CHDP Dental Training:

Fluoride Varnish

California Child Health & Disability Prevention (CHDP) Program Statewide Oral Health Subcommittee

June 2013

http://www.dhcs.ca.gov/services/chdp/Pages/FluorideVarnish.aspx

Training Objectives

• Recognize the importance of providing fluoride varnish to high risk children (0 to 6 years) in the medical office.

• Establish a protocol to implement fluoride varnish application in the medical office.

• Identify children at risk for dental decay.

• Apply fluoride varnish with confidence.

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Fluoride Varnish

The CHDP Provider’s Role

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CHDP Providers Prevent Dental Decay

• Young children are seen earlierearlier and more more frequentlyfrequently by medical providers than by a dentist

• Low income young children are at highest risk for dental decay

• Medical providers are now placing fluoride varnish to prevent decayprevent decay

• Research shows high efficacyefficacy of fluoride varnish*

4 www.ncbi.nlm.nih.gov/pmc/articles/PMC2257982/?tool=pubmed*

Fluoride Varnish --Nationwide Effort by Medical Providers

5http://www.pewstates.org/research/analysis/reimbursing-physicians-for-fluoride-varnish-85899377335

Fluoride Varnish - Who Needs It?

• Active or Past Tooth Decay – In parents, siblings,

caregivers or child– White spot lesions on teeth

• Poor Feeding Habits– Frequent snacking on

carbohydrates – Sticky sugary foods– Sweet/acidic drinks– Bottle in bed– Bottle after age 1

• Lack of Fluoride in– Drinking water **– Vitamins/Supplements– Toothpaste

• No Recent Dental Visit– Within the last year

• Poor Homecare – Lack of daily brushing and flossing

• Children with Special Health Care Needs

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CHDP children are at high caries risk!* Other Caries Risk Factors:

http://www2.aap.org/commpeds/dochs/oralhealth/docs/RiskAssessmentTool.pdfhttp://www.cdph.ca.gov/certlic/drinkingwater/Documents/Fluoridation/Tables/Table%201.pdf

** *

Fluoride Varnish - Which Teeth Benefit?

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Beginning Decay white chalky decalcification near gum line

Reversible with fluoride varnish and better home care to inhibit progression of caries

Advanced Decay destroyed enamel

No Visible Decay

but high risk

Teeth Without pulp exposure or open lesions

Irreversible, however with fluoride varnish decay progression is inhibited ~ Dental treatment needed ASAP ~

Preventable with fluoride varnish and good home care

Avoid these areas, but apply fluoride varnish to all other teeth in the mouth

Fluoride Varnish - Facts

• A protective resin coating of sodium fluoride

• Painted on teeth in ≈ 1 minute

• 1 application cuts decay risk in half *

• Applied up to 5x per year – 3x in medical office – 2x in dental office

8For more information: http://www.dhcs.ca.gov/services/chdp/Documents/CHDPDental/FVFindings0508.pdf

http://www.astdd.org/docs/Sept2007FINALFlvarnishpaper.pdf

Frequency of Application

• The optimal interval of application has not been established.*

• After the first fluoride varnish treatment, subsequent treatments can be applied every 3-4 months.

• Schedule during a well child exam, follow-up visit, or stand-alone appointment.

9* http://www.astdd.org/docs/Sept2007FINALFlvarnishpaper.pdf (See Page 4)

http://www.dhcs.ca.gov/services/chdp/Documents/CHDPDental/FVFindings0508.pdf http://www.dhcs.ca.gov/services/chdp/Documents/CHDPDental/PreventManageProtocol.pdf (See Table 4, P.754 and Table 5, P.756)

• Community Setting** (School, health fair or government program)

– Any trained person• With signed parental permission• Under a doctor’s (or dentist’s) prescription• Following doctor’s (or dentist’s) protocol

Fluoride Varnish -- Who Can Apply?

* http://www.dhcs.ca.gov/services/chdp/Documents/Letters/chdppin0608.pdf** http://www.dhcs.ca.gov/services/chdp/Documents/CHDPDental/FVAB667.pdf

• Medical Office Setting– MD– Trained nurses and assistants

under MD Rx*

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Fluoride Varnish -- Application

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Fluoride Varnish -- Instructions

Online Videos and Training Modules

American Academy of Pediatrics Television

http://www.youtube.com/watch?v=zNOlGS1ggSg&feature=player

Maryland’s Mouths Matter Module 4

http://www.mchoralhealth.org/flvarnish/mod4_0.html

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• No water restrictions after application

• Avoid crunchy, chewy, and hot foods/ drinks for the rest of the day

• Do not brush/floss until the next day

• Fluoride Varnish may leave a yellowish coating that can bebrushed off the next day

Fluoride Varnish - - Parent Information

Print copies of Fluoride Varnish - Helping Smiles Stay Strong brochure: English, Spanish, Chinese, Hmong, Korean

BROCHUREBROCHURE

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Fluoride Varnish - Billing

• Fee-for-Service Medi-Cal - Billing code: D1206 http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/dental_m00o03o09.doc

• Managed Care Medi-Cal - Reimbursement varies

- Contact individual plan

• FQHC - Not billable as a separate procedure

Reimbursable 3 times (in a 12 month period) for children age 0 through 5

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Fluoride Varnish –– How to Order

Three Ways:

1.Directly:– Oral Health Solutions 909-469-8300http://store.centerfororalhealth.org/collections/products/products/fluoride-varnish

– Medical Products Laboratories, Inc. 800-523-0191 http://www.mplusa.com/public-health/varnishamerica.html

2.Internet search:– Use search term “fluoride varnish buy”

3.Dental supply companies:– See link below for Fluoride Varnish

vendor list

15http://www.dhcs.ca.gov/Services/chdp/Documents/CHDPDental/FVVendorList.pdf

Fluoride Varnish Summary:

Can be provided in medical offices up to 3x in a 12 month period

Billable for Medi-Cal children, ages 0 through 5 years

• Fee-for-Service Medi-Cal reimbursement - $18 per application

• Managed Care Medi-Cal reimbursement - contact the Plan

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Fluoride Varnish in Your Practice: www2.aap.org/oralhealth/PracticeTools.html

Easy and Effective

Applying Fluoride Varnish is one of the easiest and most effective procedures a medical provider can do to help protect the oral health of their young patients!

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With just a swipe of fluoride varnish, I can prevent tooth

decay for this little girl!

Working Together

Together we can Together we can stop the stop the

epidemic of epidemic of dental disease!dental disease!

CHDP

Medical Providers Dental Providers

Parents/Caregivers Individuals

MD - DDS Referral Form: www.dhcs.ca.gov/services/chdp/Documents/CHDPDental/DTMPReferral.pdf

Local CHDP contact information: www.dhcs.ca.gov/services/chdp/Pages/CountyOffices.aspx18

References

Photos and graphics in this training were used by permission or from public domain.

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• Fluoride Varnish• General Information

• www.astdd.org/docs/Sept2007FINALFlvarnishpaper.pdf• www2.aap.org/oralhealth/PracticeTools.html• www.cdc.gov/fluoridation/safety/dental_fluorosis.htm #10• www.cdph.ca.gov/certlic/drinkingwater/Documents/Fluoridation/PWS%20Statewide%20Fluoridation%20Table%202010.pdf

• National Effort• http://www.pewstates.org/research/analysis/reimbursing-physicians-for-fluoride-varnish-85899377335

• Effectiveness• www.ncbi.nlm.nih.gov/pmc/articles/PMC2257982/?tool=pubmed• Risk Assessment Tool• http://www2.aap.org/commpeds/dochs/oralhealth/docs/RiskAssessmentTool.pdf• Who Can Apply• www.dhcs.ca.gov/services/chdp/Documents/Letters/chdppin0608.pdf• files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/dental_m00o03o09.doc• cda.org/popup/cda-sponsored_legislation_clarifies_who_can_place_topical_fluoride_including_fluoride_varnish

• Parent Brochure• www.cdph.ca.gov/programs/MCAHOralHealth/Documents/MO-OHP-FluorideVarnish–English.pdf• Training Modules• www.youtube.com/watch?v=cV5OmL7C8K4&feature=player_embedded • www.youtube.com/watch?v=zNOlGS1ggSg&feature=player_embedded • www.ohmdkids.org/flvarnish/

• Billing Code• files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/dental_m00o03o09.doc

• MD-DDS Referral Form• http://www.dhcs.ca.gov/services/chdp/Documents/CHDPDental/DTMPReferral.pdf

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To return to the beginning of the Fluoride Varnish Training click HERE

For CHDP Dental and other trainings: www.dhcs.ca.gov/services/chdp/Pages/Training.aspx

For local CHDP contact information: www.dhcs.ca.gov/services/chdp/Pages/CountyOffices.aspx

Fluoride Varnish- Practicum -

• Speaker Demonstration• Participant Practice

California Child Health & Disability Prevention (CHDP) Program Statewide Oral Health Subcommittee

June 2013 http://www.dhcs.ca.gov/services/chdp/Pages/Training.aspx

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