Fluoride Varnish Application

1
Fluoride Varnish Application
2
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)
• Apply knowledge of the risk assessment protocol
  prior to application of fluoride varnish
• Practice the safe use and application of fluoride
  varnish

3
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

4
Programme Manual

• The web address is
• www.child-smile.org
• Follow links
• Childsmile Nursery or school
• Guidance

Childsmile Programme Manual
5
Why apply fluoride?

• The SIGN 83 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 pre-school children
• assessed at being at increased
• risk of dental decay

6

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

7
Ref Marinho VCC, Higgins JPT, Logan S, Sheiham
A.Fluoride gels for preventing dental caries in
children and adolescents. Cochrane Database of
Systematic Reviews 2002, Issue 2. As many as
one in two children with high levels of tooth
decay would have less decay.
8
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.

9

• Chronic fluoride ingestion causes fluorosis

10
Fluoride Varnish ApplicationDuraphat
11
Fluoride Varnish Resources
12
Fluoride Varnish Safety

• Duraphat provided in Childsmile comes in 1.6ml
  cartridges.
• The dose for a pre 5 child is 0.25ml
• Dose for 5-12 year old child ( mixed dentition)
  0.40ml.
• Children should not take fluoride supplements the
  day before, on the day or
• day following Duraphat application

13
(No Transcript)
14
Toxic dose

• Acute fluoride toxicity causes nausea and vomiting

• There should be no opportunity for a child to
  ingest more than a single 0.25ml (0.4ml) dose.
• If a child is suspected of ingesting more than
  one dose they should be given milk to drink and
  the local AE department telephoned and the
  situation explained.

15
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 ?

16

• 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 2.5ml
• 20Kg 100/5.6 x 0.25ml 4.5ml

17
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 with hospitalisation for asthma and
  allergies are eliminated
• This is the DENTISTS responsibility

18
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 keptsafe and
  away from the incident

19
Reflective Diary and Direct Observational
Procedure

• You should firstly observe and assist a trainer
  apply varnish in 5 cases
• You should then apply varnish to at least 10
  children under supervision and document in the
  reflective diaries
• You should then 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

20
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

21
Competencies

• Taking a relevant history and risk-assessing for
  fluoride varnish application
• Clinical Judgment
• Technical Ability Manual Dexterity
• Communication Skills
• Professionalism
• Knowledge
• Organisation

22
Child Protection

• There are many forms of abuse physical,
  emotional, sexual, neglect non organic failure
  to thrive.
• Everyone has a part to play in making sure
  children are safe from harm
• 60 of cases of physical abuse have oro-facial
  signs

23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
Training DVD
27
(No Transcript)
28
Practical session