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Module 4: Anticipatory Guidance, Fluoride Varnish, and Referral

Key Points

  • Anticipatory guidance helps parents understand what to expect during their child’s current and approaching stages of development. EPSDT medical providers can provide parents with anticipatory guidance to promote children’s oral health.
  • The three most frequently discussed anticipatory guidance topics are (1) minimize risk of infection, (2) reduce frequency of foods and beverages containing sugar, and (3) optimize toothbrushing with fluoridated toothpaste.
  • Fluoride varnish has been found effective in preventing caries in primary and permanent teeth.
  • Fluoride varnish application is simple. Once a provider has sufficient practice, application takes 40 to 60 seconds.
  • Supplies needed to apply fluoride varnish include disposable gloves, a paper towel or disposable bib, 2" x 2" gauze sponges, fluoride varnish (preferably single-dose containers), and a disposable mouth mirror (optional).
  • A provider should refer a child to a dentist immediately if (1) the provider observes non-cavitated white spot lesions or cavitated lesions, (2) the child is at moderate or high risk for dental caries, or (3) a dental emergency is evident.
  • In situations where it is difficult or impossible for EPSDT medical providers to identify a dentist who accepts children enrolled in Medicaid, parents should be referred to Scion, the contractual agent under the Maryland Medicaid Program, which will help parents locate and access a dentist.