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Text of Fluoride Varnish and Silver Diamine Fluoride FLUORIDE VARNISH AND SILVER DIAMINE FLUORIDE: A...

  • Fluoride Varnish and Silver Diamine Fluoride

    A Resource Guide

    Prepared by

    Ruth Barzel, M.A. Katrina Holt, M.P.H., M.S., R.D., FAND

  • Cite as Barzel R, Holt K, eds. 2020. Fluoride Varnish and Silver Diamine Fluoride: A Resource Guide. Washington, DC: National Maternal and Child Oral Health Resource Center.

    Fluoride Varnish and Silver Diamine Fluoride: A Resource Guide © 2020 by National Maternal and Child Oral Health Resource Center, Georgetown University

    This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,000,000 with no funding from nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official policy of HRSA, HHS, or the U.S. govern- ment, nor should any endorsements be inferred.

    Permission is given to photocopy this publication or to forward it, in its entirety, to others. Requests for permission to use all or part of the information contained in this publication in other ways should be sent to the address below.

    National Maternal and Child Oral Health Resource Center

    Georgetown University Box 571272 Washington, DC 20057-1272 (202) 784-9771 E-mail: OHRCinfo@georgetown.edu Web site: www.mchoralhealth.org

    mailto:OHRCinfo@georgetown.edu http://www.mchoralhealth.org

  • Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

    Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . 4

    Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

    Data and Surveillance . . . . . . . . . . . . . . . . . . . . . 6 Professional Education and Training . . . . . . . . 6 Public Education . . . . . . . . . . . . . . . . . . . . . . 13

    Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15


  • F LU O R I D E VA R N I S H A N D S I LV E R D I A M I N E F LU O R I D E : A R E S O U R C E G U I D E


    The National Maternal and Child Oral Health Resource Center (OHRC) developed this pub- lication, Fluoride Varnish and Silver Diamine Fluoride: A Resource Guide, to help health pro- fessionals, program administrators, educators, policymakers, parents, and others promote oral health and prevent oral disease.

    Professionally applied fluoride varnish inhibits demineralization of tooth enamel. Fluoride var- nish can also remineralize early enamel demin- eralization. Fluoride varnish applied to the teeth of children decreases dental caries experience, especially if applied frequently and close to the time of tooth eruption.

    Fluoride varnish can easily and safely be applied by both oral health professionals and non-oral-health professionals in a variety of set- tings. The U.S. Preventive Services Task Force recommends that primary care health profession- als apply fluoride varnish to the primary teeth of children starting at the age of primary tooth erup- tion and continuing through age 5.

    Topical silver diamine fluoride (SDF) is a liquid that is applied to a tooth surface with an active dental caries lesion to arrest the lesion. SDF has been used in Japan for over 40 years to arrest dental caries lesions and reduce tooth hypersensitivity in primary and permanent teeth. During the past decade, many other countries have been using SDF with similar success. SDF was approved by the Food and Drug Administra- tion in 2014 as a treatment for sensitive teeth and has been used off-label to arrest dental caries lesions in the United States since 2015.

    SDF is safe for children and adults. The cost of SDF treatment is lower than the cost of conventional dental caries treatment. The Ameri- can Dental Association’s expert panel strongly recommends the use of 38 percent SDF solution to arrest advanced dental caries lesions on any coronal surface of primary teeth. The American Academy of Pediatric Dentistry supports the use of SDF as part of an ongoing dental-caries- management plan with the aim of optimizing individualized patient care consistent with the goals of a dental home.

    The resource guide is divided into two sec- tions. The first section describes materials, such as brochures, fact sheets, guidelines, curricula, and reports published from 2016 through 2019 as well as seminal resources published before 2016. The second section lists federal agencies, national professional associations, centers, and national coalitions that may serve as resources.

    Our intent is to share resources that are useful and that represent current science and practice. For further information, we encourage you to contact the organizations listed. Your state and local departments of health, state and local oral- health-related associations and societies, state or local oral health coalitions, and university-based libraries are additional sources of information. OHRC will update the resource guide periodi- cally, and we would appreciate hearing from you if you know of any relevant resources that are not included in this edition.


  • F LU O R I D E VA R N I S H A N D S I LV E R D I A M I N E F LU O R I D E : A R E S O U R C E G U I D E


    The following National Maternal and Child Oral Health Resource Center staff members assisted in the development of this resource guide: Beth Lowe, Katy Battani, Sarah Kolo, and Olivia Pickett. In addition, we are grateful

    to the following individuals for reviewing the resource guide: Tammy Alexander, Theresa Anselmo, LeeAnn Hoaglin-Cooper, Debora Teixeira, Sandy Tesch, Norman Tinanoff, and Christine Wood.


  • Materials

  • F LU O R I D E VA R N I S H A N D S I LV E R D I A M I N E F LU O R I D E : A R E S O U R C E G U I D E



    This document presents survey findings for the 50 states and the District of Columbia on reim- bursement for risk assessment, oral examina- tion, fluoride varnish, anticipatory guidance, and family oral health education. It presents infor- mation on the following topics: type of health professional, services, fees, procedure codes, delegation, age limit for services, number of varnish applications reimbursed annually, train- ing requirement, payor, payment by Medicaid or the Children’s Health Insurance Program, and legislative approval to reimburse health profes- sionals. Information about commercial payment and procedure codes is also included.

    American Academy of Pediatrics, Oral Health Initiative, Medicaid | Medicare | CHIP Services Dental Association; and National Academy for State Health Policy. 2018. Caries Prevention Services Reimbursement Table. Elk Grove Vil- lage, IL: American Academy of Pediatrics, Oral Health Initiative. 1 v. www.aap.org/en-us/_ layouts/15/WopiFrame.aspx?sourcedoc=/en-us/ Documents/OralHealthReimbursementChart. xlsx&action=default


    The survey is designed to obtain information about the level of students’ satisfaction with oral health services (screenings, cleanings, fluoride varnish applications, dental sealant application, and education) provided in a school-based oral hygiene program for children from families with low incomes in Nevada. The survey is available in English and in Spanish.

    Future Smiles. 2016–. Future Smiles: Satisfaction Survey. Las Vegas, NV: Future Smiles. 1 item. www.surveymonkey.com/r/FutureSmilesStudents

    Professional Education and Training APPLYING FLUORIDE VARNISH

    This video for health professionals provides information about fluoride varnish, including recommendations from professional organizations about how often it should be applied and the ages of children who should receive it. The video demonstrates how to apply it to the teeth of young children using the knee-to-knee position and with a child placed on an examination table. Tips for applying fluoride varnish effectively using both methods are provided.

    From the First Tooth. 2015. Applying Fluoride Varnish. Portland, ME: From the First Tooth. 1 video (1:50 min.). www.youtube.com/ watch?v=j8Ujt1FhMU8


    This report focuses on best practices for the use of fluoride in schools. It discusses fluoride as a measure to prevent tooth decay in children, different types of programs that provide fluo- ride to children, and different forms of fluoride. Evidence for the efficacy of fluoride in prevent- ing tooth decay and best practice criteria are provided. The report also includes state practice examples.

    Association of State and Territorial Dental Direc- tors. 2018. Best Practice Approach Report: Use of Fluoride in Schools. Reno, NV: Association of State and Territorial Dental Directors. 24 pp. www.astdd.org/docs/final-approved-fluoride-in- schools-bpar-july-2018.pdf


    http://www.aap.org/en-us/_layouts/15/WopiFrame.aspx?sourcedoc=/en-us/Documents/OralHealthReimbursementChart.xlsx&action=default http://www.aap.org/en-us/_layouts/15/WopiFrame.aspx?sourcedoc=/en-us/Documents/OralHealthReimbursementChart.xlsx&action=default http://www.aap.org/en-us/_layouts/15/WopiFrame.aspx?sourcedoc=/en-us/Documents/OralHealthReimbursementChart.xlsx&action=default http://www.aap.org/en-us/_layouts/15/WopiFrame.aspx?sourcedoc=/en-us/Documents/OralHealthReimbursementChart.xlsx&action=default http://www.surveymonkey.com/r/Fu