Improving the Oral Health of Young Children: Fluoride Varnish Training Materials and Oral Health Information for Child Health Care Providers

Oral Health as a Routine Standard of Care for Infants and Young Children

Dental caries is the most prevalent chronic disease among US children, with over 40% of all children experiencing tooth decay by the time they reach kindergarten. Early childhood caries (ECC), formerly called baby bottle tooth decay or nursing bottle mouth, is a virulent form of dental caries disease in young children under six years of age that, in the majority of cases, must be treated in a hospital setting. Oral health is an integral component of a child's overall health and well-being. Without effective interventions, dental caries in young children can result in the loss of tooth structure and early tooth loss, inadequate tooth function, chronic pain, infection, medical complications, hospitalizations, impaired speech development, poor nutrition and resultant failure to thrive or impaired growth, inability to concentrate in school and missed school days.

The American Association of Pediatrics, American Association of Pediatric Dentistry, and American Dental Association recommend infants have their first dental visit no later than one year of age. By incorporating oral health screenings, caries risk assessments, parental guidance and fluoride varnish applications into well baby visits as a routine standard of care, child health providers will be helping their young patients to achieve optimal oral health and preventing or minimizing the serious health consequences of rampant decay.

Fluoride Varnish Training Programs

The following training resources provide a concise overview of how to perform an oral examination, conduct an oral health risk assessment and apply fluoride varnish. These training programs were developed by the American Academy of Pediatrics , Society of Teachers of Family Medicine, and several State dental programs that reimburse child health care providers for the application of fluoride varnish. In most cases, continuing education credits are available upon completion of training; where applicable, information on how to apply for continuing education credits is included in the resource. Many states require completion of training for reimbursement.

Application Of Fluoride Varnish

Applying Fluoride Varnish in the Medical Setting for Medical Providers- New York State Department of Health

This training program explains the role of medical providers in identifying and preventing dental caries in children, discusses fluoride varnish risks and benefits and how oral health disease prevention services can be integrated into the medical home, and identifies oral health resources available to primary care providers. Continuing medical education credits are provided.

Applying Fluoride Varnish in the Medical Setting for Local Health Departments- New York State Department of Health

This training program explains the role of medical providers in identifying and preventing dental caries in children, discusses fluoride varnish risks and benefits and how oral health disease prevention services can be integrated into the medical home, and identifies oral health resources available to primary care providers. Continuing nursing education contact hours and certified health education specialist contact hours are provided.

Web-Based Training Program

Oral Health Risk Assessment: Training for Pediatricians and Other Child Health Professionals - American Academy of Pediatrics

This training program provides an overview of dental caries and early childhood caries, the pathogenesis of caries, how to perform an oral examination, signs of early childhood dental caries in children aged 0 to 3 years, how to conduct an oral health risk assessment, fluoride varnish application, caries prevention strategies, and oral health education for families. Continuing education credits are provided.

Smiles for Life: A National Oral Health Curriculum 3rd edition, for clinicians and educators.

Smiles for Life is a national oral health curriculum now in its third edition this curriculum is designed to enhance the role of primary care clinicians in the promotion of oral health for all age groups through the development and dissemination of high-quality educational resources.

Developed by the Society of Teachers of Family Medicine Group on Oral Health

Early Childhood Oral Health: NYC Primary Care Providers: What You Need to Know About Fluoride Varnish and How You Can Promote Early Childhood Oral Health.

A publication for primary care providers. Promote early childhood oral health in primary care. Further describes the oral examination, assessing Caries Risk, Applying Fluoride varnish, Reimbursement, Ordering fluoride varnish and additional resources and parent fact sheets,

New York City: Department of Health and Mental Hygiene

Web-Based Training Program: Dental Health Screening and Fluoride Varnish Application

Dental Health Screening and Fluoride Varnish Application

University of Minnesota

This comprehensive web-based training program covers etiology and prevention of dental caries to billing process

Power Point: Connect Oral Health to Every Child's Medical Care

Massachusetts Department of Public Health - Office of Oral Health

This training program covers the etiology of oral diseases, the relationship between systemic and oral health, procedures for performing oral health assessments, oral disease prevention strategies, and instructions on the application of fluoride varnish.

Video: Bright Smiles from Birth

American Academy of Pediatrics, Illinois Chapter

This training video shows real life examples of physician applying varnish on young children. Filmed at Advocate Hope Children's Hospital in Oak Lawn Illinois the video shows how quick and easy the procedure can be in an office setting. This video will be used to supplement the Bright Smiles from Birth Curriculum and will be used at all trainings.

Varnish Application Training

  1. Describe the four basic components of the
  2. Preventive Services Program (PSP).
  3. Understand why fluoride varnish is used as a decay-preventive agent.
  4. Explain the materials necessary to applyfluoride varnish.

BLOCK Oral Disease Toolkit

Massachusetts Department of Public Health - Office of Oral Health

The Toolkit is a comprehensive resource for child health providers that offers an overview of oral health, including but not limited to oral disease etiology, a pictorial digest of oral diseases as they relate to systemic diseases, multi-lingual anticipatory guidance for parents and caregivers, as well as other useful tools to assist child health providers incorporate oral health into their medical practice.

To learn more about the BLOCK Oral Disease Toolkit, please contact Lynn Bethel, Director of the Office of Oral Health at 617-624-6074 or .

Open Wide: Oral Health Training for Health Professionals

National Maternal and Child Oral Health Resource Center

Series of four modules designed to help health and early childhood professionals promote oral health, with information about tooth decay, risk factors, prevention, and anticipatory guidance to share with parents.

Pediatric Office Guide to Oral Health Care

Seattle Children's Hospital and Regional Medical Center

This guide helps primary care physicians check for early childhood caries. Topics include toothbrushing, toothpaste, healthy food choices, and fluoride and assist physicians in talking with parents about oral health. Pictures illustrate what to look for during visual inspection, and descriptions of the appearance of mild, moderate, and severe tooth decay are included.

Guidelines on Pediatric Oral Health

Oral Health Care During Pregnancy and Early Childhood Practice Guidelines

New York State Department of Health, August 2006

Separate oral health care recommendations are presented for prenatal, oral health and child health professionals, with emphasis placed on incorporating oral health risk assessments into routine prenatal and well-baby care. Information for oral health care professionals includes guidelines for providing appropriate treatment for pregnant women and young children.

Bright Futures in Practice: Oral Health—Pocket Guide

National Maternal and Child Oral Health Resource Center

This guide is designed to help health professionals implement specific oral health guidelines during pregnancy and postpartum, infancy, early childhood, middle childhood, and adolescence.

Additional Oral Health Resources

Early Childhood Caries and Infant Oral Health

Association of State and Territorial Dental Directors

This website is designed to serve as a comprehensive source of information for members, associate members, policymakers, oral health and public health professionals, other health care professionals, academicians, students and the public.

The Early Childhood Caries and Infant Oral Health webpage provides linkages to resources, training materials and programs, and journal articles on the etiology and prevention of early childhood caries, caries risk assessments, and the role of child health care professionals in the early identification and prevention of dental caries disease in young children.

Incorporating Oral Health Care Services into Well-Baby Care

Engaging Primary Care Providers in Children's Oral Health

National Academy for State Health Policy, September 2009

This document provides an overview of state efforts to increase access to dental care for children by using primary care medical providers. Since primary care providers have early and frequent access to infants and young children, there is an opportunity to assess a child's oral health status before problems develop. Additionally, since medical providers have higher Medicaid participation rates than dentists, preventive oral health services can be provided to low income children as part of well-baby care, with referrals made to dentists for needed treatment. The majority of states include in preventive oral health care services, risk assessment, oral examination/screening, application of fluoride varnish, anticipatory guidance and caregiver education.

Link to document can be found here:

Oral Health Risk Assessment Timing and Establishment of the Dental Home

American Academy of Pediatrics Policy Statement

The American Academy of Pediatrics recommends that every child receive oral health assessments by 6 months of age by a qualified pediatrician or a qualified pediatric health care professional. This document provides background information on the etiology and development of dental caries disease, basic prevention strategies, oral health risk assessment, risk groups for dental caries, establishing a dental home and anticipatory guidance and parent and patient education.

PEDIATRICS Vol. 111 No. 5 May 2003, pp. 1113-1116

A statement of reaffirmation for this policy was published on August 1, 2009.

Policy on Use of a Caries-Risk Assessment Tool (CAT) for Infants, Children, and Adolescents

American Academy of Pediatric Dentistry Policy Statement, Adopted 2002. Revised 2066

The purpose of this policy is to educate healthcare providers and other interested parties on the assessment of caries risk. The use of CAT will allow health care professionals to become more actively involved in identifying, providing preventive counseling, and referring infants and children at high risk for dental caries disease. It is also recommended that non-dental health care providers refer of all children, especially those at moderate or high risk, to a dentist for oral health care and establishment of a dental home.