Quality Education for a Healthier Scotland

Fluoride Varnish Application

Quality Education for a Healthier Scotland

Learning outcomes

Describe the properties of fluoride varnish and how fluoride varnish helps to reduce dental decay.

Identify the areas of competency required in the Direct Observational Procedure (DOP) DN only

Apply knowledge of the risk assessment protocol prior to application of fluoride varnish DN only

Practice the safe use and application of fluoride varnish DN only

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Session outline

Why apply fluoride varnish and how does it reduce caries

Fluoride varnish properties

Fluoride varnish safety

Completing the reflective journal and DOP

How to apply fluoride varnish (DVD)

Practical session

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Programme Manual

The web address is:www.child-smile.org.uk

Follow links:Professional > Childsmile

manuals

Programme Manual for Childsmile Staff

March 2014

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High quality evidence of the caries-preventive effectiveness of fluoride varnish in both permanent and primary dentitions is available

Why apply fluoride?

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Standard Prevention for all childrenApply sodium fluoride varnish (5%) twice a year to children over 2 years of age

Enhanced Prevention for children at increased risk of cariesApply sodium fluoride varnish (5%) an additional 1-2 times per year to children over 2 years of age

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The SIGN 183 Guideline

found fluoride varnish to

be effective in the prevention

of decay in permanent teeth and

advised that it should be

applied to the teeth at least

twice yearly for all children.

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Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoridevarnishes for preventing dental caries in children and adolescents.Cochrane Database of Systematic Reviews 2013, Issue 7

www.thecochranelibrary.com

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How does fluoride work

Topical effect which;

Slows down the development of decay by stopping demineralisation

Makes enamel more resistant to acid attack and speeds up remineralisation

Can stop bacterial metabolism and reduce acid production.

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Chronic fluoride ingestion causes fluorosis

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Fluoride Varnish ApplicationDuraphat®

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Fluoride varnish resources

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Fluoride Varnish Safety

The dose for a child aged two to six years is 0.25ml

Dose for child over six years ( mixed dentition) is 0.40ml.

Children should not take fluoride supplements for two days after the fluoride varnish application

Ensure Childsmile aftercare instruction/leaflet is given

FVAftercareInstructions.pdf [764 Kb]

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Toxic dose

If a child is suspected of ingesting more than one dose they should be given milk to drink and quickly transferred to A&E

There should be no opportunity for a child to ingest more than a single 0.25ml (0.4ml) dose.

Acute fluoride toxicity causes nausea and vomiting

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Toxic Dose

Estimated toxic dose of fluoride ingestion is 5mg of fluoride per kg of child body weight The dose of 0.25 ml of Duraphat® contains 5.6mg of fluoride, well below the toxic dose.

If the average 3 year old weighs 11-20kg. What would be the toxic dose ?

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An 11Kg child would need to swallow 55mg of fluoride to be considered to have ingested a toxic amount and a 20Kg child would need to ingest 100mg of fluoride.

11Kg = 55/5.6 x 0.25ml = 2.5ml20Kg =100/5.6 x 0.25ml = 4.5ml

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The Collapsed Child

Duraphat® applied in the correct dose is not associated with any adverse reactions

Every parent is asked about allergies and asthma, and children who have been hospitalised due to severe asthma or allergy or who are allergic to sticking plaster should not have Duraphat applied.

Duraphat –Safety Issues information sheet Childsmile Website

http://www.child-smile.org.uk/professionals/information-for-dental-practice-staff/practice-documents.aspx

Prescribing Duraphat is the DENTIST’S responsibility

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The Collapsed Child Protocol

Stop the procedure and summon help from the rest of the team/teacher

Call 999 and note the time Remove all equipment from the vicinity of the child Put the child in the recovery position Make sure all other children are kept

safe and away from the incident

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Reporting adverse reactions protocol

Remove product by tooth brushing and rinsing and follow local protocol

Complete and submit a BNF yellow card as per local procedure

If there are any adverse reactions to the fluoride varnish (e.g. mucositis, allergy etc.) then these must be reported, by either the DHSW or the EDDN, to the prescribing dentist

http://yellowcard.mhra.gov.uk/

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Reflective Diary and Direct Observational Procedure

Firstly observe and assist a trainer apply varnish in five cases. Write a reflective statement detailing your learning during observation.

Apply varnish to at least 10 children approx age under 10 years with the majority being under 6 years it should be supervised and documented in the reflective diaries

Undergo 1 Direct Observational Procedure (DOP). If you are successful then the diary is sent to NES Oral Health Improvement Tutors and you will receive your certificate

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Direct Observational Procedure

You must be assessed as competent in areas 1-7 to complete the DOP satisfactorily

If you do not complete one of the cases satisfactorily the area should be identified and addressed and the DOP re-taken

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Competencies

1. Taking a relevant history and risk-assessing for fluoride varnish application

2. Clinical Judgment

3. Technical Ability & Manual Dexterity

4. Communication Skills

5. Professionalism

6. Knowledge

7. Organisation

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Child Protection

There are many forms of abuse: physical, emotional, sexual, neglect.

Everyone has a part to play in making sure children are safe from harm

60% of cases of physical abuse have orofacial signs

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Gaining consent

Nursery/school programme Follow Childsmile consent protocol for the supply and application of Duraphat

Dental practice Follow consent protocol as per local general practice guidelines

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Communicating with children

What can we do well?

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Behave Project

Verbal and non-verbal behaviours

Instruction

Praise

Information giving

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Training DVD

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Practical session

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Learning Points

Feedback from practical session

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Appropriate preventative care

Group work

In addition to application of fluoride what other simple preventative interventions are available?

Discuss what your responsibilities are in terms of preventive advice.

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http://www.sdcep.org.uk/index.aspx?o=2858

Caries Prevention

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Flossing

Disclosing Techniques

Toothbrushes

Toothpaste

Caries Prevention

Summary

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Evidence

Scottish Dental Clinical Effectiveness Programmewww.sdcep.org.uk

The Scottish Intercollegiate Guidelines Network (SIGN)www.sign.ac.uk

The Cochrane librarywww.thecochranelibrary.com

Childsmile Programmewww.childsmile.org.uk

The yellow card schemehttp://yellowcard.mhra.gov.uk/