Association‌ of‌ State‌ &‌ Territorial‌ Dental‌ Directors
3858‌ Cashill Blvd.,‌ Reno,‌ NV‌ ‌89509
Phone‌ 775-626-5008‌‌

Dental Public Health Activities: Descriptive Summaries

Cavity Free In Tennessee - Early Childhood Caries Prevention Program

Practice Number: 48004
Submitted By: Tennessee Department of Health, Oral Health Services
Submission Date: March 2006
Last Reviewed: January 2013
Last Updated: January 2013
Best Practice Approach Example -

The Department of Health’s Division of Oral Health Services, with support by the Division of Nursing, implements a fluoride varnish application program called Cavity Free In Tennessee (CFIT).  CFIT targets Medicaid enrolled children in the Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) Program.  EPSDT children in their first year of life may visit a health care professional as many as six times, which will allow nurses and nurse practitioners opportunities to educate their parents or caregivers and deliver preventive oral health services to children.  These visits provide an opportunity to conduct dental screenings, counsel parents or caregivers, and apply fluoride varnish.  CFIT trains nurses and nurse practitioners to deliver these preventive services.  Regional Nurse Directors, Nurse Supervisors, and Public Health Nurses have been trained to deliver the CFIT services at the county public health clinics. For continual enhancement of CFIT services, when the Nurse Directors from seven rural regions and the six metropolitan areas meet quarterly, their meeting agenda includes updates on CFIT and discussions on what is working and improvement for program services. 

The program protocol for applying fluoride varnish recommends applying varnish two times a year and suggests applying every six months.  The nurses are generally applying fluoride varnish every three to six months.  Through a state contract, the fluoride varnish supplies are ordered by and shipped to the county health department.  The public health nurses maintain their inventory of fluoride varnish based on the number of applications provided to the children in their clinic.  CFIT also provides tooth brushes and offers educational materials for the parents/caregivers including an “Information for Parents about Fluoride Varnish” fact sheet and publications giving basic oral health instruction for children. Funding from the Maternal and Child Health Block Grant covers the purchases made by the CFIT program.

The program recommends that children go to their dentist for regularly visits and makes dental referrals for children with dental needs. CFIT reaches children in all seven rural regions of the state.  The target population for this program is children 0 - 5 years of age but the program is available for children 0 through 20 years of age in all rural regions. 

Training in ECC prevention and fluoride varnish application is provided to all public health nurses as part of their standardized orientation provided by the Department of Health.  From July 2009 to June 2012, more than 50,000 applications of fluoride varnish were applied to the teeth of at risk children. Many children do not access dental care until there is pain or infection or until they reach school age; CFIT allows children to receive early preventive services.  Further evaluation of this early childhood caries prevention program will be made to assess the effectiveness of the program model.

Lessons Learned:

Making the ECC and fluoride varnish application training part of the standardized orientation has allowed nurses to train nurses and has worked well with limited dental staffing patterns throughout the rural regions.  This program has fostered a positive working relationship between the medical and dental teams.

Contact Person(s) for Inquiries:

Suzanne Hayes, DDS, Dental Director, Oral Health Services, Tennessee Department of Health, Cordell Hull Bldg., 425 5th Ave. North, Nashville, TN 37243, Phone: 615-741-8618, Fax: 615-532-2785, Email: