Fluoride Tx Flashcards
What does ECC stand for? (dental)
Early Childhood Caries
What are ECC?
One or more decayed, missing, or repaired tooth surfaces in primary tooth of child <6 yo
What are the causes of ECC?
ECC is a chronic, infectious disease that is orally transmitted from family members to infants and young children
Caused by: bacteria (strep mutans), plaque (biofilm), fermentable CHO, poor oral hygiene
Results in demineralization of tooth
Why should NPs provide fluoride varnish?
Within scope of practice
Prevention: avoid primary tooth decay, avoid caries, avoid negative oral-systemic effects of dental caries
What is fluoride varnish?
Contains 5% fluoride concentrated at 22,600 ppm sodium fluoride
Cost per unit dose application: $0.55
What are fluoride’s mechanisms of action/effects?
- Reduces demineralization of enamel
- Inhibits bacterial metabolism
- Inhibits acid production
- Promotes enamel remineralization
What are the stages of the progression of dental caries?
Adhesion, colonization, de&remineralization, white spots, enamel lesion, dentin lesion, pulpal lesion
At what stages in dental caries progression can prevention occur?
Colonization and de/remineralization
At what stage in dental caries progression does a diagnosis occur?
The presence of white spots
At what stages in dental caries progression does restoration occur?
Enamel, dentin, and pulpal lesions
Prevention and early treatment of white spots
- Remineralization with fluoride varnish (FV)
- Proper home care
- Decrease CHO consumption
- Caregiver education
What do children with white spot lesions have and need?
- Dental caries
- ECC
- Immediate referral to dentist
Healthy People 2020 goal for oral health
- Reduce the proportion of children and adolescents who have dental caries in primary or permanent teeth
- Reduce the proportion of children 3-5yo with dental caries in primary teeth
Healthy People 2030 oral health goal
Increase the use of the oral health care system
USPSTF Oral Health Recommendations Children <5yo
Category B
Children <5yo: PCPs Rx oral fluoride starting at 6mos for children with deficient fluoride in water supply
Children <5yo: PCPs apply FV to primary teeth of all infants/children with first tooth eruptions
USPSTF Oral Health Recommendations Children <5yo
Category I
Uncertain harm/benefit for routine screening/dental exams for dental caries performed by PCP for children <5yo
What are the only proven strategies to reduce dental caries?
Fluorides and sealants
Dental caries risk factors
- 60-90% of people are affected by dental caries
- Lower socio-economic status increases r/f caries
What are the risks associated with fluoride treatment?
Cosmetic: Dental fluorosis
No cosmetic risk demonstrated in FV research
Otherwise no known risks
Supplies for FV application
Gloves, 2x2 gauze, FV, light source
Steps for applying FV for pediatrics
- Position child (knee to knee position for young children)
- Inspect oral cavity, noting white spot lesions or advanced decay
- Dry teeth with gauze
- Paint on FV
- Continue until all surfaces of teeth have been treated
FV Education
After care: avoid sticky food, hot beverages on the day of tx
Oral hygiene recommendations for children
Brush BID with soft brush
Toothpaste Smear < 3yo
Toothpaste Pea size > 3yo
Diet modifications for optimal oral health peds
Avoid highly fermentable CHO, avoid grazing, avoid bottles in bed
Health Promotion and Follow-Up for FV/Dental
- Establish dental home
- Refer to dentist for all white spot lesions
- Continue FV application q3-6mos through age 5
FV Billing
$30 reimbursement
CPT 99177
ICD10 Z41.8
Ages 0-6 or 7
