'From the First Tooth' presentation trains, informs medical professionals on benefits and application of fluoride varnish

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BENNINGTON — Primary care physicians and pediatricians gathered at Southwestern Vermont Medical Center on Thursday for a presentation called "From the First Tooth" to learn about oral health assessments and how to apply fluoride varnish on teeth that show signs of decaying.

Over 15 attended the session and even had the chance to apply fluoride varnish on another individual. Dr. Laura Murphy facilitated the program, which is supported by the DentaQuest Foundation. Fluoride varnish is highly concentrated fluoride and comes in the form of a sticky wax that is painted on teeth to protect from cavities and caries, or tooth decay.

The national prevalence of caries in children ages two to five was 23 percent in 2012 and is more common than asthma, according to the presentation. It's even worse in African American and Hispanic children with 44 to 46 percent having the teeth decaying issue. Murphy said that one in four children will have a cavity by age five.

Fluoride varnish can reduce caries by 37 to 63 percent.

"Somebody needs to step in. It really does make sense for us, primary care providers, people who see kids up to 10 times before their third birthday to be those people," Murphy said. "When kids have cavities their teeth hurt. They don't sleep as well. They don't learn as well. They don't grow as well because they don't eat as well."

Early childhood caries: Risk assessment

By four to six months, an assessment should be done on a child just before teeth emerge to determine the depth of nutritional and hygiene counseling. Murphy broke the risk down into moderate, poor access to health care, parents have cavities, poor diet, or developmental enamel defects and high, which means to have plaque on teeth, white spots or cavities and no systemic fluoride exposure.

Systemic fluoride is necessary for developing teeth which topical fluoride is for already developed teeth. Systemic is swallowed and benefits teeth before and after eruption, whereas topical is applied directly to teeth, according to the Vermont Department of Health.

The suggested way to perform an exam is by having the practitioner and caregiver sit in chairs facing each other with knees touching and lay the child on the connected knees so that the examiner can evaluate the mouth from an upside down perspective and the caregiver can also look into the mouth from above. When examining, the practitioner should look for discoloration and texture abnormalities such as plaque, white spots, cavities and abscesses.

A while line on a tooth can indicate a cavity, Murphy said. This will result in immediate dental referral, dietary and oral hygiene counseling, and topical fluoride treatment. If brown spots or dark lesions are found upon examination, the same treatment method would apply as if white lines were found.

Murphy explained that children are more prone to Early Childhood Caries (ECC) because of bacteria being transferred by saliva contact and for the fact that young children are eating so often throughout the day; The ph level in their mouth hardly gets a chance to recover by the next meal. The presentation stated that "oral bacteria produces acid that persists for 20 to 40 minutes after sugar ingestion," which leads to enamel demineralization.

"Early Childhood Caries is a chronic, infectious disease," Murphy said. "When babies put their hand in their mouth and put them into our mouth, that's how we all get our cariogenic bacteria."

Fluoride varnish application

Per unidose, varnish products can cost between $1 to $2.50 and contains more than necessary for one treatment. First, the practitioner should lay the child in the knee-to-knee position, apply gloves and dry teeth with a gauze in a well-lit area. Murphy suggested using a head lamp if needed. By using a mirror to seek out the desired teeth or to stretch the cheek, a practitioner would use the brush tool to paint the varnish on the inside and outside of said teeth. Once saliva returns after application, the varnish will set and won't be sticky.

After application, Murphy said the child should stick to soft foods for the rest of the day, not brush that night, and avoid consuming fluoride tablets or drops.

Pediatrician Judy Orton received a varnish application and said it felt like the anbesol numbing cream with a flavor.

"I see children that would benefit from this," Orton said.

Further prevention includes having a caregiver brush a child's teeth twice a day until age eight or nine or until they develop basic motor skills, diet counseling by promoting breastfeeding, limiting sugar and snacks or at least establishing a beginning and end time for meals, and restricting juice to four ounces per day.

The presentation also informed about the appropriate amount of toothpaste a child should used. For children less than 3-years-old, a tiny smear should be used, and for those older than three, a pea size should be used.

Under the Affordable Care Act, a reimbursement rate between $13 and $20 is set for Vermont when using fluoride varnish. By promoting oral health in family practices, children can be referred to dentists and have that exposure more frequently, and the office can benefit from increased revenue at high and low volumes.

Registered Nurse Jennifer Steinhoff thinks the training will help benefit children she already sees.

"I liked just learning how to do it and interacting," she said. "I've never used varnish before."

Makayla-Courtney McGeeney can be reached at (802)-447-7567, ext. 118.


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