Fluoride varnish

Fluoride varnish:

• Is a topical treatment applied on the surfaces of teeth using a small brush and sets on contact with saliva.
• Prevents new cavities from forming and helps stop tooth decay that has already started.
• Has a protective effect that lasts several months.

In the C&TC setting, fluoride varnish should be applied to the teeth of all infants and children at minimum at C&TC visits up to four times a year, starting when the first tooth erupts. This is in addition to fluoride varnish that is applied in a dental home.

Fluoride varnish is safe to use on babies and young children. Fluoride varnish minimizes the risk of ingestion because only a small amount of varnish is used and adheres to teeth immediately.

Fluoride varnish must be applied by a physician, qualified health care professional, trained clinic staff under supervision, or other trained allied health providers. Peer to peer training is not recommended.

Fluoride varnish should not be given to families to apply at home.

1. Anyone applying fluoride varnish must complete a C&TC recommended training.
2. Obtain verbal or written consent from a parent or legal guardian before applying fluoride varnish.
   • Verbal consent must be obtained each time before applying fluoride varnish. Document the verbal consent in the child's chart, including that a discussion of the risks and benefits of fluoride varnish application took place.
   • Keep the written consent form on file with the child's health records. Consent forms are valid for one year.
3. Refer to Fluoride Varnish Application in the MHCP Provider Manual, C&TC Section.

Recommended online trainings:

• Medical assistants and other non-licensed personnel performing fluoride varnish as a delegated task must review MN Oral Health Coalition's video on fluoride varnish application
• Providers and those who supervise staff applying fluoride varnish should watch the Smiles for Life: Caries Risk Assessment, Fluoride Varnish Application 30 minute YouTube video training.

Alternative trainings:

• Smiles for life complete curriculum is a broader overview; the entire course can be completed for continuing medical education.
• Crush Cavities Fluoride Varnish Application Training for Clinics course provides a broad overview of oral health and fluoride varnish.

Note: Although not demonstrated in these videos, appropriate personal protection equipment including eye shields must be worn during fluoride varnish application.

Fluoride varnish application (FVA) is a covered service for children from birth to 21 years who are enrolled in Minnesota Health Care Programs (MHCP). Refer to the Fluoride section of the MCHP provider Manual for the most updated coding and billing information.

For questions about billing, please contact the Minnesota Department of Human Services, Provider Call Center, (651) 431-2700 or (800) 366-5411, or the health plan.

If the recipient is part of the managed care or private insurance plan, contact the health plan directly for their specific billing information.

The AAP Children's Oral Health website has practical information about implementing oral health care in your clinic. Learn how to perform an oral health risk assessment, apply fluoride varnish, and find tools for nutrition and oral health family education.

Helpful, free resources are available online for family education. Below are links to materials for use in the clinic setting. Resources include activities for children and videos for staff and families.

Minnesota Resources

Fluoride Varnish Treatments and Your Child Flyer (PDF)

Fluoride Varnish Treatments and Your Child Flyer (Word)

Additional languages available on C&TC Translated Documents web page

Healthy Teeth, Healthy Baby

National Resources

Brush, Book, Bed: How to Structure Your Child's Nighttime Routine

National Maternal & Child Oral Health Resource Center (OHRC)

Cavity Free at Three

Think Teeth

Sesame Street Healthy Teeth, Healthy Me

A dentist referral is required at every C&TC visit, starting at the eruption of the first primary tooth and no later than 12 months of age. This first visit ideally starts a "dental home," an ongoing relationship with a dentist for comprehensive and family-centered oral health care.

The American Academy of Pediatrics (AAP) recommends that a child with dental disease have an active referral to a pediatric dentist for diagnosis and treatment.

For help in finding a dentist:

• Contact the health plan listed on the child's insurance card.
• Contact local public health for information about mobile dental clinics and other community dental resources.

U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.

Dental caries is preventable but remains a significant problem. The prevalence of dental caries in children has been increasing, particularly in young children ages 2 to 5 years.

Low-income children and those without dental care are at high risk for dental caries. Poor dental health in low-income children often result from lack of access to preventive measures, few dentists for Medicaid-enrolled children, and shortage of dentists in some areas.

Primary healthcare providers can help prevent dental caries. Medicaid-eligible children in Minnesota can receive at least one C&TC visits every year. Applying fluoride varnish during these visits is an easy, safe, and effective way to prevent dental caries.

• Bright Futures in Practice: Oral Health
• Centers for Disease Control and Prevention, Children's Oral Health
• Children's Dental Health Project
• C&TC FACT Sheet: Oral Health and Fluoride Varnish