CHDP Dental Training Fluoride Varnish California Child Health

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/Fluoride. Varnish. 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. 2

Fluoride Varnish The CHDP Provider’s Role 3

CHDP Providers Prevent Dental Decay • Young children are seen earlier and more frequently 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 decay • Research shows high efficacy of fluoride varnish* * www. ncbi. nlm. nih. gov/pmc/articles/PMC 2257982/? tool=pubmed 4

Fluoride Varnish Nationwide Effort by Medical Providers http: //www. pewstates. org/research/analysis/reimbursing-physicians-for-fluoride-varnish-85899377335 5

Fluoride Varnish - Who Needs It? CHDP children are at high caries risk!* Other Caries Risk Factors: • 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 * http: //www 2. aap. org/commpeds/dochs/oralhealth/docs/Risk. Assessment. Tool. pdf * * http: //www. cdph. ca. gov/certlic/drinkingwater/Documents/Fluoridation/Tables/Table%201. pdf 6

Fluoride Varnish - Which Teeth Benefit? No Visible Decay Beginning Decay but high risk white chalky decalcification near gum line Preventable with fluoride varnish and good home care Reversible with fluoride varnish and better home care to inhibit progression of caries Advanced Decay Teeth Without destroyed enamel pulp exposure or open lesions Irreversible, however with fluoride varnish decay progression is inhibited ~ Dental treatment needed ASAP ~ Avoid these areas, but apply fluoride varnish to all other teeth in the mouth 7

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 5 x per year – 3 x in medical office – 2 x in dental office For more information: http: //www. dhcs. ca. gov/services/chdp/Documents/CHDPDental/FVFindings 0508. pdf 8 http: //www. astdd. org/docs/Sept 2007 FINALFlvarnishpaper. 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 standalone appointment. * http: //www. astdd. org/docs/Sept 2007 FINALFlvarnishpaper. pdf (See Page 4) http: //www. dhcs. ca. gov/services/chdp/Documents/CHDPDental/FVFindings 0508. pdf http: //www. dhcs. ca. gov/services/chdp/Documents/CHDPDental/Prevent. Manage. Protocol. pdf (See Table 4, P. 754 and Table 5, P. 756) 9

Fluoride Varnish - Who Can Apply? • Medical Office Setting – MD – Trained nurses and assistants under MD Rx* • 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 * http: //www. dhcs. ca. gov/services/chdp/Documents/Letters/chdppin 0608. pdf ** http: //www. dhcs. ca. gov/services/chdp/Documents/CHDPDental/FVAB 667. pdf 10

Fluoride Varnish - Application 11

Fluoride Varnish - Instructions Online Videos and Training Modules American Academy of Pediatrics Television http: //www. youtube. com/watch? v=z. NOl. GS 1 g g. Sg&feature=player Smiles for Life - University of Connecticut http: //www. youtube. com/watch? v=c. V 5 Om. L 7 C 8 K 4 &feature=player Maryland’s Mouths Matter Module 4 http: //www. mchoralhealth. org/flvarnish/mod 4_0. ht ml 12

Fluoride Varnish - Parent Information BROCHURE • 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 be brushed off the next day Print copies of Fluoride Varnish - Helping Smiles Stay Strong brochure: English, Spanish, Chinese, Hmong, Korean 13

Fluoride Varnish - Billing Reimbursable 3 times (in a 12 month period) for children age 0 through 5 • Fee-for-Service Medi-Cal - Billing code: D 1206 http: //files. medi-cal. ca. gov/pubsdoco/publications/masters-mtp/part 2/dental_m 00 o 03 o 09. doc • Managed Care Medi-Cal - Reimbursement varies - Contact individual plan • FQHC - Not billable as a separate procedure 14

Fluoride Varnish – How to Order Three Ways: 1. Directly: – Oral Health Solutions 909 -469 -8300 http: //store. centerfororalhealth. org/collections/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 http: //www. dhcs. ca. gov/Services/chdp/Documents/CHDPDental/FVVendor. List. pdf 15

Fluoride Varnish Summary: Can be provided in medical offices up to 3 x 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 Fluoride Varnish in Your Practice: www 2. aap. org/oralhealth/Practice. Tools. html 16

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! With just a swipe of fluoride varnish, I can prevent tooth decay for this little girl! 17

Working Together CHDP Medical Providers Parents/Caregivers Together we can stop the epidemic of dental disease! Dental Providers 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/County. Offices. aspx 18

• Fluoride Varnish • General Information • • References • www. astdd. org/docs/Sept 2007 FINALFlvarnishpaper. pdf • www 2. aap. org/oralhealth/Practice. Tools. html • www. cdc. gov/fluoridation/safety/dental_fluorosis. htm • www. cdph. ca. gov/certlic/drinkingwater/Documents/Fluoridation/PWS%20 Statewide%20 Fluoridation%20 Table%202010. pdf National Effort • http: //www. pewstates. org/research/analysis/reimbursing-physicians-for-fluoride-varnish-85899377335 Effectiveness • www. ncbi. nlm. nih. gov/pmc/articles/PMC 2257982/? tool=pubmed Risk Assessment Tool • http: //www 2. aap. org/commpeds/dochs/oralhealth/docs/Risk. Assessment. Tool. pdf Who Can Apply • www. dhcs. ca. gov/services/chdp/Documents/Letters/chdppin 0608. pdf • files. medi-cal. ca. gov/pubsdoco/publications/masters-mtp/part 2/dental_m 00 o 03 o 09. doc • cda. org/popup/cda-sponsored_legislation_clarifies_who_can_place_topical_fluoride_including_fluoride_varnish Parent Brochure • www. cdph. ca. gov/programs/MCAHOral. Health/Documents/MO-OHP-Fluoride. Varnish%E 2%80%93 English. pdf Training Modules • www. youtube. com/watch? v=c. V 5 Om. L 7 C 8 K 4&feature=player_embedded • www. youtube. com/watch? v=z. NOl. GS 1 gg. Sg&feature=player_embedded • www. ohmdkids. org/flvarnish/ Billing Code • files. medi-cal. ca. gov/pubsdoco/publications/masters-mtp/part 2/dental_m 00 o 03 o 09. doc MD-DDS Referral Form • http: //www. dhcs. ca. gov/services/chdp/Documents/CHDPDental/DTMPReferral. pdf 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/County. Offices. aspx Photos and graphics in this training were used by permission or from public domain. 19

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 20