Fluoride Varnish Application

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

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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

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Programme Manual

• The web address is
• www.child-smile.org.uk
• Follow links
• Professional gt Childsmile manuals

Programme Manual for Childsmile Staff March
2014
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Why apply fluoride?

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

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Standard Prevention for all children Apply sodium
fluoride varnish (5) twice a year to children
over 2 years of age Enhanced Prevention for
children at increased risk of caries Apply sodium
fluoride varnish (5) an additional 1-2 times per
year to children over 2 years of age
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• The SIGN 183 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 all children.

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Marinho VCC, Worthington HV, Walsh T, Clarkson
JE. Fluoridevarnishes for preventing dental
caries in children and adolescents.Cochrane
Database of Systematic Reviews 2013, Issue 7

www.thecochranelibrary.com
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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.

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• Chronic fluoride ingestion causes fluorosis

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Fluoride Varnish ApplicationDuraphat
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Fluoride varnish resources
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Fluoride Varnish Safety

• The dose for a child aged two to six years is
  0.25ml
• Dose for child over six years ( mixed
  dentition) is 0.40ml.
• Children should not take fluoride supplements for
  two days after the fluoride varnish application
• Ensure Childsmile aftercare instruction/leaflet
  is given
• 
  FVAftercareInstructions.pdf 764 Kb

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Toxic dose

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

• Acute fluoride toxicity causes nausea and vomiting

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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 ?

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• 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

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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 who have been hospitalised due to
  severe asthma or allergy or who are allergic to
  sticking plaster should not have Duraphat
  applied.
• Duraphat Safety Issues information sheet
  Childsmile Website
• http//www.child-smile.org.uk/professionals/i
  nformation-for-dental-practice-staff/practice-docu
  ments.aspx
• Prescribing Duraphat is the DENTISTS
  responsibility

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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

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Reporting adverse reactions protocol
Remove product by tooth brushing and rinsing and
follow local protocol Complete and submit a BNF
yellow card as per local procedure If there are
any adverse reactions to the fluoride varnish
(e.g. mucositis, allergy etc.) then these must be
reported, by either the DHSW or the EDDN, to the
prescribing dentist
http//yellowcard.mhra.gov.u
k/
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Reflective Diary and Direct Observational
Procedure

• Firstly observe and assist a trainer apply
  varnish in five cases. Write a reflective
  statement detailing your learning during
  observation.
• Apply varnish to at least 10 children approx age
  under 10 years with the majority being under 6
  years it should be supervised and documented in
  the reflective diaries
• 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

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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

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Competencies

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

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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 orofacial
  signs

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Gaining consent
Nursery/school programme Follow Childsmile consent protocol for the supply and application of Duraphat
Dental practice Follow consent protocol as per local general practice guidelines
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Communicating with children

• What can we do well?

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Behave Project

• Verbal and non-verbal behaviours

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Training DVD
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Practical session
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Learning Points

• Feedback from practical session

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Appropriate preventative care

• Group work
• In addition to application of fluoride what other
  simple preventative interventions are available?
• Discuss what your responsibilities are in terms
  of preventive advice.

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http//www.sdcep.org.uk/index.aspx?o2858
Caries Prevention
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Summary
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Evidence

• Scottish Dental Clinical Effectiveness Programme
• www.sdcep.org.uk
• The Scottish Intercollegiate Guidelines Network
  (SIGN)
• www.sign.ac.uk
• The Cochrane library
• www.thecochranelibrary.com
• Childsmile Programme
• www.childsmile.org.uk
• The yellow card scheme
• http//yellowcard.mhra.gov.uk/