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Fluoride Varnish and Silver Diamine Fluoride a Resource Guide

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Fluoride Varnish and Silver Diamine Fluoride A Resource Guide Prepared by Ruth Barzel, M.A. Katrina Holt, M.P.H., M.S., R.D., FAND Cite as Barzel R, Holt K, eds. 2020. Fluoride Varnish Permission is given to photocopy this publication and Silver Diamine Fluoride: A Resource Guide. or to forward it, in its entirety, to others. Requests Washington, DC: National Maternal and Child Oral for permission to use all or part of the information Health Resource Center. contained in this publication in other ways should be sent to the address below. Fluoride Varnish and Silver Diamine Fluoride: A Resource Guide © 2020 by National Maternal and National Maternal and Child Oral Health Child Oral Health Resource Center, Georgetown Resource Center University Georgetown University Box 571272 This publication was supported by the Health Washington, DC 20057-1272 Resources and Services Administration (HRSA) of (202) 784-9771 the U.S. Department of Health and Human Services E-mail: [email protected] (HHS) as part of an award totaling $1,000,000 with Web site: www.mchoralhealth.org no funding from nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official policy of HRSA, HHS, or the U.S. govern- ment, nor should any endorsements be inferred. Contents Introduction ............................... 3 Acknowledgments .......................... 4 Materials .................................. 5 Data and Surveillance ..................... 6 Professional Education and Training ........6 Public Education ......................13 Organizations ............................. 15 Introduction The National Maternal and Child Oral Health SDF is safe for children and adults. The Resource Center (OHRC) developed this pub- cost of SDF treatment is lower than the cost of lication, Fluoride Varnish and Silver Diamine conventional dental caries treatment. The Ameri- Fluoride: A Resource Guide, to help health pro- can Dental Association’s expert panel strongly fessionals, program administrators, educators, recommends the use of 38 percent SDF solution policymakers, parents, and others promote oral to arrest advanced dental caries lesions on any health and prevent oral disease. coronal surface of primary teeth. The American Professionally applied fluoride varnish inhibits Academy of Pediatric Dentistry supports the use demineralization of tooth enamel. Fluoride var- of SDF as part of an ongoing dental-caries- nish can also remineralize early enamel demin- management plan with the aim of optimizing eralization. Fluoride varnish applied to the teeth individualized patient care consistent with the of children decreases dental caries experience, goals of a dental home. especially if applied frequently and close to the The resource guide is divided into two sec- time of tooth eruption. tions. The first section describes materials, such Fluoride varnish can easily and safely be as brochures, fact sheets, guidelines, curricula, applied by both oral health professionals and and reports published from 2016 through 2019 as non-oral-health professionals in a variety of set- well as seminal resources published before 2016. tings. The U.S. Preventive Services Task Force The second section lists federal agencies, national recommends that primary care health profession- professional associations, centers, and national als apply fluoride varnish to the primary teeth of coalitions that may serve as resources. children starting at the age of primary tooth erup- Our intent is to share resources that are useful tion and continuing through age 5. and that represent current science and practice. Topical silver diamine fluoride (SDF) is a For further information, we encourage you to liquid that is applied to a tooth surface with an contact the organizations listed. Your state and active dental caries lesion to arrest the lesion. local departments of health, state and local oral- SDF has been used in Japan for over 40 years health-related associations and societies, state or to arrest dental caries lesions and reduce tooth local oral health coalitions, and university-based hypersensitivity in primary and permanent teeth. libraries are additional sources of information. During the past decade, many other countries OHRC will update the resource guide periodi- have been using SDF with similar success. SDF cally, and we would appreciate hearing from you was approved by the Food and Drug Administra- if you know of any relevant resources that are tion in 2014 as a treatment for sensitive teeth and not included in this edition. has been used off-label to arrest dental caries lesions in the United States since 2015. FLUORIDE VARNISH AND SILVER DIAMINE FLUORIDE: A RESOURCE GUIDE 3 Acknowledgments The following National Maternal and Child to the following individuals for reviewing the Oral Health Resource Center staff members resource guide: Tammy Alexander, Theresa assisted in the development of this resource Anselmo, LeeAnn Hoaglin-Cooper, Debora guide: Beth Lowe, Katy Battani, Sarah Kolo, Teixeira, Sandy Tesch, Norman Tinanoff, and and Olivia Pickett. In addition, we are grateful Christine Wood. FLUORIDE VARNISH AND SILVER DIAMINE FLUORIDE: A RESOURCE GUIDE 4 Materials Materials Data and Surveillance Professional Education CARIES PREVENTION SERVICES and Training REIMBURSEMENT TABLE APPLYING FLUORIDE VARNISH This document presents survey findings for the 50 states and the District of Columbia on reim- This video for health professionals provides bursement for risk assessment, oral examina- information about fluoride varnish, including tion, fluoride varnish, anticipatory guidance, and recommendations from professional organizations family oral health education. It presents infor- about how often it should be applied and the mation on the following topics: type of health ages of children who should receive it. The video professional, services, fees, procedure codes, demonstrates how to apply it to the teeth of delegation, age limit for services, number of young children using the knee-to-knee position varnish applications reimbursed annually, train- and with a child placed on an examination table. ing requirement, payor, payment by Medicaid Tips for applying fluoride varnish effectively or the Children’s Health Insurance Program, and using both methods are provided. legislative approval to reimburse health profes- From the First Tooth. 2015. Applying Fluoride sionals. Information about commercial payment Varnish. Portland, ME: From the First Tooth. and procedure codes is also included. 1 video (1:50 min.). www.youtube.com/ American Academy of Pediatrics, Oral Health watch?v=j8Ujt1FhMU8 Initiative, Medicaid | Medicare | CHIP Services Dental Association; and National Academy for BEST PRACTICE APPROACH REPORT: State Health Policy. 2018. Caries Prevention Services Reimbursement Table. Elk Grove Vil- USE OF FLUORIDE IN SCHOOLS lage, IL: American Academy of Pediatrics, Oral Health Initiative. 1 v. www.aap.org/en-us/_ This report focuses on best practices for the use layouts/15/WopiFrame.aspx?sourcedoc=/en-us/ of fluoride in schools. It discusses fluoride as Documents/OralHealthReimbursementChart. a measure to prevent tooth decay in children, xlsx&action=default different types of programs that provide fluo- ride to children, and different forms of fluoride. Evidence for the efficacy of fluoride in prevent- FUTURE SMILES: STUDENT SURVEY ing tooth decay and best practice criteria are provided. The report also includes state practice The survey is designed to obtain information examples. about the level of students’ satisfaction with oral health services (screenings, cleanings, fluoride Association of State and Territorial Dental Direc- varnish applications, dental sealant application, tors. 2018. Best Practice Approach Report: Use and education) provided in a school-based oral of Fluoride in Schools. Reno, NV: Association hygiene program for children from families with of State and Territorial Dental Directors. 24 pp. low incomes in Nevada. The survey is available www.astdd.org/docs/final-approved-fluoride-in- in English and in Spanish. schools-bpar-july-2018.pdf Future Smiles. 2016–. Future Smiles: Satisfaction Survey. Las Vegas, NV: Future Smiles. 1 item. www.surveymonkey.com/r/FutureSmilesStudents FLUORIDE VARNISH AND SILVER DIAMINE FLUORIDE: A RESOURCE GUIDE 6 CLINICAL RECOMMENDATIONS FOR CONNECTING SMILES: IMPROVING USE OF PROFESSIONALLY-APPLIED HEALTH THROUGH ORAL HEALTH OR PRESCRIPTION-STRENGTH, HOME- INTEGRATION USE TOPICAL FLUORIDE AGENTS FOR This training contains five modules for health pro- CARIES PREVENTION IN PATIENTS AT fessionals and their staff about oral health and chil- ELEVATED RISK OF DEVELOPING CARIES dren, caries risk assessment, oral health anticipatory guidance for families, benefits of fluoride and This guide provides information that health fluoridated water, fluoride varnish, and strategies professionals can use in making decisions about for integrating oral health into a medical practice. which fluoride agents (fluoride varnish, fluoride The training is recognized by the South Carolina mouthrinse, fluoride gel or paste) are most Medicaid agency as a prerequisite for applying appropriate for infants and children under age 6, fluoride varnish and billing for this service. [Funded children and adolescents ages 6–18, and adults by the Maternal and Child Health Bureau] over age 18, as well as for adult root caries. Dos- ages and application schedules are provided. Risk South Carolina Department of
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