S.M.I.L.E. PLUS INTERVENTION A Fluoride Varnish Daycare Program in - - PowerPoint PPT Presentation
S.M.I.L.E. PLUS INTERVENTION A Fluoride Varnish Daycare Program in Point Douglas & Downtown Winnipeg Presented by: Linda Pharand, RDH Senior Dental Hygienist Overview History & Evolution of the Fluoride Varnish Daycare Program
A Fluoride Varnish Daycare Program in Point Douglas & Downtown Winnipeg Presented by: Linda Pharand, RDH
Senior Dental Hygienist
History & Evolution of the Fluoride Varnish Daycare Program S.M.I.L.E.plus Key Messages Fluoride Varnish 101 Tips for a Successful Daycare Visit Starting Your Own Program Did You Know?
S.M.I.L.E. stands for:
Saving Mouths in Income Limited Environments
Designed for lower-income working families We treat children at a school-based dental clinic The “plus” refers to screening, education & intervention programs
To help address the issue of
early childhood caries in Point Douglas and Downtown areas by treating children in daycares that are associated with high dental needs
To reach more children than
the original outreach program involving FFHVs (Families First Home Visitors)
Red = Point Douglas Yellow = Downtown
Originally began in homes of
parents from Families First Home Visitor Program in 2005
200 families enrolled & 50
completed the 3 year program
Only 1 child developed cavities
Data from 2005-2009
Dental hygienists were
accompanied by Dr. Bob Schroth once/year for an examination
This program evolved into the Daycare Fluoride Varnish Program in
Designed for children attending daycare
up to school age (some exceptions exist)
32 daycares participate in the program 10-40 children participate at each site
When the program began…
2 Dental Hygienists dedicated approx. 3 days/week to the
program
Today...
1 dental hygienist with the help of a dental assistant when
possible dedicates approx. 3 days/week to the program
Other venues might
include:
Parenting groups Healthy Baby groups Immunization clinics
Primary teeth are very important:
Hold the spaces open for permanent
teeth (to avoid crowding)
Allow for proper speech development Allow for proper nutrition & growth Help provide a sense of self-esteem
through a healthy smile
A devastating disease Bacterial plaque mixes with
sugars found in milk (or any
water) and erodes the enamel of teeth
Decay can “spread” quickly
Never put a baby to bed with a bottle Recommend rocking, singing, or wrapping baby in a warm blanket
instead
If a child goes to bed with a bottle, gradually weaken the bottle with
water over 4-6 weeks until it is all water
Week 1 Week 2 Week 3 Week 4
Frequently “lift the lip” to
A fluoride varnish application
may help if decay is noticed
A white, sticky liquid that quickly
adheres to the teeth
An easy method to prevent &
sometimes arrest tooth decay
May stop decay from spreading Any discoloration is temporary
Varnish attaches to the tooth
surface
Fluoride is slowly released to
promote tooth re-mineralization
Very low ingestion rate,
decreasing any risk of fluoride toxicity or fluorosis
Every 3 to 4 months Starting at 6 months of age or
the appearance of the first tooth
A dental hygienist will visit the
daycare at an arranged time
Parents receive information on fluoride varnish
and opportunity to participate in program
Consent forms kept by daycare Each application takes less than
1 minute
Consent form should return to Dental Program upon child’s
withdrawal from daycare
Early childhood tooth
decay is an infectious disease BUT it is preventable
Early interventions like
fluoride varnish can make a difference
Less Operating Room visits Every child deserves a
healthy smile
Most daycares prefer morning visits Children are well rested & cooperation is
best at this time
Some prefer late afternoon visits Allows us to see children attending
Nursery or Kindergarten class during the day
Each visit usually lasts less than 1 hour We always allow the daycare to choose the day & time of visit
Each daycare is different Staff will dictate success of the program Offer a Q & A sheet to staff that dislike fluoride Do not avoid that person Have a conversation about the safety measures in place
Some of the best ideas have come from the staff i.e. The “train” & the “waiting room” Invite timid children to sit on a staff
member’s knee
If staff member says a child is refusing to participate, go along
with their assessment
Parents are not present and the staff know them well, therefore
they will often speak for them
The waiting room approach to fluoride varnish
applications works very well
Young or anxious children can watch others to help
alleviate fears
Start with a confident child
Line up chairs one behind
the other
Apply fluoride at the
“train station”
Begin with a confident child
Be prepared to work in non-traditional settings
i.e. Outside
Use demonstrations
(Children like to touch and feel)
Use a soft voice Have child watch until he/she is comfortable Use knee to knee when necessary Stickers, stickers, stickers!
Infant centres do not allow
chairs
Children can be seated in
high chairs
A change table covered
with our knee to knee cushion works best
(Cushion must be sanitized before and after each use)
Knee to knee cushion
Leave consent forms at
daycare while treatment is
mishandling forms
Each child is given a code
number for anonymity
When child withdraws from
program – form should be archived
Are you interested in starting a similar program in your area?
Hand sanitizer Gauze Latex free gloves Toothbrushes Fluoride varnish – 5% sodium
unidose (0.25mL)
Carrying case Brown paper bags Tray liners
Typical set-up
Speak to the Daycare Association coordinator in your area Meet with the Daycare Director at your local daycare and
explain concept
Arrange your paperwork Order supplies Contact S.M.I.L.E.plus if you have any questions
Combination of Fluoride Varnish Program & Daycare Tooth Brushing
Program
Design a consent form including a phone number for informative phone call
for concerns
Add new daycares connected to higher needs schools in other areas of
Winnipeg
The Daycare Fluoride Varnish Program
began in January 2009 in Point Douglas
It began in Downtown centres in May 2009 A daycare in the River East area was added in February 2015 As of January 2015, 3603 children have received fluoride varnish
treatments since the beginning
1065 children actively participate in the program yearly
January 2015
Approximately 8% of the children
present with pre-existing caries*
Approximately 13% present with pre-existing dental
treatment
Approximately 0.6% develop new caries Approximately 2% receive new dental treatment
*Caries defined as visible cavitated lesions Data includes all age groups in all daycare settings January 2015
996 children have received fluoride
applications for at least 1 year
249 children have received fluoride applications for at least 2
years
45 children have received fluoride applications for at least 3 years 8 children have received fluoride applications for at least 4 years 2 children have received fluoride applications for at least 5 years
Data from total number of children who received fluoride treatment One year equals 4 fluoride varnish treatments January 2015