July 15, 2008
Iverson Active gets a fluoride varnish treatment at the Dental Clinic in Bethel. YKHC file photo.
Fluoride varnish proves effective in fighting tooth decay
By Tiffany Zulkosky, YKHC Public Relations Staff
Rural Alaska's children and adolescents suffer from a caries, or tooth decay, rate 2.5 to 5 times the rate of children in the general United States population. Due to the geographic isolation of many communities and the lack of access to dental care providers, many children are unable to visit dental clinics on a regular basis.
In response to the lack of access to dental care services, the YKHC Dental Department collaborated with the Community Health Aide Program (CHAP) to develop a study that would identify the role of a Health Aide in improving the overall oral health win rural communities. Led by Dr. Mandie L. Smith, staff dentist at YKHC, a community-based fluoride intervention project was developed which focused on preventing tooth decay in children.
"Fluoride varnish applications have been studied extensively for safety and effectiveness in reducing the dental decay rate," said Dr. Smith. "Because health aides are often the first access to health care that a resident in the village has, we believe the application of fluoride varnish during routine health care visits can dramatically improve the oral health status of members within those communities."
CHAP selected Pilot Station as the test site for the study. In August 2007, Dr. Smith and Dr. Anthony G. Brusca, another staff dentist, traveled to Pilot Station, conducting a one-day training with health aides on the benefits and techniques of applying fluoride varnish. In addition, YKHC partnered with the local Tribal council and school to educate community members on the benefit of fluoride varnish treatments.
Baseline data was gathered by performing dental screenings on children in kindergarten through twelfth grade. Dr. Smith and Brusca documented 2,864 teeth in 167 participating children. There were 224 partially erupted teeth in the participants, 47 of which had caries experience. "Caries experience" is defined as tooth decay, which can be present in various stages.
Throughout the next eight months, Health Aides applied the honey-like fluoride varnish on the newly erupted teeth of children during routine health care visits. Dr. Smith maintained indirect supervision of the Health Aides through weekly teleconferences.
In April 2008, Dr. Smith and Brusca returned to Pilot Station to reassess the teeth of the children who had been receiving fluoride treatments. Of the 138 children participating, 3,572 teeth were counted. In the 179 partially erupted teeth counted, only 12 had caries experience.
"According to the data, the decay rate was at 20.9 percent prior to the fluoride varnish intervention. Following eight months of Health Aide participation, that rate dropped to 6.7 percent," said Dr. Smith. "The results are significant and prove that access to routine fluoride varnish applications in other high risk communities will be critical in the prevention, progression and transmission of the carious disease process."
Since the inception of the program, the fluoride varnish application training has been integrated into the standard CHAP training.
"By reducing the decay rate, the scope of dental services will move away from emergency services, which are costly in terms of patient discomfort, and monetarily, as related to travel expenses," concluded Dr. Smith. "Focus will shift to prevention and routine care, and as the disease rate continues to drop, funds can be shifted to providing more advanced dental services."
