chdp dental training: fluoride varnish california child health & disability prevention (chdp)...
TRANSCRIPT
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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