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Dental Public Health Activities: Descriptive Summaries

Healthy Smiles Fluoride Varnish Program

Practice Number: 37002
Submitted By: North Dakota Department of Health, Family Health Division
Submission Date: January 2010
Last Reviewed: August 2011
Last Updated: August 2011
Best Practice Approach Example Healthy Smiles Fluoride Varnish Program

Research shows that fluoride varnish is highly effective in reducing tooth decay by 25 percent to 45 percent. The Healthy Smiles Fluoride Varnish Program was created to reduce oral health disparities in North Dakota (ND) children and improve access to preventive dental care for underserved populations. The program trains medical and dental professionals (including licensed practical nurses (LPNs), registered nurses (RNs), physicians, physician assistants, dental hygienists and dental assistants) to conduct dental screenings and apply fluoride varnish. Training is provided by the North Dakota Department of Health (NDDoH) Public Health Hygienists and is available free of charge. A three-hour module teaches disease progression, demonstrates clinical application technique, and reviews anticipatory guidance. The NDDoH is in the process of launching an on-line version in the fall of 2011 to improve access capabilities for busy health care professionals.

There are 28 single and multi-local public health units (e.g., service centers) throughout the state with staff LPNs and RNs. More than 100 of these healthcare professionals from local public health units have received training through the Healthy Smiles program since 2007.  These healthcare providers have expanded preventive oral health care by adding dental screenings and fluoride varnish applications into their routine well-baby and well-child visits. Local public health units cover the costs of staff and dental materials. Services are billed to Medicaid or private insurance for reimbursement. The NDDoH does not incur any operating costs for direct services. 

All participating local units send monthly demographic and service data on children receiving screenings and fluoride varnished applications to NDDoH for tracking and analysis. Currently, 14 local public health units are participating in the Healthy Smiles program providing fluoride varnish to 1,800 children annually. 

The NDDoH is pleased to join with medical professionals to expand Healthy Smiles to children from newborn through twenty years of age. In January, 2011 the Healthy Smiles Fluoride Varnish Program expanded training into pediatrician’s offices. Currently, pediatricians and staff in 3 North Dakota cities have been trained and are providing fluoride varnish as part of their well-baby and well-child visits. To include pediatricians is a major step in reaching populations in need at a very young age, as well as on a continual basis. Pediatricians bill for services to Medicaid or private insurance, as well as submit data in the same manner as the local public health units.

In May, 2011 the decision was made to eliminate the fluoride mouth rinse program. The program originally began in 1976 with fluoride tablets and later changed to mouth rinse in 2004. Based upon economics, as well as fluoride retention rate, the decision was made to switch from mouth rinse to varnish. Beginning in September, 2011, Healthy Smiles Fluoride Varnish Program is expanding into the school system.  Healthy Smiles will be targeting schools 19 mouth rinse schools and 41 schools with a 50 percent or greater Free and Reduced-Price Meal rate. These schools are located statewide. The NDDoH Public Health Hygienists will provide direct services to students which have obtained signed parent-guardian consents. This service is free of charge and Medicaid or private insurance will not be billed at this time. Because of a recent rules change in North Dakota, hygienists are allowed to provide direct services within their scope of practice while working under the general supervision of a licensed dentist. The NDDoH Public Health Hygienists are able to provide direct services under a standing order implemented by a dentist employed as a temporary employee with NDDoH. 

Lessons Learned:

Program creation and implementation takes team work, collaboration from a variety of partners and patience. Gathering information from programs in other states (even though the laws vary from state to state) that have been operational for awhile is essential. Experience speaks loudly.

Be creative with your target population. Start small and hopefully you will experience slow and steady growth. When we offered healthy Smiles to the pediatricians and staff we had an overwhelming amount of interest, which is good; however we were unable to handle the large clinics and medical facilities due to financial and staff shortages. We stepped back, regrouped and learned early on that when you have a great service to offer, be prepared to handle the requests for training and implementation.

Contact Person(s) for Inquiries:

Kimberlie J. Yineman, RDH, BA, Director, Oral Health Program, Family Health Division, North Dakota Department of Health, 600 E. Boulevard Avenue, Department 301, Bismarck, ND 58503, Phone: 701-328-4930, Fax: 701-328-1412, Email: 

Robyn Stearns, Oral Health Prevention Coordinator, North Dakota Department of Health, 600 E. Boulevard Avenue, Department 301, Bismarck, ND 58505-0200, Phone: 701-328-4915, Fax: 701-328-1412, Email: