The Preventive Services Program offers two applications per year. In a recent study children who had no fluoride treatments were more than twice as likely to have decay as those who received a yearly application of fluoride varnish, and almost four times as likely to have decay as those who received fluoride varnish applications at six-month intervals.
The End Result
HAPPY, HEALTHY
SMILES
Presenter
Presentation Notes
The end result is happy, healthy smiles.
2828
Test Your Knowledge
Can you answer the following questions?
Presenter
Presentation Notes
Let’s take a look at some photos and test your knowledge.
2929
Is it mandatory that the teeth be dried before fluoride varnish application?
Presenter
Presentation Notes
How would you answer this question? Is it mandatory that the teeth be dried before fluoride varnish application?
• No, it is not mandatory to dry the teeth before varnish application.
• The child may use a dry toothbrush to remove plaque and debris, but it is not necessary.
• A gauze may be helpful to clear up debris and saliva, but is not necessary.
Is it mandatory that the teeth are dried before fluoride varnish application?
Presenter
Presentation Notes
No it is not mandatory to dry the teeth before varnish application. It is possible that the child will have completed a dry brushing of his or her teeth before you see them. This will be adequate for removing plaque and debris. However it is not essential to do this before the varnish is applied. A piece of gauze may be another way to clear up debris and saliva, but it also is not necessary. Fluoride varnish will set up in a moist environment.
3131
Does the child have to wait 30 minutes after varnishapplication before he/she can eat or drink?
Presenter
Presentation Notes
How about this question? Does the child have to wait 30 minutes after varnish application before he/she can eat or drink?
32
• It is not necessary that the child wait after the fluoride varnish has been applied.
• The child can eat and drink normally, however, it is a good idea to avoid crunchy food and very hot liquids.
Does the child have to wait 30 minutes after varnish application before he/she can eat or drink?
Presenter
Presentation Notes
It is not necessary that the child wait to eat or drink after the fluoride varnish application. In fact, we encourage the child to swallow immediately after the application, then get a drink of water. The child then may eat and drink normally. It is recommend to avoid crunchy foods and very hot liquids for the remainder of the day.
3333
Can the child have themouth mirror for home use?
Presenter
Presentation Notes
Can the child have the mouth mirror for home use?
• No, the child cannot take the mouth mirror home.
34
Can the child have themouth mirror for home use?
Presenter
Presentation Notes
No, the child cannot take the mouth mirror home. Doing so can spread germs from one child to another. It is a disposable mouth mirror and is designed for one time use.
You are Doing Your Part to Prevent This!
On Behalf of Missouri’s Children----THANK YOU!
Presenter
Presentation Notes
You are doing your part to prevent rampant dental decay such as this. On behalf of Missouri’s children---Thank You!
3636
Questions?
ContactDepartment of Health and Senior Services
Oral Health Program1-800-891-7415
Orhttp://health.mo.gov/living/families/oralhealth/psp
To locate the Oral Health ConsultantNearest You
Presenter
Presentation Notes
If you have questions please contact the Oral Health Program at the Department of Health and Senior Services. 1-800-891-7415 or visit our web site; www.health.mo.gov enter oral health into the search engine and you will be able to locate information regarding oral health and the Preventive Services Program. Thank you
3737
Thank Youfor Joining with Others to Improve the
Oral Health of Missouri’s Children
Presenter
Presentation Notes
This now completes the fluoride varnish application training course. Please return to the fluoride varnish training web page to register at “training completion/registration form” In order to receive the completion of training certificate you must complete the questionnaire. You must answer each question correctly in order to automatically be allowed to move on to the next question; after answering all 3 questions correctly, you will be directed to a downloadable and printable certificate of completion for your personal records. We thank you for joining with others to improve the oral health of Missouri’s children.
