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  S.M.I.L.E. plus Key Messages  Fluoride Varnish 101  Tips for a Successful Daycare Visit  Starting Your Own Program  Did You Know?

History & Evolution of the Fluoride Varnish Daycare Program

What is the S.M.I.L.E. plus program?  S.M.I.L.E. stands for: S aving M ouths in I ncome L imited E nvironments  Designed for lower-income working families  We treat children at a school-based dental clinic  The “ plus” refers to screening, education & intervention programs

The Daycare Fluoride Varnish Program Why?  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 Red = Point Douglas Home Visitors) Yellow = Downtown

History of the Program  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

Evolution of the Program  This program evolved into the Daycare Fluoride Varnish Program in order to reach more children  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

Evolution of the Program  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

Can it be adapted to other meeting places?  Other venues might include:  Parenting groups  Healthy Baby groups  Immunization clinics

Questions?

S.M.I.L.E. plus Key Messages

“They’re Only Baby Teeth Aren’t They?” 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

What is Early Childhood Tooth Decay?  A devastating disease  Bacterial plaque mixes with sugars found in milk (or any other liquid other than water) and erodes the enamel of teeth  Decay can “spread” quickly

What Should be Done?  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

What Should be Done?  Frequently “lift the lip” to check for signs of decay  A fluoride varnish application may help if decay is noticed

Fluoride Varnish 101

What is Fluoride Varnish?  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

How does Fluoride Varnish Work?  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

How Often is it Applied?  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

S.M.I.L.E. plus in Daycares  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

Rewards!  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

Questions?

Tips for a Successful Visit

Timing  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

Daycare Staff  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

Daycare Staff  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”  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

“The Train”  Line up chairs one behind the other  Apply fluoride at the “train station”  Begin with a confident child

More Tips for Success…  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!

Tips for Success…  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 Knee to knee cushion (Cushion must be sanitized before and after each use)

Paperwork  Leave consent forms at daycare while treatment is ongoing to avoid mishandling forms  Each child is given a code number for anonymity  When child withdraws from program – form should be archived

Examples of Forms

Q & A Handout

Progress Notes

Fluoride Varnish Notes

Questions?

Starting Your Own Program Are you interested in starting a similar program in your area?

Supplies Needed  Hand sanitizer  Gauze  Latex free gloves  Toothbrushes  Fluoride varnish – 5% sodium unidose (0.25mL)  Carrying case  Brown paper bags Typical set-up  Tray liners

How to Get Started  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

Future Plans for S.M.I.L.E. plus  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

Questions?

Did You Know?

Did You Know?  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

Did You Know?  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

Did You Know?  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

Thank you! Any questions on the Fluoride Varnish Daycare Program? Contact Linda at S.M.I.L.E. plus lpharand@wrha.mb.ca 204-940-1737

Upcoming Telehealth Session: Date: TBA Topic: Newcomers and Oral Health

Healthy Smile Happy Child Coordinator: Daniella DeMaré Ph: 204-789-3500 Email: ddemare@chrim.ca HSHC website: http://www.wrha.mb.ca/healthinfo/preventill/ oral_child.php