A Collaborative Effort between

Indian Health Service (IHS) and

the IHS Head Start Program

Course Objectives
1. Describe Early Childhood Caries (ECC)
2. List two ways to prevent ECC.
3. Recognize the various stages of ECC.
4. Discuss the benefits of topical fluoride.
5. List the 5 steps to applying fluoride varnish.
6. Demonstrate the appropriate application of fluoride

varnish.
7. List one key message for families to prevent ECC.

Why are Baby Teeth

Eating and nutrition
Important?

Holding space for the permanent teeth

Talking
Smiling

What is Early Childhood

Caries?
ECC is the presence of

any decayed, filled, or

extracted (due to decay)
teeth in the primary
dentition (baby teeth).

Involves infectious

bacteria, often passed

from mothers to babies.

The teeth often decay

very quickly.

Effects of ECC
Pain
Infection
Higher risk of new

cavities

Missed school days

and
difficulty
concentrating in school

What Causes ECC?

Pathological Factors

Bacterial biofilm
Ingestion of simple carbohydrates
Reduced salivary function
TOOTH DECAY

Protective Factors
Fluoride
Antibacterials
Oral hygiene habits
Flow and composition of saliva
Structure of tooth minerals in each
individual
Dental Sealants
NO TOOTH DECAY

Demineralization and
Remineralization

ECC and AI/AN Children

76% of AI/AN children

ages 2-5 have

experienced dental
cavities.

68% have untreated

decay.

Over 50% have severe

ECC.

1999 IHS Oral Health Survey

Two is Too Late!

Costs of ECC
Traditional dental

treatment is largely
ineffective at reducing
the bacteria that cause
ECC.
ECC can cost thousands

of dollars to treat each

child, even exceeding
$8,000 when a child is
hospitalized and treated
under general anesthesia.

Fluoride
Inhibits demineralization
Enhances remineralization
Inhibits plaque bacteria

Ways to Obtain Fluoride:

Systemic

Water

Prescription drops or tablets

Ways to Obtain Fluoride:

Topical
Fluoride Toothpaste
Fluoride Varnish
Fluoride Mouthrinses

Fluoride Toothpaste
Recommend cleaning the

teeth daily with a small

smear of fluoride
toothpaste as soon as the
first tooth erupts.

At three years of age,

brush daily with a pea-size

dab of fluoride toothpaste

Topical Fluoride Recommendations for High-Risk Children. Development of Decision Support Matrix: Recommendations from MCHB Expert
Panel, 2008

What is Fluoride Varnish?

Highly concentrated

topical fluoride
treatment

Can reverse white spot

lesions.

Safe for young children

Easy to apply

Advantages of Fluoride
Varnish
Safe
Easy to Apply
Accepted by patients
No special

requirements

Research with AIAN

children
Medical staff applied during

well-child visits.

Children who received four or

more application of varnish

between the ages of 9-24
months of age had 35%
reduced decayed surfaces
over children who received
none.

Holve S, IHS Primary Care Provider, Oct 2006.

Due to the high prevalence

of dental caries, most

AI/AN children can be
considered high-risk for
dental
caries unless a
.
dental professional has
classified them differently

Who does What in AI/AN

Communities?
Age

Staf

9-24 months Medical Staff

2-3 years

CHRs, WIC, PHNs

3-5 years
per year

Head Start staff

Protocol
4 treatments
3-4 treatments
3-4 treatments

Work together to prevent

ECC!
Fluoride varnish for
every
infant and child
Dental screenings
Parent education
Caries Stabilization

5 Steps to Applying Fluoride

Varnish

Step 1: Getting Ready

Supplies
Fluoride Varnish
Gauze squares
Non-latex gloves
Child-size toothbrush (optional)

Principles of Infection
Control
1. Take action to stay healthy: wash hands or use

an alcohol-based hand rub before and after

applying varnish on each child.

2. Avoid contact with blood and body fluids:

wear gloves.

3. Make items safe for use: use all disposable

items.

4. Limit contamination: set up on a paper towel

and dispose of all items after each application.

Applying Infection Control

Principles
Set Up

Application

Clean Up

Step 2: Oral Health

Assessment
Use the knee to knee

position if you are

working with babies and
very young children.

Children 3 and older can

stand in front of you.

If you use a toothbrush

Show the

caregivers how to
brush

Use the

toothbrush as a
mouth prop

Oral Health Assessment

First Sign of ECC: White Spot

Lesions
Can be remineralized with
Changes in diet
Fluoride varnish
Daily brushing with

fluoride toothpaste.

Early and Moderate ECC

Caries Stabilization: ITR

Ask your dental

clinic if they
provide Caries
Stabilization and
ITR for young
children.

Severe ECC

Step 3: Dry the teeth

Use the gauze

squares

Step 4: Apply Fluoride

Varnish

http://www.youtube.com/watch?v=cV5OmL7C
8K4

Step 5: Take Home

Messages
Dont brush until

the next day for

optimal benefit of
the fluoride varnish.

Brush daily with a

fluoride toothpaste.

5 Steps Review

Note: During all steps, be sure to follow the principles of infection control.
All of the supplies are disposable and intended for single use only!

What can YOU do to

prevent ECC?
Provide oral health

screenings and
fluoride varnish for the
children you work
with.

Provide oral health

messages to families
in your community.

Summary

Instructions for Course

Completion
After completing the course and receiving a score of
at least 80% on the posttest, you will receive a
certificate.

After demonstrating application of fluoride varnish on

a child in the appropriate age group, have a medical

or dental health professional sign your certificate.

Standing orders must be provided by a dentist or

physician. Make sure he/she is licensed in the state

you work in if you will be providing fluoride varnish
treatments for non-native children.

Special Thanks
We want to thank California First
Smiles for use of some of their
photos and Dr. Joanna Douglass
for use of her video.