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Fluoride Varnish

preparing for fluoride varnish

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Key Facts

  Share these facts to help improve the oral health of children and adolescents and their families.

  • Fluoride varnish treatment effectively inhibits demineralization of teeth, resulting in highly significant dental caries reductions. 1
  • Fluoride varnish is an easy, safe way to apply topical fluoride to teeth. 2
  • Fluoridated toothpaste and fluoride varnish are the most effective chemical strategies to prevent early childhood caries. 3
  • Fluoride varnish applied to the teeth of young children in primary care settings decreases dental caries experience, especially if applied frequently and close to the time of tooth eruption. 4
  • Professionally applied fluoride varnish can remineralize early enamel dental caries in children. 5
  • Children and adolescents treated with fluoride varnish experience, on average, a 37 percent reduction in their primary teeth and a 43 percent reduction in decayed, missing, and filled tooth surfaces in their permanent teeth. 6
  • Although it is recommended that most children receive a fluoride varnish application at least every 6 months, some children may need monthly applications to reduce early childhood caries risk. 7
  • Fluoride varnish is well tolerated by infants and young children, has a prolonged therapeutic effect, and can be applied by both oral health professionals and non-oral-health professionals in a variety of settings. 8
  • The U.S. Preventive Services Task Force recommends that primary care health professionals apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption and continuing through age 5. 9
  • Fluoride varnish can be provided as part of a regular child health clinic program (well or sick visit) by trained pediatricians, family physicians, nurse practitioners, health auxiliaries, or community health workers. 10
  • Home visiting models can introduce children and their families to preventive oral health practices, improve oral health literacy, establish dental homes, and provide fluoride varnish applications. 11
  • Collaborations between tribal, state, and federal agencies to provide effective tooth-decay-prevention interventions, such as water fluoridation of villages with suitable water systems and provision of fluoride varnishes, should be encouraged. 12

References

  1. Sharma G, Puranik MP, Sowmya KR. 2015. Approaches to arresting dental caries: An update. Journal of Clinical and Diagnostic Research 9(5):ZE08–ZE11.
  2. Manski MC, Parker ME. 2010. Early childhood caries: Knowledge, attitudes, and practice behaviors of Maryland dental hygienists. Journal of Dental Hygiene 84(4):190–195.
  3. Garcia R, Borelli B, Dhar V, Douglass J, Gomez FR, Hieftje K, Horowitz A, Li Y, Ng M, Twetman S, Tinanoff N. 2015. Progress in early childhood caries and opportunities in research, policy, and clinical management. Pediatric Dentistry 37(3):294–299.
  4. Douglass JM, Clark MB. 2015. Integrating oral health into overall health care to prevent early childhood caries: Need, evidence, and solutions. Pediatric Dentistry 37(3):266–274.
  5. Marinho VCC, Worthington HV, Walsh T, Clarkson JE. 2013. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 7:CD002279.
  6. Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. 2016. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment—A systematic review. BMC Oral Health.
  7. Ramos-Gomez F. 2014. A model for community-based pediatric oral heath: implementation of an infant oral care program. International Journal of Dentistry Epub 156821.
  8. Clark MB, Slayton RL; American Academy of Pediatrics, Section on Oral Health. 2014. Fluoride use in caries prevention in the primary care setting. Pediatrics 134(3):626–633.
  9. U.S. Preventive Services Task Force. 2014. Dental caries in children from birth through age 5 years: Screening. Rockville, MD: U.S. Preventive Services Task Force.
  10. American Academy of Pediatrics, Section on Oral Health. 2014. Maintaining and improving the oral health of young children. Pediatrics 134(6):1224–1229.
  11. Brickhouse TH, Haldiman RR, Evani B. 2013. The impact of a home visiting program on children's utilization of dental services. Pediatrics (Suppl 2):S147-–S152.
  12. Centers for Disease Control and Prevention. 2011. Dental caries in rural Alaska Native children: Alaska, 2008. MMWR Morbidity and Mortality Weekly Report 60(37):1275–1278.

OHRC Publications

This section contains OHRC-produced materials.


Details

Barzel R, Holt K. 2012. Child and adolescent oral health issues. Washington, DC: National Maternal and Child Oral Health Resource Center, 8 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This fact sheet provides health professionals with information on issues related to child and adolescent oral health. Topics include dental caries, access to care, children and adolescents with special health care needs, dental sealants, fluorides, nutrition, injury and violence, and tobacco. [Funded by the Maternal and Child Health Bureau]


Details

Barzel R, Holt K, with the Association of State and Territorial Dental Directors' Fluorides Committee. 2010. Fluoride varnish: An effective tool for preventing dental caries. Washington, DC: National Maternal and Child Oral Health Resource Center, 4 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This fact sheet provides information about fluoride varnish and its uses, effectiveness, safety, service delivery, and reimbursement for health professionals and oral health professionals. [Funded by the Maternal and Child Health Bureau]


Details

Bertness J, Holt K, eds. 2016. Fluoride varnish: A resource guide (2nd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center, 22 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This guide provides an annotated list of resources on the use and application of fluoride varnish, including materials on data and surveillance; policy; professional education, tools, and training; public education; and state and local program reports. The guide also lists federal agencies, national professional associations, resource centers, and national coalitions that may serve as resources. [Funded by the Maternal and Child Health Bureau]


Details

Casamassimo P, Holt K, eds. 2016. Bright Futures: Oral health—Pocket guide (3rd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center, 90 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This pocket guide offers health professionals an overview of preventive oral health supervision for five periods—pregnancy and postpartum, infancy, early childhood, middle childhood, and adolescence. The pocket guide is designed to help health professionals implement specific oral health guidelines during these periods. For each period, information about family preparation, risk assessment, interview questions, screening, examination, preventive procedures, anticipatory guidance, measurable outcomes, and referrals are discussed. The content aligns with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (4th ed.). [Funded by the Maternal and Child Health Bureau]


Details

Holt K, Barzel R. 2010. Pain and suffering shouldn't be an option: School-based and school-linked oral health services for children and adolescents. Washington, DC: National Maternal and Child Oral Health Resource Center, 4 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This fact sheet provides information about the importance of good oral health during childhood and adolescence. Topics include school readiness, disparities, oral trauma, nutrition, dental sealants, fluoride varnish, and school-based and school-linked oral health services. [Funded by the Maternal and Child Health Bureau]


Details

National Maternal and Child Oral Health Resource Center and Ohio Department of Health. 2011. Smiles for Ohio–Fluoride varnish: Training for primary medical care providers serving children enrolled in Medicaid. Washington, DC: National Maternal and Child Oral Health Resource Center; Columbus, OH: Ohio Department of Health, 1 v

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This series of four modules is designed to increase knowledge among Medicaid/Healthcheck primary care medical professionals and other health professionals about reducing the incidence of dental caries in infants and children under age 3 and to contribute to the establishment of a dental home. Topics include the role of primary care medical professionals; the dental caries process; caries risk assessment; and anticipatory guidance, fluoride varnish, and referral.


Details

Tinanoff N, Lowe E, Holt K, Goodman H. 2010. Maryland's Mouths Matter: Fluoride varnish and oral health screening programs for kids—Training for EPSDT medical providers in Maryland. Washington, DC: National Maternal and Child Oral Health Resource Center; Baltimore, MD: Maryland Department of Health, Office of Oral Health, 1 v

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This curriculum is designed to provide Early and Periodic Screening, Diagnosis, and Treatment medical providers (i.e., physicians, nurse practitioners) and other health professionals in Maryland with knowledge and skills to reduce the incidence of dental caries among children ages 3 and under and to contribute to the establishment of a dental home. The series of four modules provides information on the role of medical providers in children's oral health. Also included are a description of the dental caries process and instructions on how to conduct a dental caries risk assessment. The modules also address the provision of anticipatory guidance, the application of fluoride varnish, and the importance of referring young children to a dentist. [Funded in part by the Maternal and Child Health Bureau]

     


OHRC Library

This section contains recent materials, not including OHRC-produced materials.


Details

ADA Center for Evidence-Based Dentistry. 2013. Topical fluoride for caries prevention: Full report of the updated clinical recommendations and supporting systematic review—A report of the Council on Scientific Affairs. Chicago, IL: ADA Center for Evidence-Based Dentistry, 118 pp

American Dental Association, Center for Evidence-Based Dentistry
211 East Chicago Avenue
Chicago, IL 60611-2678

Telephone: (312) 440-2500
Website: http://ebd.ada.org
Available from the website.

This report provides evidence-based recommendations for the use of professionally applied topical fluorides to prevent dental caries. The report addresses the impact of topical fluoride vs. no topical fluoride on new and early carious lesions; which topical fluoride was most effective in preventing, arresting, or reversing dental caries; and whether an oral prophylaxis before application improved fluoride uptake. The report also describes the systematic review of the literature, methodologies used to develop the clinical recommendations, limitations related to the evidence and review, and future research needs.


Details

Association of State and Territorial Dental Directors, Fluorides Committee. 2016. Fluoride varnish: An evidence-based approach [upd.]. [Reno, NV]: Association of State and Territorial Dental Directors, 19 pp

Association of State and Territorial Dental Directors
3858 Cashill Boulevard
Reno, NV 89509

Telephone: (775) 626-5008
Fax: (775) 626-9268
E-mail: info@astdd.org
Website: http://www.astdd.org
Available from the website.

This brief presents information to help health professionals design, implement, and evaluate community-based programs that apply fluoride varnish. Topics include a definition of fluoride varnish and how it prevents tooth decay; the characteristics, effectiveness, and safety of fluoride varnish; and recommendations for using fluoride varnish. The brief also provides tips for selecting cost-effective community and school dental-caries-prevention programs.


Details

From the First Tooth. 2015. Starting a state pediatric oral health initiative: Step-by-step guide of lessons learned in four New England states. [Portland, ME]: From the First Tooth, 31 pp

From the First Tooth
c/o MaineHealth 110 Free Street
Portland, ME 04101

Telephone: (207) 662-6296
E-mail: info@fromthefirsttooth.org
Website: http://www.fromthefirsttooth.org
Available from the website.

This document provides guidance for states on designing and implementing a program to train private medical practices, community health centers, and health professional schools to incorporate oral health assessments, health education, fluoride-varnish application, and referrals into standard pediatric practice. Topics include program partners, financing, recruitment, training, adoption, sustainability, and measures. Additional topics include the importance of engaging future health professionals, educating consumers, and establishing a dental home.


Details

Massachusetts Department of Public Health, Division of Primary Care and Health Access, Office of Oral Health. 2016. Fluoride varnish training manual for Massachusetts health care professionals. Boston, MA: Massachusetts Department of Public Health, Division of Primary Care and Health Access, Office of Oral Health, 13 pp

Massachusetts Department of Public Health, Office of Oral Health
250 Washington Street, 5th Floor
Boston, MA 02108

Telephone: (617) 624-6060
Secondary Telephone: (617) 624-5992
Fax: (617) 624-6062
Website: http://www.mass.gov/dph/oralhealth
Available from the website.

This manual is designed to help health professionals implement fluoride-varnish applications for infants, children, and adolescents ages 6 months to 21 years who are enrolled in Massachusetts' Medicaid program. Contents include office-based and online training options; steps for establishing and using fluoride varnish in the office; a template for documenting the oral examination, procedure and post-procedure, and risk factors for dental caries; facts on fluoride-varnish application; coding, reimbursement, and claim submission; and information for caregivers about fluoride varnish.


Details

University of North Dakota School of Medicine and Health Sciences, Center for Rural Health. 2016. Fluoride varnish application in primary care settings. Grand Forks, ND: University of North Dakota School of Medicine and Health Sciences, Center for Rural Health, 2 pp

University of North Dakota School of Medicine and Health Sciences, Center for Rural Health
501 North Columbia Road Stop 9037
Grand Forks, ND 58202-9037

Telephone: (701) 777-3848
Fax: (701) 777-6779
E-mail: ruralhealth@med.und.edu
Website: https://ruralhealth.und.edu
Available from the website.

This fact sheet presents findings from a survey of primary care health professionals in North Dakota to assess their knowledge about fluoride-varnish application and determine how many were providing and billing for the service. Contents include information about the percentage of pediatricians and family practice physicians who conducted oral health risk assessments, those who had a list of dentists for client referral, and who applied fluoride varnish for infants and children beginning at age 6 months.

     

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