Fluoride Application Training

1

• Fluoride Application Training
• margaretpaterson_at_nhs.net

2
This lecture will cover

• The clinical part of the care manual
• How to carry out the clinical training and the
  reflective journal
• How to apply the fluoride varnish

3
Fluoride Varnish

• Fluoride Varnish is normally a very safe material
  to use
• Chronic fluoride ingestion causes fluorosis

4
Fluoride Varnish Safety

• The Duraphat that ChildSmile uses comes in 1.6 ml
  cartridges. The dose for a nursery child is 0.25
  ml of Duraphat. The cartridge is marked out in
  0.25ml sections so this is easily dispensed
• As only 0.25ml is on the tray, no child should
  ever be at risk of receiving too high a dose
• For the mixed dentition 0.4 ml is recommended
• Children should not take fluoride supplements the
  day before, on the day or day following Duraphat
  application

5
Toxic Dose

• There should be no opportunity for a child to
  ingest more than a single dose. However, in very
  rare cases, a problem may arise
• Acute fluoride toxicity causes nausea and
  vomiting
• If suspected give milk to drink and quickly
  transfer to local AE

6
The Collapsed Child

• Duraphat applied in the correct dose is not
  associated with any adverse reactions
• Every child is asked about allergies and asthma.
  Children who have been hospitalised with asthma
  or who have allergies are eliminated
• This is the prescribing DENTISTS responsibility

7
Protocol for Collapsed Child

• Stop the procedure immediately
• Summon help from rest of dental team and/or class
  teacher
• Remove all equipment
• Put child in recovery position, ensuring chin is
  elevated
• Member of team move other children/family members
  away from the incident

8
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 oro-facial
  signs

9
DOP (Direct Operational Procedure)

• Firstly observe your trainer complete at least 5
  cases and discuss
• Undertake 10 supervised varnish application cases
  in the primary care setting
• A DOP is then to be carried out in the primary
  care setting

10
DOP (Part 2)

• You must be assessed as competent in areas 1-7
  to complete the DOP satisfactorily
• If you do not complete one of these
  satisfactorily the area should be identified and
  the DOP retaken

11
1. Medical History

• Relevant medical history and risk assessment
  includes
• Asthmatics or hospitalisation due to asthma or
  allergies
• Any abnormality of the oral soft tissues
• Gross caries which involve pulpal exposure
• Non-compliant child
• Child feeling unwell on the day

12
2. Clinical Judgement

• The trainee should
• Consider all the information obtained at the risk
  assessment and reach a decision whether or not to
  apply Duraphat and /or refer to a dentist
• Demonstrate that they are able to thoroughly
  inspect the lips and mouth for any abnormality

13
3. Technical Ability Manual Dexterity

• All technical procedures must be performed
  appropriately, accurately and efficiently. The
  trainee should demonstrate they can
• set up the tray as per the application protocol
• dispense the appropriate quantity (0.25ml) of
  fluoride varnish
• apply the fluoride varnish as per the application
  protocol
• carry out the procedure in a manner that ensures
  the comfort of the child

14
4. Communication Skills

• The trainee should demonstrate good communication
  skill
• All stages of the procedure must be explained to
  the child and family in a manner they can
  understand
• Good oral health messages should be given to the
  child/family when appropriate

15
5. Professionalism

• The trainee should
• Show respect, courtesy and compassion for the
  child
• Maintain honesty and confidentiality
• Adhere to the GDC guidelines regarding
  professional conduct at all times
• Demonstrate they act in a professional manner
  during the procedure

16
The Principles of Practice in Dentistry

• As a dental professional, you are responsible
  for
• Putting patients interests first and acting to
  protect them
• Respecting patients dignity and choices
• Protecting the confidentiality of patients
  information
• Co-operating with other members of the dental
  team and other healthcare colleagues in the
  interests of patients 
• Maintaining professional knowledge competence
• Being trustworthy

17
6. Knowledge

• The trainee should demonstrate an appropriate
  level of knowledge in the field. This will be
  assessed by using appropriate questions regarding
  the procedure
• How does fluoride varnish help prevent caries?
• What is the toxic dose of fluoride varnish for
  pre 5 children?
• What is the protocol for a collapsed patient?
• What is the protocol for a patient when there is
  concern regarding child protection?

18
7. Organisation

• The trainee must
• Be prepared for each child and work in an
  organised manner
• Demonstrate they have taken precaution to prevent
  fluoride being accessible to the child
• Undertake fluoride varnish application in an
  appropriate amount of time

19
To summarise

• You must observe and assist with the placement of
  fluoride varnish on at least 5 different patients
  and discuss them with the dentist /mentor
• You then will apply fluoride varnish to at least
  10 different patients with a range of ages, in
  the clinical setting and enter them in the
  reflective diary
• You will undertake the DOP in the clinical
  setting after you have completed enough patients
  (minimum of 10) to feel confident about the
  procedure
• If successful send in your completed journal
• Your certificate will be sent to you

20
Direct Observation Procedure 2 Fluoride Varnish
Application Nursery Setting
Case Complexity Low Medium High Taking a
relevant history and risk-assessing the patient
for fluoride varnish application Further training
required Competent Clinical Judgement Further
training required Competent Technical Ability
and Manual Dexterity Further training required
Competent Communication Skills Further training
required Competent Professionalism Further
training required Competent Knowledge Further
training required Competent Organisation Furthe
r training required Competent Satisfaction
with OSCE Further training required
Competent
21

• You are now an Enhanced Duty Dental Nurse

22
Fluoride Varnish Application

• Before the patient arrives the nurses should
  check that they have an equipment pack.
• Each pack should contain
• 1 tray
• 1 brush
• 4 size 2 cotton wool rolls
• 1 disposable dental mirror
• 1 pair of disposable tweezers
• 1 bib

23
You will also need

• Boxes of Duraphat cartridges check expiry date
• Syringe and cannula
• Box of latex free gloves
• 2 pairs of adult safety glasses
• 1 pair of child safety glasses

24
In the Nursery

• Nurses must check before any inspection is
  started that you have the correct child and the
  DHSW has checked they have been validated

25
In Practice

• The children will be turning up with their
  parents/carers so they dont need consent
• Their medical history should tell you if they
  have severe asthma or allergies but ask again if
  there have been any change
• The dentist should be on the premises and have
  signed the form for the procedure. If it is not
  signed, do not go ahead with the application

26
The Risk Assessment

• The risk assessment reduces the possibility of
  children with any problems being included
• This is carried out BEFORE the application
  procedure for the fluoride is started
• Make sure the child is sitting comfortably

27
Extra-oral Examination

• Does the child appear well?
• Check the skin of the face and around the mouth
  for abnormalities such as spots, inflammation,
  swelling etc
• Check the lips for lesions/infections

28
Intra-oral Examination

• Check the right and left inner cheeks and the
  insides of the lips using the disposable mirror
• Check the top and underneath the tongue

29
Teeth

• Check the upper right teeth and gums
• Check the upper left teeth and gums
• Check the lower right teeth and gums
• Check the lower left teeth and gums
• If everything appears normal the Duraphat may be
  applied

30
The Application Procedure

• Gently retract the right cheek with your finger
  or mirror and dry the upper right canine and
  molars with a cotton wool roll
• Place the cotton wool roll in the upper right
  buccal sulcus
• Brush the Duraphat into the contact points
  between the canine/molars
• Apply more varnish to the occlusal surface of the
  molars
• Repeat for the upper left, lower right and lower
  left
• Brush remaining varnish on the anterior teeth

31
Name _________________________________________
__ Childsmile Code __ __ __ / __ __ __ / __
__ __ Reflective Diary Direct Observation
Procedure (DOP) Fluoride Varnish Application
32
Clinical Training Session Fluoride Varnish
Application
Case 1

• Taking a relevant history and risk-assessing the
  patient for fluoride varnish application
• ___________________________________________
  _________
• Clinical Judgement
• ____________________________________________
  ________
• Technical Ability and Manual Dexterity
• ____________________________________________
  ________
• Communication Skills
• _____________________________________________
  ________
• Professionalism
• ______________________________________________
  _______
• Knowledge
• _________________________________________________
  ______
• Organisation

33
The Application Procedure

• The clinical nurse should check that the 4 cotton
  wool rolls, mirror, brush etc are accounted for
  and disposed of in the clinical waste bag
• If parents are present, summarise the after care
  instructions and ask if they have any questions
• Parents should not watch children other than
  their own having the fluoride varnish applied
• Wipe the bean bag/chair

34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
Questions?????