Pediatrics - teeth

Anyone here been asked to apply fluoride varnish to children's teeth?

Seems to be a trend where hygienists, who are barred from applying fluoride varnish without an Rx from a dentist, are teaching nurses how to apply fluoride varnish.

whaddaya think of that?

Shirley Gutkowski, RDH, BSDH, FACE

[RDH1, ADN, BSN, RN]

Hmmm. As a registered dental hygienist, and future RN (May 2010 yay!), I apply varnish at my dental hygiene job, but I've never heard of nurses doing it in the hospital. I can't imagine this would take priority in a hospital setting as far as care for peds goes. Are you talking about an outpatient clinic? What states? I just completed my peds hospital clinical rotation and haven't heard anything about this.

Speaking as a hygienist, I would mind teaching a nurse how to do this.

An RN would need an order from an MD/dentist also.

Here is an some info on who may apply fluoride varnish in the state of Massachusetts, but an order is still needed to apply it.

http://www.mass.gov/Eeohhs2/docs/masshealth/provlibrary/fv-manual.pdf

Who can apply fluoride varnish?

Dental professionals are not the only health professionals who can apply fluoride varnish. In Massachusetts, MassHealth has approved the application of fluoride varnish by physicians. The procedure can also be applied by dentists, dental hygienists, physicians, physician assistants, nurse practitioners, registered nurses and licensed practical nurses.

This is beginning to be common practice in MD offices:

"Fluoride varnish application in

a physician office is safe, effective

and easy. The treatment requires

minimal training and no special

equipment." See page 7 of http://docs.google.com/viewer?a=v&q=cache:c4Tzkcn3oMYJ:www.hpsm.org/documents/providers/newsletter/final.fall09_provider.pdf+fluoride+varnish+doctor+office+nurse&hl=en&gl=us&pid=bl&srcid=ADGEESjoIBCjlick61QysvTH5A_bAei426gJpglLoKBTxOiY_HG7khPxyO54mQiWQ-j2-rijhg2URnsuaE3iNvVY9FOjpleJ3dTDFshOZA2FkQdsSpUMYxkM7dFv4n_FGj9YK6CG8Zvq&sig=AHIEtbQFYpzHiJPlyHatDtPyYBPXgEBbPA

In California, medical assistants apply the fluoride varnish. http://74.125.155.132/search?q=cache:a9GHQSYsx60J:www.co.kern.ca.us/health/fall09.pdf+fluoride+varnish+kern+county&cd=1&hl=en&ct=clnk&gl=us&client=firefox-a

"Physician’s Assistant Fernando Mata

relates that he evaluates a child’s risk

factors first. If the varnish is indicated,

the Medical Assistant is notified and

performs the fluoride varnish application."

Edited Nov 21, 2009 by Neveranurseagain

[~Mi Vida Loca~RN, ASN, RN]

Is this the same as the fluoride foam stuff?? They do this to my kids at the dentist office and it is done by the hygienist.

one of my kids had it done at the peds office during an annual wellness exam. the ped did it though

[RDH1, ADN, BSN, RN]

Whoops, I meant "wouldn't mind" teaching an RN how to do this. Can't figure out how to edit my post:(

[RDH1, ADN, BSN, RN]

Is this the same as the fluoride foam stuff?? They do this to my kids at the dentist office and it is done by the hygienist.

Nope, varnish is a fluoride, but it's like a thick liquid that's "painted" on the teeth. The nice thing about it is that with most brands, the child can eat and drink right after. They don't have to wait 30 min. And we can get it in all of those small grooves of the teeth that cavities like to pop up in:)

[~Mi Vida Loca~RN, ASN, RN]

Nope, varnish is a fluoride, but it's like a thick liquid that's "painted" on the teeth. The nice thing about it is that with most brands, the child can eat and drink right after. They don't have to wait 30 min. And we can get it in all of those small grooves of the teeth that cavities like to pop up in:)

I see thanks.

[Shirdent]

I guess the thing to me is that hygienists are already ready to provide that service as well as other services, like

• noticing abnormal wear,
  
• abnormal eruption
  
• early white spot decay
  
• Soft tissue lesions
  
• facial development
  
• loose teeth
  
• loose fillings
  

and so much more that it seems redundant to ask a busy nurse to learn all that.

Fluoride is not inert, it's easy to overdose specially with a high concentration of F in the varnish. Anyway I was just wondering how wide spread it was.

Shirley Gutkowski, RDH, BSDH, FACE

I think many people don't take their kids to the dentist until it's too late. I have a friend who's 3 year old son needed four--yes four cavities filled by his first visit to the dentist. I've heard many other moms say that their kids under 5 have cavities. Some people simply can't afford dental check-ups, so I think it's great that some peds offices do it at annual check-up. OUr ped didn't do a full oral hygiene exam, she basically had the varnish ready when she came in, so I guess it's part of standard procedure for well exam. Not sure if they would ask a nurse to learn all about tooth decay, etc. my kids have regular 6 month dental cleanings ever since age 12months and have never had a fluoride varnish treatment at the ped dentist office, go figure.

[Shirdent]

I agree! It would be well worthwhile to have a dental hygienist at a pediatric office to attend to the children's teeth. No point in trying to make hygienists out of nurses, they have enough to do.

Shirley Gutkowski, RDH, BSDH, FACE