Sioux Lookout Zone Fluoride Varnish Program Baby teeth – keep them beautiful with fluoride varnish

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Determinants of Health: Access to health services

Overview

The Sioux Lookout Fluoride Varnish Program is a community-based oral health promotion program designed to reduce early childhood caries among 6 months to 5 years old Aboriginal children. Community-based nutrition educators provide oral health counseling to prenatal and new mothers and apply fluoride varnish twice per year to children. Fluoride varnish treatment conferred an 18% reduction in the 2-year mean net decay missing filled surfaces (dmfs) increment for Aboriginal children and a 25% reduction for all children. Children in the control group had 1.96 times higher caries incidence compared to those in the fluoride varnish group (95%CI = 1.08–3.56).

Primary Source Document

H Lawrence (Community Dentistry Discipline, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada), D Binguis (Sioux Lookout Zone Dental Program, First Nations & Inuit Health Branch, Ontario Region, Health Canada, Sioux Lookout, ON, Canada), J Douglas (Sioux Lookout Zone Dental Program, First Nations & Inuit Health Branch, Ontario Region, Health Canada, Sioux Lookout, ON, Canada), L McKeown (Dental Hygiene Program, Confederation College, Thunder Bay, ON, Canada and Dr S.M. Bloom’s Dental Clinic, Thunder Bay, ON, Canada), B Switzer (Community Dentistry Discipline, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada), A Laporte (Health Economics Discipline, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada) , A 2-year community-randomized controlled trial of ?uoride varnish to prevent early childhood caries in Aboriginal children Community Dentistry and Oral Epidemiology

Contact information of developer(s) and/or implementer(s)

Herenia P. Lawrence, Associate Professor of Community Dentistry, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, 124 Edward Street, Room 515D, Toronto, ON, Canada M5G 1G6 Tel: +1 416 979 4908 (ext. 4492) Fax: +1 416 979 4936 E-mail: herenia.lawrence@utoronto.ca

Intervention Focus

Intervention Goal / ObjectiveLevel(s) TargetedEquity Focus
To prevent early childhood caries among high-caries- risk, 6 months to 5 years old aboriginal children.
  • Community level
People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.
To measure the effectiveness of ?uoride varnish and caregiver counseling in preventing early childhood caries in Aboriginal children.
  • Community level
People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

  • Oral Health Promotion
  • Oral HP Children/Youth
  • Oral HP Infants/Preschool
  • Oral HP Integration

Risk Reduction

    Specific Activities of the Intervention

    • Counselling sessions to those who are at high risk for a chronic disease
    • Partnership development
    • Other

    Priority/Target Population for Intervention Delivery

    Life Stage

    • Prenatal
    • Infancy (birth to 2 years)
    • Early childhood (age 3-5 years)

    Settings

    Educational Settings

    • Early learning environment (ages 0-5)
    • Elementary school

    Community Setting

    • Home
    • Health care setting
    • Other

    Outcomes

    Outcomes and Impact Chart
    Level of ImpactDescription of OutcomeEquity Focus
    Community LevelAdjusted odds ratio for caries incidence was 1.96 times higher in the controls than in the fluoride varnish group (95% CI = 1.08–3.56; P = 0.027). For those caries-free at baseline, the number (of children) needed to treat (NNT) equaled 7.4.Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.
    Individual LevelApplication of fluoride varnish at least twice per year, in conjunction with caregiver counseling, is effective to prevent early childhood caries (ECC), reduce caries increment and oral health inequalities between young Aboriginal and non-Aboriginal children.Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.
    Community LevelFluoride Varnish treatment conferred an 18% reduction in the 2-year mean ‘net’ dmfs (decayed missing filled surfaces) increment for Aboriginal children. Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.
    Community LevelFluoride Varnish treatment conferred a 25% reduction in the 2-year mean ‘net’ dmfs (decayed missing filled surfaces) increment for all children.Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

    Adaptability

    Implementation History

    • Multiple implementations - Similar settings/populations/providers - The intervention has been implemented more than twice in the same setting with the same population by similar providers, and is theoretically applicable to other settings and/or populations. This can include multiple implementations during the same time period. *Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.

    Expertise Required for Implementation within the Context of the Intervention

    • Requires specialized skills that are easily available within the context - The intervention requires the participation of personnel with advanced skills (e.g. medical doctors, epidemiologists, social workers) but that are easily available within the intervention context.

    Are there supports available for implementation

    Yes. Volunteers for oral examiners calibration sessions, community collaborations, funding

    Are there resources and/or products associated with the interventions

    Yes. Local radio broadcasts, posters, pamphlets, media promotions