Department of Health
John J. Dreyzehner, MD, MPH, Commissioner

Early Childhood Caries Prevention
A Fluoride Varnish Program for Public Health Nurses

Dental decay is one of the most common chronic infectious diseases among U.S. children. This preventable health problem begins early: 17% of children aged 2 to 4 years have already had decay. By the age of 8, about 52% of children have experienced decay, and by the age of 17, dental decay affects 78% of children. Among low-income children, almost 50% of tooth decay remains untreated, and may result in pain, dysfunction, underweight, and poor appearance — problems that can reduce a child's ability to succeed in the educational environment.

In 2004, former Governor Phil Bredesen signed legislation that amended the dental practice act to allow public health nurses to apply fluoride varnish to children’s teeth. As a result, many children in Tennessee are now being treated for the epidemic of early childhood caries (ECC).

The change also allowed the Department of Health to launch its “Cavity Free In Tennessee – Early Childhood Caries Prevention Program.” Implementation of this program targets regular Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) visits with children at risk for ECC. In the first year of life, a child may visit a health care professional as many as six times as a part of EPSDT. Nurses and nurse practitioners can deliver preventive oral health services to children during these visits, as well as educate their parents or caregivers about keeping children’s teeth healthy. These visits provide an opportunity for children to receive dental screenings, the application of fluoride varnish, and early dental referrals. Because many children do not access dental care until there is a need or until school-age, this program now allows many children to receive a preventive service they might not have otherwise received.

Children will continue to be referred to their dental provider for regularly scheduled visits for dental services or at any sign of need such as decay, eruption abnormalities, prolonged nonnutritive sucking, and other oral health concerns. While children, birth to 5 years old, are the target population for Cavity Free In Tennessee (CFIT), this program is available for children and teens in all seven rural regions of Tennessee.

In response to the Surgeon General’s Report of 2000 and a National Call to Action, the medical and dental professionals in Tennessee have partnered to address this preventable childhood disease.

This program addresses three objectives of the Healthy People 2010 Oral Health Objectives:

• To reduce the proportion of children and adolescents who have dental caries in their primary or permanent teeth.
• To reduce the proportion of children, adolescents, and adults with untreated dental decay.
• To increase the proportion of low-income children and adolescents who received preventive dental care during the past year.₁

Health disparities were highlighted in the 2000 Surgeon General’s Report: Oral Health in America, where it was reported that no less than a “silent epidemic of oral diseases is affecting our most vulnerable citizens – poor children, the elderly, and many members of racial and ethnic minority groups."₂

A National Call to Action to Promote Oral Health is addressed to professional organizations and individuals concerned with the health of their fellow Americans. It is an invitation to expand plans, activities, and programs designed to promote oral health and prevent disease, especially to reduce the health disparities that affect members of racial and ethnic groups, poor people, many who are geographically isolated, and others who are vulnerable because of special oral health care needs.₃

This program is changing perceptions of oral health; overcoming barriers by replicating effective programs and proven efforts; increasing oral health workforce diversity, capacity, and flexibility; and increasing collaborations. These are four of the five actions outlined in the Call to Action.

Cavity Free in Tennessee is a Win ~ Win Situation
for everyone...Increased preventive measures, fewer dental cavities, increased dental referrals, increased collaboration, and appreciation among health professionals…and a brighter future for Tennessee!

_{1 CDC, Children's Oral Health: http://www.cdc.gov/fluoridation/other.htm
2 2000 Surgeon General’s Report: Oral Health in America: http://www.surgeongeneral.gov/library/oralhealth/
3 National Call to Action to Promote Oral Health: http://www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.htm}