Purpose: Oral health disparities, including dental caries, have a major impact on both short and long-term health and quality of life. Globally, many individuals lack the knowledge and access to dental care, oral hygiene supplies, fluoridated water or fluoride supplements. Fluoride Varnish (FV) application has been used as a means to promote oral health in various underserved regions of the world. The DNP Family Nurse Practitioner (FNP) Faculty at The University at Buffalo have incorporated oral health content into the curriculum and clinical experience. It is vital to provide DNP FNP students education regarding risk factors for childhood caries, subsequent adult caries and the resulting implications for oral systemic health. During various mission trips, FNP students and faculty have provided education regarding oral health, applied FV, provided oral hygiene supplies, and training to hundreds in remote settings. To assure this intervention is sustainable students and faculty have trained volunteers who are living in the region on FV application and provided supplies for future application. This proved to be cost effective means to promoting safe, sustainable primary and secondary dental carie prevention.
Review of Literature:
Dental caries is an international public health challenge and Early Childhood Caries ECC is a serious public health problem in both developing and industrialized countries. The disease of ECC is defined as the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth in a child under the age of 6, and in children younger than 3 years of age, any sign of smooth surface caries is indicative of severe early childhood caries (S-ECCC) (Tinanoff, Kierce, Newman, & Ryley, 2017).
Bonetti & Clarkson, 2016 reported on six Cochrane systematic reviews involving 200 trials and more than 80,000 participants. The evidence from the systematic reviews confirms the effectiveness of fluoride varnish; applied professionally 2-4 times a year is beneficial for preventing caries in both primary and permanent teeth. Globally, the efficacy of FV is acknowledged in clinical practice guidelines.
Results:
The application of fluoride varnish is inexpensive and time efficient. Supplies cost approximately one dollar per treatment. The procedure takes approximately 10 minutes to complete. Nurse practitioner students can be trained in a group setting on fluoride varnish application, which can be accomplished in approximately 1 hour, making the intervention cost effective and sustainable. Educating students on the benefit of improving oral systemic health will improve the overall health of underserved populations. Prevention of dental caries with fluoride varnish alone is a major step to improve oral systemic health. The results of fluoride varnish application are tremendous potentially saving $1200-1300 lifetime cost per each carie. The number of individuals that can be treated on any single mission range from 100-500, pending the age of the population.
Conclusion: DNP FNP students provided training on oral health, correct oral hygiene and applied fluoride varnish to orphans and refugees in various settings. Training caretakers in various settings and providing supplies for future treatments promoted sustainability. Training of FNP students at the UB SON has been accomplished and effective. Two DNP FNP students were able to do their research on training of global health workers on the application of fluoride varnish for sustainability. This intervention can then be translated to their local clinical settings / local providers / school nurses.
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