Download Fluoride varnish - Nurse Practitioners of Oregon

Delivering Oral Health Services
During Well-child Visits
3 SIMPLE STEPS
Step 1: Oral health screening and risk assessment (birth – 3 years)
RISK ASSESSMENT • Key factors that determine risk: - Are there decay or white spot lesions visible? - Has child ever had any cavities or fillings? - Has mother (or primary caregiver) or siblings had cavities or fillings in the past year? - Is there visible plaque? SCREENING • Position the child - Infant: knee‐to‐knee position - Older child: position the child on an exam table and work from above the head • Lift the lip and look in the mouth for: - Visible plaque - Early signs of decay (white spot or line lesions along the gum line) - Brown spots on teeth - Signs of moderate to severe dental decay where portions of the teeth are decayed - Signs of a dental abscess • Determine if child is at risk and would benefit from fluoride varnish application • Refer child to dentist, as necessary Step 2: Application of fluoride varnish
APPLY THE VARNISH • Dry teeth with gauze (if possible) • Apply fluoride varnish to all surfaces of the teeth • Once applied, the varnish sets quickly INSTRUCT THE PARENT AND GIVE AFTER‐CARE INSTRUCTIONS • Eat a soft, non‐abrasive diet for the rest of the day • Do not brush or floss until the next morning • The teeth may be yellow and not shiny until the next day Step 3: Deliver anticipatory guidance to family
“LIFT THE LIP” TRAINING
• Show how to examine the child using the lap position. Recommend doing this monthly. ENCOURAGE FAMILIES TO: • Begin cleaning and brushing teeth every day, as soon as the first tooth appears. • Choose healthy snacks like fruits, vegetables and cheese; limit sugary, starchy or sticky snacks. • Avoid “grazing” – snacking or sipping sweet liquids throughout the day. Adapted from the Washington Dental Service Foundation © 2004‐2010, Photo credits: WDS Foundation & University of WA Pediatric Dentistry
FLUORIDE VARNISH APPLICATION
- Apply to children at‐risk of tooth decay, beginning with the first tooth.
- Apply 2‐4 times/year for maximum benefit. Many providers apply varnish on the same schedule as childhood immunizations. Supplies needed:
• Cotton gauze (2x2) • Fluoride varnish and applicator • Latex/vinyl gloves Step 1: Position the child—lap to lap
• For an infant or toddler, place the child on the parent’s lap with the head on their knees and the legs around the waist. Position yourself knee‐to‐knee with the parent and treat the child from above the head. • Or, place the young child on an exam table and work from above the head. Step 2: Apply the fluoride varnish
• Open the child’s mouth. • Dry the teeth with gauze. • Apply a thin layer of the fluoride varnish to all surfaces of the teeth. • Once it is applied, the fluoride varnish sets quickly with contact of the saliva. • Repeat the fluoride varnish application every 3 – 6 months as necessary. Step 3: Follow-up info for parent
• Teeth may be yellow from the varnish. • Child should eat a soft, non‐abrasive diet for the rest of the day. • Do not brush or floss until the next morning. • Give the parent the information sheet “Fluoride Varnish.” Adapted from the Washington Dental Service Foundation © 2004‐2010
Photo credits: Nick George—The Chronicle, University of Washington Pediatric Dentistry and Dr. Russell Maier
READY, SET, IMPLEMENT
Oral health screening in the medical office 1. Determine who will deliver the services. a.
b.
c.
d.
e.
History/risk assessment: ___________________________________________________ Screening (provider): ______________________________________________________ Anticipatory guidance/patient education (oral hygiene, nutrition): __________________ Fluoride varnish education: _________________________________________________ Fluoride varnish application: ________________________________________________ 2. Decide when the services will be delivered. (Example: Coordinate fluoride varnish with immunizations/well‐child visits at 6, 9, 12, 15‐18, 24 and 36 month visits. Separate visits for high‐risk patients.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. Identify an oral health champion in the office to: a. Order supplies (varnish/materials) and education materials: _______________________ b. Identify and incorporate prompts for providers and patients: ______________________ c. Ensure new employees receive training: _______________________________________ 4. Create a plan for fluoride varnish and oral health education materials. a. Who will order: ___________________________________________________________ b. Where will they be stored: __________________________________________________ c. For patient visit, who will get supplies ready (i.e., clip dose to chart): ________________ 5. Who will coordinate dental referrals and ensure that dental referral information is in exam room or at front desk? __________________________________________________________________________ 6. Establish process for documentation. (Example: For paper charts, use stickers or other prompts; for intake form and exam form, determine location for tracking such as immunization flip tab, dental tab, graphs, history section, etc.) 7. Create process for eligibility determination and billing. (Example: flag chart) Guidelines for Oral Health Care in Pregnancy
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Dental care is safe and essential during pregnancy
Pregnancy is not a reason to defer routine dental care or treatment
Diagnostic measures, including needed dental x-rays, can be undertaken safely
Scaling and root planing to control periodontal disease can be undertaken safely; avoid using metronidazole
in the first trimester
Treatment for acute infection or sources of sepsis should be provided at any stage of pregnancy. A number of
antibiotics are safe for use
Treatment, including root-canal therapy and tooth extraction, can be undertaken safely
Needed diagnosis, preventive care, and treatment can be provided throughout pregnancy; if in doubt,
coordinate with the woman’s prenatal medical provider
Emergency care should be provided at any time during pregnancy
Delay in necessary treatment could cause unforeseen harm to the mother and possibly to the fetus
For many women, treatment of oral disease during pregnancy is particularly important because health and dental
health insurance may be available only during pregnancy or up to two months post-partum
Medical Conditions and Dental Treatment Considerations
Hypertensive Disorders and Pregnancy
Hypertensive disorders, including chronic or preexisting hypertension and the development of hypertension during pregnancy, occur in 12–22%
of pregnant women. Oral health professionals should be aware of hypertensive disorders because of increased risk of bleeding during
procedures. Consult with the woman’s prenatal care provider before initiating dental procedures in women with uncontrolled severe
hypertension (blood pressure values greater than or equal to 160/110mm Hg).
Diabetes and Pregnancy
Gestational diabetes occurs in 2–5% of pregnant women in the U.S. It is usually diagnosed after 24 weeks of gestation. Any inflammation
process, including acute and chronic periodontal infection, can make diabetes control more difficult. Poorly controlled diabetes is associated
with adverse pregnancy outcomes such as preeclampsia, congenital anomalies, and large-for gestational age newborns. Meticulous control to
avoid or minimize dental infection is important for pregnant women with diabetes. Controlling all sources of acute or chronic inflammation helps
control diabetes.
Heparin and Pregnancy
A small number of pregnant women with the diagnosis of thrombophilia (a blood disorder) may be receiving daily injections of heparin to
improve pregnancy outcome. Heparin increases the risk for bleeding complications during dental procedures. Dental providers should consult
with the woman’s prenatal medical provider prior to dental treatment.
Risk of Aspiration and Positioning During Pregnancy
Pregnant women have delayed gastric emptying and are considered to always have a ―full stomach.‖ Thus, they are at increased risk
for aspiration. Maintaining a semi-seated position or positioning with a pillow helps avoid nausea or aspiration and can make the woman
feel more comfortable.
Guidelines for Treatment in Pregnancy
Indications
anytime
during
pregnancy
Radiographs
Diagnostic xrays are safe
during
pregnancy
Use neck
(thyroid collar)
and abdomen
shield
Analgesics (with
FDA category*)
Local Anesthetic
(with FDA
category*)
Amalgam
placement or
removal
Acetaminophen
(B)
Meperidine (B)
Morphine (B)
Codeine (C)
Lidocaine with
epinephrine (2%)
(B), considered
safe during
pregnancy
No evidence that
the type of
mercury released
from existing
fillings harms the
fetus
Acetaminophen +
Codeine (C)
Mepivacaine (3%)
(C), use if benefit
outweighs
possible risk to
fetus
Acetaminophen +
(Hydrocodone (C)
e.g. Vicodin
Use rubber dam
and high-speed
evacuation to
reduce mercury
vapor inhalation
Nitrious Oxide
Anesthesia
30% nitrous oxide
can be used
when topical or
local anesthetics
are inadequate
Penicillin (B)
Amoxicillin (B)
Cephalosporins (B)
Clindamycin (B)
Erythromycin not in
estolate form (B)
Pregnant women
require lower
levels of nitrous
oxide to achieve
sedation
Quinolones (C)
Clarithromycin (C)
As prophylaxis for
dental surgery: use
same criteria for all
people at risk for
bacteremia
Acetaminophen +
Oxycodone (C)
e.g. Percocet
1st Trimester
(1-13 weeks)
Antibiotics & AntiInvectives (with FDA
category*)
Spontaneous pregnancy loss occurs in 10-15% of all clinically-recognized pregnancies in the first trimester. Most losses
are due to chromosome abnormalities. Yet, women may prefer to wait until the second trimester (14th week) for dental
care.
AVOID:
Metronidazole
(B)
2nd Trimester
(14-27 weeks)
3rd Trimester
(28-40 weeks)
NEVER &
CAUTIONS
NEVER USE
Ibuprofen or
Indomethacin
NEVER USE
Aspirin unless
prescribed by the
prenatal care
provider
Caution: Consult
with prenatal
care provider
before
recommending
Ibuprofen (B) or
Naprosyn (B)
during the 1st
and 2nd
trimesters
AVOID:
Sulfonamides (C)
Caution:
CONSULT with
prenatal care
provider if using
anesthesia other
than a local block
e.g. IV sedation
or GA
NEVER USE
Tetracycline (D)
Erythromycin in
estolate form
*Cat B: No evidence of risk in humans; either animal studies show risk (human findings do not) or, if no adequate human studies done, animal findings negative.
*Cat C: Human studies are lacking and animal studies are either positive for fetal risk or lacking as well; potential benefits may justify the potential risk.
*Cat D: Positive evidence of risk. investigational or post marketing data show risk to fetus. Nevertheless, potential benefits may outweigh the risk.
Consult with the patient’s prenatal care provider with questions and concerns about the use of any medication.
These recommendations have been reviewed with dentists and prenatal care providers—obstetricians, family doctors, nurse practitioners—throughout Oregon.
We believe they represent the standard of care in Oregon. if you have questions about individual patients, contact that patient’s care provider directly.
Produced with support from the Northwest Center to Reduce Oral Health Disparities (NIH/NIDCR U54 DE019346), School of Dentistry, University of Washington.
SUGGESTED CITATION: Northwest Center to Reduce Oral Health Disparities, 2009. Guidelines for Oral Health Care in Pregnancy. Seattle, WA: School of
Dentistry, University of Washington.
Source material for this document includes Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines. New York, NY: New York State
Department of Health, 2006.
ACOG GUIDELINES FOR DENTAL CARE IN PREGNANCY: Caries, poor dentition, and periodontal disease may be associated with an increased risk for preterm
delivery. it is very important that pregnant women continue usual dental care in pregnancy. This dental care includes routine brushing and flossing, scheduled
cleanings, and any medically needed dental work. Many dentists will require a note from the obstetrician stating that dental care requiring local anesthesia,
antibiotics, or narcotic analgesia is not contraindicated in pregnancy. The dentist should be aware that pregnant women’s gums do bleed more easily.
Found in Guidelines for Perinatal Care, Sixth Edition, pp 123-124; http://www.acog.org/publications/guidelinesForPerinatalCare/gpc-83.pdf Copyright October 2007
by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists
FLUORIDE VARNISH
Five things every parent should know:
n
Tooth decay hurts and can make it hard for children to eat, speak, sleep and learn. o Using fluoride is a safe way to prevent tooth decay. Fluoride varnish is a protective coating of fluoride that is painted onto the teeth. It goes on quickly and doesn’t hurt. It can even heal early tooth decay!
p
q
r
All children and adults who are at risk for tooth decay should get fluoride varnish.
You can get fluoride varnish during any visit to your doctor or dentist.
Fluoride varnish works best if you get it 2 to 4 times a year. After fluoride varnish treatment:
Keep the varnish on the teeth as long as possible: Ö Offer your child soft foods for the rest of the day. Ö Do not brush or floss teeth until the next day. Did you know?
Tooth decay is almost 100% preventable. To keep your child smiling: - Brush and floss every day. - Use fluoride (toothpaste, varnish, water). - Choose healthy snacks like fruits, vegetables and cheese. - See a dentist regularly. Adapted from the Washington Dental Service Foundation. EL BARNIZ DE FLUORURO
Cinco cosas que todos los padres debe saber:
Los caries dental son doloroso. Los niños con caries tienen dificultad para
comer, hablar, dormir y aprender.
El uso del fluoruro es una forma de prevenir los caries dental. El barniz de
fluoruro es una capa protectora de fluoruro que se aplica sobre los
dientes. El barniz se aplica rápido y sin dolor. ¡Incluso puede curar las
caries que están empezando a aparecer!
Todos los niños y adultos que corren el riesgo de tener caries deberían
recibir el barniz de fluoruro.
Se puede recibir en cualquier consulta con su médico o dentista.
El barniz de fluoruro funciona mejor si se recibe 2 a 4 veces por año.
Después del tratamiento con barniz de fluoruro:
Mantenga el barniz en los dientes el mayor tiempo posible:
Dé a su hijo comidas blandas durante el resto del día.
No le cepille los dientes ni use hilo dental hasta el día siguiente.
¿Sabía que…?
La caries dental es casi un 100% prevenible.
Para mantener la sonrisa de su hijo:
- Cepíllele los dientes y use el hilo dental
todos los días.
- Use fluoruro (pasta dental, barniz, agua).
- Elija refrigerios sanos como frutas,
verduras y queso.
- Llévelo al dentista regularmente.
Adaptado de la Fundación de Servicios Dentales de Washington.
First Tooth es una asociación entre el Programa de Salud Oral de la Autoridad de Salud de Oregón y la Coalición de Salud Oral de Oregón.
www.healthoregon.org/oralhealth
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University of Washington • Pediatric Dentistry ALUMNI NEWS
Use this poster to educate your patients about the difference between good and bad snacks.