Hawai'i Nurse - May 2022

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Page 14 • Hawaiʻi Nurse May, June, July 2022 Oral Health Toolkit for Hawaiʻi Providers Providing Oral Health Service in Primary Care Practice An 8-minute video providing instruction on the 5 essential oral health services provided during a well child visit. Essential Oral Health Services Provided During a Well Child Visit 1. Caries risk assessment 2. Knee-to-knee clinical exam 3. Fluoride varnish application 4. Education/anticipatory guidance 5. Establishing a dental home Watch the video: https://vimeo.com/uhmanoanursing/oralhealthinpractice Steps to Applying Fluoride Varnish Supplemental Companion Video Handout for Providers Aloha Healthcare Providers, Oral health is integral to overall health. Unfortunately, far too many individuals in the State of Hawaiʻi are not able to access the oral health care they need and deserve. The consequences of poor oral health are far- reaching including the negative oral and overall health effects as well as the unnecessary costs of emergency room visits for preventable oral health conditions. The integration of oral health into primary care practice is one substantial and economical way to reduce the poor oral health outcomes and improve overall health and quality of life for our island residents. Young children are seen by primary care providers more often than oral health professionals, with an average of 12 recommended pediatric well-child visits conducted in the first 36 months and yearly between 3 until 21 years of age. Each primary care visit is an opportunity to assess oral health status, provide oral health education, connect families to a dental home and when appropriate, apply fluoride varnish. The following oral health toolkit was developed through a collaboration between the Hawaiʻi State Department of Health, Family Health Services Division, and the UH Mānoa Nancy Atmospera-Walch School of Nursing. Included in this toolkit, you will find the following items to help you to effectively integrate oral health into your practice. Items For Primary Care Providers: • Steps to Applying Fluoride Varnish (Video and Handout) o Visualexamplesofearlychildhoodcaries o Template:FluorideVarnishProgressNotes Items For Families: • Fluoride Varnish Factsheet For more information and resources on improving oral health outcomes, please contact me at mattheus@hawaii.edu. Mahalo, Deborah Mattheus, PhD, APRN-Rx, CPNP Nancy Atmospera-Walch Professor in School Health and Associate Professor Hawaiʻi Keiki: Healthy & Ready to Learn, Senior Practice Director and Dental Sealant Program Director Materials Needed • Gloves • Fluoride varnish and applicator (Figure 1) • 2x2 gauze squares Use this template and create a smart phrase in EMR to ease in charting • Disposable tongue blade or mouth mirror (optional) Name of Patient: __________________ DOB: _____________ Application Oral Examination Steps Caries 6. Obtain or enamel the defects materials not present Plaque 7. Inform does not caregiver present of on the teeth procedure and obtain consent Figure 1: Single dose fluoride varnish product Caries 8. Reassure Risk Assessment caregiver that any discoloration from varnish No Caries is temporary Risk Moderate to High Risk for Caries *(See section below) 9. Position child in “knee-to-knee” position (Figure 2) Consent obtained 10. Prepare the fluoride varnish Procedure • Be Documentation sure to mix to assure consistent fluoride levels Child was positioned for varnish application. Teeth were dried. Varnish was applied. Child tolerated procedure well with no during complications. application Procedure 11. Dry the could teeth not before completed fluoride due varnish to child is non-cooperation. applied with 2x2 gauze Figure 2: “Knee to knee” position Post-Procedure Documentation Fluoride 12. Apply varnish a thin handout layer of provided? varnish to Yes surfaces / No of teeth Caries (Figure prevention 3) handout provided? Yes / No Child has dentist? Yes / No If no dentist, dental referral made? Yes / No • Yellowish tint may appear ____________________________________ 13. No eating or drinking for 30 minutes after fluoride ____________ Name, Title, Signature of Varnish Provider Date / Time varnish procedure * Risk Factors: Children with at least one of the below risk factors Post-Varnish Application Instructions Figure 2: should Knee-to-knee be considered position at moderate caries risk. The presence of multiple factors places the child at high caries risk. • Do not brush or floss for at least 4-6 hours after Social and Medical History Factors application • Avoid Born prematurely hot beverages • Avoid Limited hard access or to crunchy dental care foods Importance Preventive of a Dental Behaviors Home Template: Fluoride Varnish Progress Note Lower socioeconomic status (on Medicaid) Special Health Care Needs Caries present Family members with cavities Brushing < 2 x daily • Children No fluoride are in water recommended or supplements to go to the dentist within Dental Findings 6 months of getting their first tooth and no later Congenital than tooth their defect first birthday. Plaque on teeth • HDS Caries Medicaid/CCMC present can help find a QUEST dentist. Parent Diet Issues should be advised to call 808-792-1070 for assistance. Drinks juice or sugary drinks between meals Eats sugary snacks between meals Sleeps with both or at breast Figure 3: Varnish application March 2022 University of Hawaiʻi at Mānoa Nancy Atmospera-Walch School of Nursing March 2022 University of Hawaiʻi at Mānoa Nancy Atmospera-Walch School of Nursing
May, June, July 2022 Hawaiʻi Nurse • Page 15 Early Childhood Caries Normal and Abnormal Findings During Your Oral Examination Fluoride Varnish Factsheet For Parents Normal Baby Teeth Chalky White Spots Around the Gum Line Signs of Early Decay What is fluoride varnish? • Fluoride varnish is a protective coating that is applied to teeth to help prevent cavities. Why is fluoride varnish recommended? Brown Spots Signs of Moderate Decay Blackened and Missing Teeth Signs of Severe Caries Template: Fluoride Varnish Progress Note Use this template and create a smart phrase in EMR to ease in charting Template: Fluoride Varnish Progress Note Name of Patient: __________________ Use this template and create a smart DOB: _____________ phrase in EMR to ease in charting Name Oral Examination of Patient: __________________ DOB: _____________ Caries or enamel defects not present Plaque Oral Examination does not present on teeth Caries or enamel defects not present Plaque Caries Risk does Assessment not present on teeth No Caries Risk Caries Moderate Risk to Assessment High Risk for Caries *(See section below) Consent No Caries obtained Risk Moderate to High Risk for Caries *(See section below) Consent Procedure obtained Documentation March 2022 Child was positioned for varnish application. Teeth were dried. Varnish was applied. Child tolerated procedure University of Hawaiʻi at Mānoa Nancy Atmospera-Walch School of Nursing Procedure well with no Documentation complications. Child Procedure was positioned could not be for completed varnish application. due to child Teeth non-cooperation. were dried. Varnish was applied. Child tolerated procedure well with no complications. Post-Procedure Procedure could Documentation not be completed due to child non-cooperation. Fluoride varnish handout provided? Yes / No Post-Procedure Caries prevention Documentation handout provided? Yes / No Child Fluoride has varnish dentist? handout Yes / No provided? Yes If no / dentist, No dental referral made? Yes / No Caries prevention handout provided? Yes / No Child ____________________________________ has dentist? Yes / No If no dentist, dental ____________ referral made? Yes / No Name, Title, Signature of Varnish Provider Date / Time ____________________________________ ____________ Name, Title, * Risk Signature Factors: Children of Varnish with Provider at least one of the Date below / Time risk factors should be considered at moderate caries risk. The presence of multiple factors places the child at high caries risk. * Risk Factors: Children with at least one of the below risk factors should be considered at moderate caries Social and risk. Medical The presence History Factors of multiple factors places the child at high caries risk. Lower socioeconomic status (on Medicaid) Born prematurely Special Social and Health Medical Care History Needs Caries Factors present Limited Lower socioeconomic access to dental status care (on Medicaid) Family Born prematurely members with cavities Special Health Care Needs Caries present Limited Preventive access Behaviors to dental care Family Brushing members < 2 x daily with cavities No fluoride in water or supplements Preventive Behaviors Dental Brushing Findings < 2 x daily No Congenital fluoride tooth in water defect or supplements Plaque on teeth Dental Caries present Findings Congenital tooth defect Plaque Diet Issues on teeth Caries Drinks present juice or sugary drinks between meals Eats sugary snacks between meals Diet Sleeps Issues with both or at breast Drinks juice or sugary drinks between meals Eats sugary snacks between meals Sleeps with both or at breast March 2022 University of Hawaiʻi at Mānoa Nancy Atmospera-Walch School of Nursing • Fluoride varnish makes teeth stronger, stops cavities from getting worse and helps to prevent new cavities from forming. Cavities can cause pain that may lead to trouble eating, speaking, playing and learning. It can also cause serious infections. Is fluoride varnish safe? • Yes. Fluoride varnish is safe for any age. It can even be used on babies when their first teeth come in. If you have questions or concerns about using fluoride varnish, talk to your doctor or dentist. Children should see a dentist starting by age 1. How is fluoride varnish applied? • Fluoride varnish is painted on the teeth with a brush by a trained dentist, dental hygienist, doctor or nurse. It is quick and easy and there is no pain or bad taste. The varnish sticks to the teeth and may make the teeth look yellowish, but this will go away when the teeth are brushed the next day. How long does fluoride varnish last? • Fluoride varnish keeps protecting teeth for several months. It works best if it is reapplied every three to six months. Can I eat, drink or brush my teeth after fluoride varnish is applied? • Do not brush or floss for at least 4-6 hours after application. • Avoid hot beverages until the following day. • Avoid hard or crunchy foods until the following day. Is fluoride covered by my insurance? • Most dental and medical insurance providers, including Medicaid, cover fluoride varnish. • Ask your provider to check your coverage. March 2022 University of Hawaiʻi at Mānoa Nancy Atmospera-Walch School of Nursing
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Hawai'i Nurse - May 2022

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