Oral Health America Webinar Series
Fluoride in Practice—Resources from the Association of State and Territorial Dental Directors
December 7, 2017
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HOUSEKEEPING INFORMATION • •
Please remember to MUTE your phone. Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions. • •
• •
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Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
CE Credit Available
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LeeAnn Hoaglin Cooper, RDH, BS Fluorides Committee Consultant, ASTDD
Chris Wood, RDH, BS
Executive Director, ASTDD
FLUORIDATION AND FLUORIDE- RESOURCES ORAL HEALTH AMERICA DECEMBER 7TH, 2017
ACKNOWLEDGEMENT Supported by Cooperative Agreement 1U58DP004919-04 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.
OBJECTIVES Participants will be able to: ▪
describe the fluoride resources available on the ASTDD website.
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describe the process used to develop reliable and valid issue briefs and white papers
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identify critical elements for cost-effective fluoride programs including: community water fluoridation, fluoride mouthrinsing, fluoride supplements, fluoride toothpaste, fluoride varnish, and or silver diamine
WHO IS ASTDD?
ASSOCIATION OF STATE AND TERRITORIAL DENTAL DIRECTORS
directors and staff of state public health agency.
affiliate of the Association of State and Territorial Health Officials (ASTHO) since 1948
formulates and promotes national dental public health policy
assists state dental programs in the development and implementation of programs and policies for the prevention of oral diseases;
builds awareness and strengthens dental public health professional knowledge and skills by:
developing position papers and policy statements
provides information on oral health to health officials and policy makers
conferences for the dental public health community
ASTDD FLUORIDES COMMITTEE The Fluorides committee assures that ASTDD positions and policies are presented in appropriate venues and oversees activities the association may be involved in regarding fluorides, including the fluoride awards at the annual meeting. 2017 Volunteer Members: Jason Roush, DDS, Chair, • Bruce Austin, DDS, Oregon • William Bailey, DDS University of Colorado • Susan Deming RDH, Michigan • Kip Duchon, PE Centers for Disease Control • Judy Feinstein, Consultant, (formerly Maine) • Stephanie Holmquist, Alaska • Jay Kumar DDS, MPH, California • Clare Larkin, RDH MSEd, Minnesota • Jane McGinley, RDH, MBA, American Dental Association
• • • • • • • •
Dixianne Parker, RDH, MEd, Georgia Howard Pollick BDS, MPH, University of California San Francisco Jaclyn Seefeldt, BS, RDH, North Dakota Gina Sharps, MPH, RDH, West Virginia Lyubov Slashcheva, DDS, University of Iowa Bradley Whistler, DMD, Alaska Beth Wyatt, Colorado Kimberlie Yineman, RDH, BA North Dakota
LOGIC MODEL
For more information: www.cdc.gov/tools/logic-models/index.html
ASTDD Membership
HOW WE DEVELOP OUR DOCUMENTS
Executive Board
A COMMUNITY AFFAIR Experts Partner organizations Committee
PROCESS
Dental Public Health Resource Committee
Consultant
http://www.astdd.org/dental-public-health-resources-committee/ Guidance Document for Drafting Dental Public Health Resource Documents
How we REALLY DO IT – Details!
FLUORIDATION AND FLUORIDE WEB PAGE
WWW.ASTDD.ORG
LOOK AT SEARCH: A-Z TOPICS…… Basic Screening Best Practices • Community Water Fluoridation • Improving Children’s Oral Health Through Coordinated School Health Programs • School Fluoride Programs-currently under review • Collaborations • Data Collection FLUORIDES and FLUORIDATION Head Start Mobile and Portable Dental Services in Pre-School and School Settings School Screenings
FLUORIDES and FLUORIDATION Webpage Navigation • Current fluoride information first • Other organizations and fluoride-related information • Other organization fluoride related policy statements • Other organization resources
www.ilikemyteeth.org
COMMUNITY WATER FLUORIDATION •
Natural Fluoride in Drinking Water 9/2016
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Best Practice Approach Report-Use of Fluoride: Community Water Fluoridation 06/2016
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Policy on Community Water Fluoridation 06/2015
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Fluoridation Awards Database –Current
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Fluoridation Rollback Database
In the United States, less than one-half of one percent of U.S. residents on community water systems have drinking water exceeding 2 ppm and less than one-tenth of one percent have water exceeding 4 ppm
The Association of State and Territorial Dental Directors (ASTDD) fully supports and endorses community water fluoridation in all public water systems at the optimal level recommended by the US Public Health Service.
SUPPLEMENTS AND TOOTHPASTE ▪
Fluoride Toothpaste-2016 ASTDD supports twice daily use of toothpaste containing 1000-1500 ppm fluoride, in fluoridated and non-fluoridated communities, for the prevention of tooth decay beginning with the eruption of the first tooth and throughout life.
▪
Fluoride Supplements-2013
ASTDD supports the use of fluoride supplements for children who are at high-risk for dental caries, whose primary source of drinking water has suboptimal levels of fluoride and whose other ingested sources of fluoride are low. Fluoride supplements should be prescribed based on caries risk assessment and fluoride history. Healthcare professionals should monitor parents’ compliance with the current supplement dosage schedule on an ongoing basis
FLUORIDE VARNISH •
School-based Fluoride Varnish Program Report and Catalog-2017
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Fluoride Varnish Policy Statement-2015
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Fluoride Varnish Issue Brief-2014
SILVER DIAMINE FLUORIDE- used “off label” for treatment/arrest of caries in children and adults. Webinar 01/2017
Fact Sheet 07/2017
Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc. 2016;44(1):16-28. AAPD Guideline For using Silver Diamine Fluoride to Treat Dental Caries. Oct. 2017. www.aapd.org/media/Policies_ Guidelines/G_SDF.pdf Photos: Courtesy of Steve Duffin
All fluoride products
GENERAL PRINCIPLES
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have a systemic AND a topical effect
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prevent dental caries in the primary AND permanent teeth, particularly when initiated before tooth decay develops
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are more effective on smooth surfaces than pits/fissures.
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require reapplication to achieve and maintain efficacy
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use in combinations •
do not provide additive benefits
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increase costs
SCHOOL-BASED FLUORIDE PROGRAMS No
school-based fluoride program outcome evaluation since 1986 National Preventive Dentistry Demonstration Program (NPDDP) demonstrated results contrary to conventional wisdom.
Disney JA, Bohannan HM, Klein SP, Bell RM. A case study in contesting the conventional wisdom: schoolbased fluoride mouthrinse programs in the USA. Community Dent Oral Epidemiol. 1990 Feb;18(1):46–54.
APHA Technical Report. Review of the National Preventive Dentistry Demonstration Program. Am J Public Health. 1986 Apr;76(4):434-47.
School-based
programs outside the US have fewer fluoride resources and are not directly comparable
Mathu-Muju, R, Friedman JW, Nash DA. Oral Health Care for Children in Countries Using Dental Therapists in Public, School-Based Programs, Contrasted with That of the United States, Using Dentists in a Private Practice Model. AJPH 2013 Sep;103(9) e7-e1.
CDC.
Recommendations for using fluoride to prevent and control dental caries in the United States. 2001 Available from:
ADA,
Council of Scientific Affairs Expert Panel on Topical Fluoride Caries Preventive Agents. Weyant RJ, et al. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. Am Dent Assoc. 2013 Nov;144(11):1279-91.
Cochrane
Database of Systematic Reviews. Marinho VC, Higgins JT, Sheiham A. and Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. 2004
FAVORITE CITATIONS
THANK YOU!
Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
CE Credit Available
Contact Information • LeeAnn Cooper • lahcooper@comcast.net • Chris Wood • cwood@astdd.org • Eamari Bell • eamari.bell@oralhealthamerica.org