WEEKLY FLUORIDE MOUTHRINSE MANUAL FOR ELEMENTARY SCHOOLS IN UTAH

Transcription

1 WEEKLY FLUORIDE MOUTHRINSE MANUAL FOR ELEMENTARY SCHOOLS IN UTAH A Guide and Training Manual for Mouthrinse Coordinators and Volunteers

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3 UTAH DEPARTMENT OF HEALTH W. David Patton Ph.D Executive Director DIVISION OF COMMUNITY AND FAMILY HEALTH SERVICES George W. Delavan, M.D., M.P.H. Director ORAL HEALTH PROGRAM Steven J. Steed, D.D.S. Dental Director Revised by: Michelle Martin RDH, MPH Oral Health Specialist UDOH 2011 FOR MORE INFORMATION CONTACT: Utah Department of Health Division of Community & Family Health Services Oral Health Program 288 North 1460 West PO Box Salt Lake City, Utah Telephone: (801)

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5 PREFACE A FLUORIDE MOUTHRINSE PROGRAM BECAUSE FLUORIDE IS THE MOST IMPORTANT PART OF PREVENTIVE DENTAL HEALTH *Fluoride is effective Tooth decay among U.S. children has decreased dramatically. In large part, this is due to the widespread use of fluoride. Fluoride heals weak areas of the tooth enamel, making it resistant to decay. It also slows down bacterial action which may cause decay. Fluoride can be incorporated in several manners: daily fluoride drops and tablets, fluoridated community water systems, some foods contain very small amounts of fluoride, toothpaste, self-applied daily or weekly rinses, and professionally applied gels and varnishes. The variety of sources for fluoride are complementary to one another providing balance for good dental health. Fluorides may reduce dental decay in children by as much as 80%. A weekly fluoride mouthrinse program alone reduces cavities by an average of 30%. The weekly mouthrinse does not replace the benefits of fluoridated water systems or daily fluoride tablets, nor does the mouthrinse replace fluoride toothpaste or professional fluoride applications. *Fluoride mouth rinse is efficient and safe The rinsing program is simple for school children to learn and to do. The procedure is easily supervised by parent volunteers, teachers or teachers' aides. The amount of fluoride in a single application is so small, no ill effects will be felt if, by mistake, a child swallows the mouthrinse. *Fluoride mouth rinse is inexpensive The cost is between $2.00 and $4.00 per school year for each child. In contrast, a daily home mouthrinse program would cost approximately $35.00 per school year per child.

6 TABLE OF CONTENTS PREFACE i TABLE OF CONTENTS..... iii LAYING THE FOUNDATION How to Establish a Fluoride Mouthrinse Program Gaining Support for a Fluoride Mouthrinse Program Sample Parent Interest Survey, Form GETTING STARTED Fluoride Mouthrinse Systems Ordering The Fluoride Mouthrinse Materials Sample Parent Consent Form, Form Fluoride Mouthrinse School Roster, Form Fluoride Mouthrinse Class Roster, Form Volunteer Training Workshop CONDUCTING THE RINSE Suggestions for Successful Rinsing Preparing for The Mouthrinse Session Conducting The Mouthrinse Session Emergency Procedures APPENDICES Appendix A Fluoride Mouthrinse Suppliers Appendix B Sources of Information Appendix C Volunteer Training Exam and Answer Key Appendix D Fluoride Mouthrinse Volunteer Certificate

7 LAYING THE FOUNDATION HOW TO ESTABLISH A FLUORIDE MOUTHRINSE PROGRAM 1. IDENTIFY A PROGRAM COORDINATOR FOR YOUR SCHOOL Many of the PTA Health Commissioners also serve as the mouthrinse coordinators. School nurses, teachers and school staff may be chosen as the coordinators. 2. INFORM AND RECRUIT PARENT VOLUNTEERS A cover letter with a written description of the program, a consent form, a volunteer sign up sheet and Fluoride Does Work and Questions Parents Ask handouts may be sent home with the students on the first day of school. The success rate on returns seems to be highest by sending out the information with the registration packets. Several rinsing administrators to supervise actual rinsing procedure with the children will probably be needed depending on the size of the school. It is suggested that someone be available to explain the program and answer questions at the Back to School Night or at a PTA meeting. In seeking volunteers, don't overlook the fathers. 3. PREPARE CONSENT FORMS Consent forms must be signed by a parent or guardian in order for a child to participate in the program. The forms are printed on school stationery. If ample forms are prepared, there will be a supply on hand for second notices and for children who enroll in the school later in the year. 4. PLACE AN INITIAL ORDER FOR SUPPLIES AND SECURE ADEQUATE STORAGE SPACE Decide which fluoride mouthrinse system will be used and place an initial order for supplies to cover the estimated needs of the program for the first three months. The Unit Dose system is recommended because of its convenience and greater teacher acceptance. The traditional mix and pump system has the advantage of a slightly lower cost. In either case, it will be necessary to secure storage space. A suitable storage area is a room which can be locked and is maintained at room temperature. Supplies are never kept in the classroom. (See Appendix A, page 20) 5. DISTRIBUTE AND COLLECT CONSENT FORMS A child must have a permission slip signed by a parent or guardian in order to participate in the mouthrinse program. The signed permission forms are kept on file at the school. A phone follow-up may be necessary for those parents who fail to return the written materials in the allotted time. (See Sample Parent Consent form, page 10)

8 6. PREPARE PARTICIPANT ROSTERS There are two rosters which need to be accurately completed. The school roster lists grades rinsing, teacher names, the rinsing administrators in each classroom and numbers of students rinsing and not rinsing. The individual class roster lists the names of participating students in each classroom. Copies should be kept by the coordinator and by the school office as well as each rinse administrator. The rosters are kept current to avoid any confusion in the classrooms on rinse days, especially if a substitute rinsing administrator conducts the rinse. (See School Roster and Class Roster, pages 11 and 12) 7. DETERMINE A TIME AND PLACE TO HOLD THE MOUTHRINSE The coordinator will want to work closely with the principal and teachers to determine the best time and place to hold the mouthrinse. Although there are several locations in the school where a rinse may be held, time can be saved and confusion avoided if it is held in the classrooms. 8. ORDER SUPPLIES TO COMPLETE THE SCHOOL YEAR Place an order based on the number of collected permission slips. Although the shelf life of the Unit Dose is approximately one year, Medical Products Laboratories will ship large orders in partial shipments over the year allowing an extension of expiration dates and reducing the storage space requirements. If possible, order enough supplies to accommodate new students who may wish to start the program. Any supplies left over at the end of the school year may be used to start the program the following year. 9. HOLD A VOLUNTEER TRAINING WORKSHOP A training workshop for parent volunteers, teachers and other school personnel involved in the program is essential. It is recommended that each participant read the Weekly Fluoride Mouthrinse Manual before attending the workshop. A training workshop is held annually so that all volunteers can be certified yearly. Certification consists of having the volunteers take the examination found in Appendix C of this manual (See page 25), correcting and clarifying their errors with the trainer, and placing their certificate in the school office files. (See page 28) 10. REHEARSE THE PROCEDURE WITH THE STUDENTS Prior to the first rinse day, describe the rinsing procedures to the students and explain the benefits of the mouthrinse. It may be helpful, particularly for younger children, to practice rinsing with water until they can demonstrate rinsing without swallowing.

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10 GAINING SUPPORT FOR A FLUORIDE MOUTHRINSE PROGRAM Being well informed is the best way to gain and maintain support for your school fluoride mouthrinse program. The following is a discussion of issues frequently raised when the program is presented for consideration. This information goes beyond the when, where and how of conducting the rinse. For more information contact your local health department or the Oral Health Program at the Utah Department of Health. (See Appendix B, page 22) * Programs such as this belong at home. They are the parents' responsibility rather than the schools'. It is the responsibility of parents to provide for the dental health of their children. By supporting a school mouthrinse program for their children, parents are able to address this responsibility in a very inexpensive, efficient and effective way. A school-based weekly fluoride mouthrinse program has the following advantages: It costs $2.00 to $4.00 depending upon the system used, compared with $35.00 per child per school year for a daily home-based fluoride mouthrinse. It achieves the same reduction in decay as a daily home mouthrinse program. It is easily administered by volunteers. It reaches those children who may not be getting proper home or professional care. * My child gets fluoride at home. Isn't that enough? Usually when parents make this statement they are referring to fluoride drops or tablets. Fluoride mouthrinses, toothpastes and professionally applied gels and varnishes provide additional benefit. Therefore, a child receiving a daily fluoride tablet or fluoridated water still benefits from fluoride mouthrinses. A variety of sources combines for good dental health.

11 * I don't pay taxes to have a teacher use classroom time to give fluoride. When teachers or other school personnel supervise the rinse procedures, they do more than merely administer the mouthrinse. They are helping their students increase dental health awareness. The five minutes spent rinsing each week provides an excellent "teaching time" for dental health. If parents and school personnel feel strongly that the program is not an appropriate usage of school time or personnel, the program can be administered by volunteers outside of classroom time. Though it is more difficult to do so, the rinse may be conducted before or after school or during recess. * My dentist told me that the rinse is not effective if the teeth have not been brushed beforehand. Most of the mouthrinse studies that serve as the basis for the American Dental Association's acceptance of this method of topical fluoride application were done without prior teeth cleaning. Many researchers feel that plaque may help bind the fluoride rinse solution to the tooth surfaces, making prior teeth cleaning contraindicated. A 25% reduction in dental decay has been documented without prior teeth cleaning. For more information see: * My dentist said the problem now is decay on the chewing surfaces of the teeth where fluoride is not as effective. It is true that placing sealants on the chewing surfaces of the back teeth is the most effective method of preventing cavities that occur in pits and fissures of the molar teeth. It is also true that regular use of topical fluorides provides continuous and effective protection for the smooth surfaces of all the teeth. One preventive measure cannot be singled out at the expense of the other. It takes a total dental prevention program to insure cavity-free teeth. * I am concerned about my child swallowing the mouthrinse solution. If established protocols for administering the rinse are carefully followed, there is little danger that the rinse will be swallowed. If, however, the rinse is occasionally swallowed, your child is in no danger. The amount of fluoride ingested would be well within the range which is safely tolerated.

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13 SAMPLE PARENT INTEREST SURVEY Dear Parent, More than 25 years ago, the Utah Department of Health initiated a fluoride mouthrinse program for Utah's elementary school children. Since that time, administrators, teachers, PTA members and interested parents working together to implement fluoride mouthrinse programs, have played an important role in greatly improving the dental health of thousands of Utah children. A fluoride mouthrinse program for preventing tooth decay compliments other uses of fluoride for cavity prevention. Fluoride is known to reduce decay in children up to 80%. A weekly topical fluoride mouthrinse alone reduces cavities by an average of 25%. A school-based fluoride mouthrinse, costing between $2.00 and $4.00 per child per year, achieves the same reduction in decay as a daily, home-based rinse program costing about $35.00 per child per year. The school mouthrinse does not eliminate the need for other dental health measures. Daily fluoride drops or tablets are still needed until age 16 when all of the permanent teeth are completely formed. Additionally, brushing with a fluoride toothpaste, professionally applied topical fluoride treatments and placement of sealants in the permanent molars are essential in a total dental health program. The school mouthrinse program is safe, effective and easy to learn. Participants, with parental permission and under the supervision of trained volunteers, rinse their mouths for one minute each week with a 0.2% neutral sodium fluoride solution. As a PTA, we need your help in assessing parent interest in a Weekly Fluoride Mouthrinse Program. Please complete the section below and return it to your child's teacher by (date). Sincerely, THIS IS NOT A PERMISSION SLIP Please check all that apply. I am in favor of a fluoride mouthrinse program at my child's school. I am willing to pay $ per child per year for the program. I am not in favor of a fluoride mouthrinse program at my child's school. Name

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15 GETTING STARTED FLUORIDE MOUTHRINSE SYSTEMS Two systems are available. Both are 0.2% sodium fluoride solutions and are equally effective in reducing decay. The Unit Dose Mouthrinse System This system of fluoride mouthrinse comes premixed and premeasured in individual cups of 0.2% sodium fluoride solution. It completely eliminates the chore of mixing and pumping the sodium fluoride solution. The materials required for the Unit Dose system include individual units of five ml or ten ml mouthrinse, napkins and trash bags. Advantages Time is saved by eliminating the need to mix and pump the rinse. Teacher acceptance increases and volunteer morale is improved. Safety increases because there is no fluoride powder on hand. Waste of unused solution is eliminated. Disadvantages Cost is slightly higher than the Mix and Pump System. More storage space is required than for the Mix and Pump System. The Mix and Pump Fluoride Mouthrinse System This system of providing fluoride mouthrinse requires a trained volunteer to mix the sodium fluoride powder with water in a jug according to manufacturer's directions. After the solution is mixed, the volunteer pumps the solution into individual cups using a calibrated pump. The materials required for this system include 100% sodium fluoride powder packets, mouthrinse jugs with child-proof caps, calibrated five ml and ten ml pumps, disposable cups, napkins, and trash bags. Advantages Cost is less than the Unit Dose System. Long shelf-life of the packets of sodium fluoride powder allow annual shipments. Little storage space is required. Disadvantages Mixing and pumping of doses lengthens preparation time. Limited shelf-life of mixed solution, about three weeks. The concentrated powder is a potential safety hazard. Nevertheless, the remarkable safety record, with no reported accidents, should be noted.

16 ORDERING THE FLUORIDE MOUTHRINSE MATERIALS Initial Order As soon as it has been determined which system will best meet the needs of your school and which company you will purchase your supplies from, prepare to make an initial order. Regardless of which system you are using, order supplies for three months, based on your best estimate of the number of students who will participate. (See Appendix A, page 20) Full Order Once the consent forms and monies are collected, a full supply order may be placed to last the remainder of the year. If the Unit Dose from Medical Products Laboratories is being ordered, it is possible to request that the supplies be sent in partial shipments. If possible, include enough product in the last shipment to provide for the start of the next school year. Placing the Order Orders should be made directly with the manufacturer and may be placed by phone. Your supplies will be delivered C.O.D. from 4 to 6 weeks after the order is received by the company. When placing the order, confirm the price of the product, request a quote of shipping rates, and confirm how payment will be handled. The manufacturer will need the following information: Name of School Billing Address Shipping Address Number of Kindergarten Children Participating Number of First to Sixth Grade Children Participating Total Number of Children Participating If using the Mix and Pump System, designate the supplies you will need: Jugs: 5 ml pumps: 10 ml pumps:

17 Yes to FLUORIDE MOUTHRINSE Fluoride hardens the teeth already in the mouth, thereby making them more resistant to tooth decay. Fluoride can repair the earliest stage of decay before it turns into a cavity that needs to be filled. Tooth decay, although on the decrease, is still the most common chronic disease affecting school age children. Using fluoride may reduce dental decay in children by as much as 80%. Weekly fluoride mouthrinsing alone reduces cavities by 25%. Children, whether getting fluoride at home or not, can benefit from the mouthrinse. The school is offering this preventive program and encourages your child s participation. Please complete the form below and return to the school immediately. YES I would like my child to participate in the fluoride mouthrinse program. I am donating $ for the cost of the fluoride mouthrinse for one year. No I would not like my child to participate in the fluoride mouthrinse program. Child s Name Last First Middle Child s Date of Birth Teacher s Name Month / Day / Year Parent Signature Date VOLUNTEERS to be trained to administer the mouthrinse are vital to the success of the program. If you are willing to help, please fill in your name and a phone number where you can be reached. Name Phone

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19 FLUORIDE MOUTHRINSE SCHOOL ROSTER POST ORIGINAL IN THE CENTRAL PREPARATION AREA, COPIES TO THE SCHOOL OFFICE AND COORDINATOR'S NOTEBOOK. FLUORIDE MOUTHRINSE CLASS ROSTER School School Year Room Number Grade Teacher In the columns below, list the participants and non-participants alphabetically. Update the list as changes occur. Indicate the actual number who rinse each week in the appropriately dated box. Teacher Grade Room # Administer #students #rinsing #not rinsing

20 VOLUNTEER TRAINING WORKSHOP It is important that all those who have some responsibility with the mouthrinse program receive adequate training. The mouthrinse coordinator or an appointed volunteer is responsible to arrange for and conduct the training workshop for mouthrinse administrators. The mouthrinse procedures are easily learned and can be administered by non-dental adult personnel. Students may NOT prepare, distribute or supervise the mouthrinse. It is suggested that each volunteer read the Weekly Fluoride Mouthrinse Manual before attending the Training Workshop. When they have completed the training, volunteers are invited to take a Volunteer Training Exam and receive Fluoride Mouthrinse Volunteer Certification. (See Appendix C and D, pages 24-28) Suggestions for the Agenda I. An Overview of a Weekly Fluoride Mouthrinse Program A description of the school s program presented by the Oral Health Program, Local Health Department or the Mouthrinse Coordinator. 2. Preparing for a Mouthrinse Session A discussion about the preparation procedures presented by the Mouthrinse Coordinator. 3. Conducting a Mouthrinse Session A discussion about conducting a mouthrinse session presented by the Mouthrinse Coordinator. 4. Volunteer Duties A description and demonstration of volunteer duties presented by the Mouthrinse Coordinator, followed by the making of volunteer assignments. 5. Questions and Answers 6. Administration of the Volunteer Training Exam, followed by Certification Checklist for Preparation 1. Date, place and time for the meeting arranged and publicized 2. Tables for rinsing materials 3. Rinse materials 4. Sample rosters 5. Weekly Fluoride Mouthrinse Manuals 6. Pens or pencils for the exam

21 CONDUCTING THE RINSE SUGGESTIONS FOR SUCCESSFUL RINSING 1. In order to minimize confusion, hold the mouthrinse on the same day and at the same time each week. By selecting Tuesday, Wednesday or Thursday the increased absenteeism occurring on Mondays and Fridays can be avoided. 2. Hold the mouthrinse at a time when it is unlikely that the children will eat or drink during the next 30 minutes. The first thing in the morning or just after lunch are good times. 3. When conducting the rinse, limit the number of participants to 30 at a time for each mouthrinse administrator. For best efficiency, conduct the rinse in the classroom, where there are groups of about 30 students. The classroom rinse takes less time than the rinse held outside of the classroom. It also nearly eliminates the problem of avoidance and allows for more accurate record keeping. 4. Carefully monitor the timing and the procedure during each rinse session. Because it is essential that the children rinse for one minute, it is important that they start and finish together. In addition, best results are realized if they forcibly swish the rinse in their mouths rather than shake their heads. 5. Time goes more rapidly for the children if they can see the hand on a clock or timer. "Talking" the children through the rinse by discussing fluorides, good snacks, dental visits and brushing and flossing may also help keep their minds on rinsing. 6. A successful mouthrinse program is built on a cornerstone of volunteer coordinators and mouthrinse administrators who generate enthusiasm. Being well informed is the best way to motivate others. Know what the program is, how it works, and why it is effective.

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23 PREPARING FOR THE MOUTHRINSING SESSION The Procedure for Schools Using the Unit Dose System Referring to the school mouthrinse roster in the central preparation area, prepare and deliver a mouthrinse tray to each participating classroom. Include a unit dose cup and a napkin for each participating child and a plastic waste bag. Identify the tray with the teacher's name and room number. If the rinse is held in a central area, deliver the supplies for all of the participants to a rinse table or cart in the central rinse area. Consult the individual class rosters to make sure only children with permission to rinse are in the area. The Procedure for Schools Using the Mix and Pump System The preparation of the mouthrinse does not take place in the area where the rinse is conducted. The best place to prepare, mix and pump into individual cups is in the area where supplies are stored. 1. In a central preparation area, mix the fluoride in the polyethylene jugs according to the manufacturer's directions which appear on the powder packets and on the jugs. A three gram packet of powder dissolved in 1500 ml (1 1/2 quarts) of water will provide 300 five ml rinses. The correct amount of rinse for kindergarten children is five ml. A three gram packet dissolved in 1500 ml of water will provide 150 ten ml rinses. The correct amount for the children in grades one through six is ten ml. 2. Fill the jug with the correct amount of water and add the sodium fluoride powder. Secure the child-proof cap and shake to thoroughly dissolve the powder. 3. Remove the cap and insert the five ml pump or the ten ml pump. Tighten the cap and pump one dose to prime. Discard the first dose of solution. The correct amount is measured by one stroke of the pump. 4. Referring to the school roster, prepare and deliver a classroom rinse tray for each participating classroom. Include a pre-filled mouthrinse cup and a napkin for each participant and include a plastic waste bag. Identify the tray with the teacher's name and room number. If the rinse is held in a central area, deliver the supplies for all participants to a rinse table or cart in the central rinsing area. Consult the roster to make sure only children with permission to rinse are in the area.

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25 CONDUCTING THE MOUTHRINSING SESSION If the mouthrinse is being conducted in the classroom, the classroom tray may be left in the room and the teacher may conduct the rinse when it is convenient. 1. Check the roster to identify the participating students. 2. Distribute a napkin and a cup containing mouthrinse solution to the participating students and instruct them to wait for the signal to begin. If the unit dose is being used, have the students remove the pull-tab lid. 3. Instruct the children to empty the contents of the cups into their mouths, then give the signal to swish their mouths forcefully for one minute. 4. At the end of one minute, instruct the students to spit the solution back into the cups, wipe their mouths with the napkins and slowly stuff the napkins into the cups. 5. Collect the used cups and napkins in the plastic waste bags provided. If a child accidentally swallows the weekly portion of rinse, there should be no adverse reaction. Children who repeatedly swallow the rinse should be given a water rinse until they demonstrate that they are able to rinse without swallowing. Note: Fluoride mouthrinsing is not recommended for children under five years of age or for any child with an uncontrolled swallowing reflex because of their inability to rinse without swallowing. EMERGENCY PROCEDURES In the event that a student ingests large quantities of fluoride mouthrinse concentrate or several cups of Unit Dose: DO NOT INDUCE VOMITING CALL THE POISON CENTER Call the Poison Center in Salt Lake City at 1 (800) Be prepared to give information on the child's weight, general health, the amount ingested, and the fluoride concentration which is.2% Sodium Fluoride.

26 FLUORIDE MOUTHRINSE SUPPLIERS APPENDIX A Unit Dose Fluoride Mouthrinse System Medical Products Laboratories 9990 Global Road Philadelphia, PA (215) (800) (Geri at Ext. 126) All the supplies needed including individual unit dose cups of plain or flavored premixed 0.2% sodium fluoride in five ml or ten ml cups, napkins and trash bags. The shelf-life is approximately one year. The minimum order is one case containing a 288 doses - a 32 week supply for nine students. Pharmascience Inc ch. Darnley Rd. Montreal, Quebec (514) Fax: (514) H4T 1M4 All the supplies needed including individual packets of plain or flavored premixed 0.2% sodium fluoride in five ml or ten ml doses. The shelf-life is two to three years. Minimum order is one case containing a 32 week supply for nine students. Mix and Pump Fluoride Mouthrinse System Medical Products Laboratories 9990 Global Road Philadelphia PA (215) (800) (Geri at Ext. 126) All the supplies needed including sodium fluoride powder for mixing plain or flavored and colored solution, polyethylene containers, five ml and ten ml plastic pumps, cups, napkins and trash bags. The sodium fluoride powder has a shelf-life of several years. The mixed solution has a shelf-life of about three weeks. Colgate-Hoyt Laboratories One Colgate Way Canton, MA (800) Ready to use sodium fluoride solutions flavored and colored, containers and pumps. Be a wise consumer; comparative shop. Contact the individual companies for product information and price, including shipping costs, then choose.

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28 APPENDIX B SOURCES OF INFORMATION I. LOCAL HEALTH DEPARTMENT Each school is served by a district or county health department. The health department serving your school should be the school's primary source of consultation and information. District Counties Served Phone Bear River Box Elder, Cache, Rich (435) Central Juab, Millard, Piute (435) Sanpete, Sevier, Wayne Davis County Davis (801) Salt Lake Valley Salt Lake (801) Southeastern Utah Carbon, Emery, Grand, (435) San Juan Southwestern Utah Beaver, Garfield, Iron, (435) Kane, Washington Summit County Summit (435) Tooele County Tooele (435) Tri-County Daggett, Duchesne, Uintah (435) Utah County Utah (801) Wasatch City-County Wasatch (435) Weber-Morgan Weber, Morgan (801) II. UTAH DEPARTMENT OF HEALTH Division of Community & Family Health Services Oral Health Program 288 North 1460 West PO Box Salt Lake City, Utah Phone: (801) III. THE NATIONAL CARIES PROGRAM National Institute of Dental Research Westwood Building, Room Westbard Avenue Bethesda, Maryland 20205

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30 APPENDIX C VOLUNTEER TRAINING EXAM To demonstrate your understanding of the school fluoride mouthrinse program, answer the following 21 questions. Circle the letter/letters corresponding to your answer. 1. The single most effective way to prevent dental decay in children is by: a. daily brushing and flossing. b. cutting down on sweet snacks. c. using fluorides routinely. d. visiting the dentist regularly. 2. The weekly sodium fluoride mouthrinse solution is: (choose two) a. meant to be swallowed. b. placed directly on the teeth. c. an effective tooth whitener. d. temporarily incorporated into the outer tooth surface. 3. A weekly sodium fluoride mouthrinse can benefit: a. children drinking fluoridated water. b. children taking a daily fluoride tablet. c. children brushing daily with a fluoride toothpaste. d. children currently not using fluoride products. e. all of the above. 4. The sodium fluoride rinse is recommended for: a. preschool aged children. b. children 5 years and older. c. all children regardless of age. 5. Research has proven that the weekly 0.2% rinse reduces cavities by: a. 15%. b. 25%. c. 80%. 6. Mixed sodium fluoride rinse must be: a. kept refrigerated to prolong the shelf life. b. stored in the polyethylene jugs capped with child-proof lids. c. used within three months. 7. Mixed sodium fluoride rinse and sodium fluoride packets: a. may be stored in any dry storage area. b. may be stored in the classroom out of reach of students. c. must be stored in a locked, central storage area. 8. The unmixed sodium fluoride packets: a. must be stored at room temperature. b. will keep for years when stored properly. c. can safely be stored in a classroom. d. a and b.

31 9. The rinse should be pre-mixed at a central area: a. if the students will be rinsing in another central area. b. if the students will be rinsing in their classrooms. c. a and b. 10. For students rinsing in the classroom, it is recommended that: a. a jug of rinse may be pre-mixed and delivered to the classroom to be stored and dispensed later in the day at the teacher's convenience. b. only a classroom tray with enough prefilled cups and napkins for the number of participants should enter the classrooms. c. a teacher store, mix and dispense the mixed rinse solution and sodium fluoride packets in his or her classroom. 11. A child may participate in the rinse only if: a. the parent has given verbal permission. b. a signed parent consent form is on file. c. a timer with a minute hand is available. 12. Time the rinse for a full: a. 30 seconds. b. 60 seconds. c. 90 seconds. 13. If possible, the children should not eat or drink after rinsing, for: a. 30 minutes. b. 60 minutes. c. 90 minutes. 14. When supervising the rinse, it is recommended to limit the group rinsing to: a. 30 students per mouthrinse administrator. b. 60 students per mouthrinse administrator. c. 90 students per mouthrinse administrator. 15. While rinsing, students should be instructed to: a. move their lips and cheeks vigorously. b. shake their heads back and forth vigorously. c. merely hold the rinse in their mouths. 16. Once the timed rinse is over, instruct the students to: a. return the solution to their cups. b. orderly file past a sink to discard the solution. c. swallow the rinse. 17. If a child accidentally swallows the weekly portion of rinse once: a. report the incident immediately to proper medical authorities. b. there should be no adverse reaction. c. have the child practice with a water rinse until he or she demonstrates the ability to rinse. d. b and c. e. all of the above.

32 18. In the unlikely event of an extreme overdose: a. induce vomiting. b. call poison control and follow instructions. c. ask the child if he ll be OK until he gets home. d. all of the above. 19. When distributing the rinse, each participant: a. should receive a pre-filled rinse cup or Unit Dose and napkin. b. should be instructed to start and stop rinsing with a timed group. c. should be instructed not to eat or drink for half an hour if possible. d. should be reminded not to swallow the rinse. e. all of the above. 20. Students may help: a. mix the rinse. b. dispense the rinse. c. supervise the rinse. d. all of the above. e. none of the above; all volunteers must be trained adults. 21. A total dental health preventive program includes: a. fluoride obtained from fluoridated water, tablets, or drops. b. fluoride applications from toothpastes, mouthrinses, or professionally applied fluoride gels and varnishes. c. daily brushing and flossing. d. regular dental examinations. e. placement of sealants in the permanent molars. f. all of the above The Answer Key is on page 19.

33 ANSWER KEY 1. c Using fluorides routinely can reduce decay by as much as 80%. 2. b & d The weekly sodium fluoride solution is placed directly on the teeth. It is then temporarily incorporated into the outer tooth surface. 3. e All children can benefit from fluorides. 4. b Fluoride mouthrinsing is not recommended for children under five years of age or for any child with an uncontrolled swallowing reflex. 5. b Research has proven that weekly rinsing with a 0.2% sodium fluoride solution reduces cavities by 25%. 6. b Mixed sodium fluoride rinse must be stored at room temperature in the polyethylene jugs capped with child proof lids. It has a three week shelf life. 7. c Fluoride powder packets and jugs of mouthrinse belong in a locked central storage area, not in the classroom. 8. d Sodium fluoride packets will keep for years at room temperature. They must be stored in a locked central storage area, not in the classroom. 9. c The rinse should be mixed at a central area so that large amounts of rinse do not enter the rinse area. 10. b It is recommended that a rinse tray for each participating classroom be prepared at a central area so a jug of rinse will not be stored in the classroom. 11. b A child may participate only if a signed parent consent form is on file. 12. b The rinse should be timed for one full minute. 13. a Whenever feasible, the children should not eat or drink for 30 minutes after rinsing. 14. a It is recommended that only 30 students per supervisor rinse at one time. 15. a Participants should be encouraged to use their lips and cheeks to move the solution and be discouraged from merely holding the rinse in their mouths or just shaking their heads back and forth. 16. a The rinse should not be swallowed. The children should return the solution to their cups, wipe their mouths with napkins and then stuff the napkins into the cups to absorb the solution. 17. d If a child accidentally swallows the weekly portion of rinse, there should be no adverse reaction. But any child who repeatedly swallows the rinse should be given a water rinse until they demonstrate that they are able to rinse. 18. b Call poison control and be prepared to give them information on the child s weight, quantity taken and strength of fluoride. Follow Instructions! 19. e As participants are handed a pre-filled rinse cup and napkin, they should be instructed to wait and rinse with a timed group. They should be reminded not to swallow the rinse or eat or drink for half an hour after. 20. e Only trained adults can prepare or administer the rinse. 21. f All of the above. Congratulations! Your volunteer work for the Weekly School Fluoride Mouthrinse Program will make a valuable contribution to the good dental health of Utah's children.

34 APPENDIX D FLUORIDE MOUTHRINSE VOLUNTEER CERTIFICATE FLUORIDE MOUTHRINSE VOLUNTEER CERTIFICATION I,, certify that I have read and understand the material covered in the Weekly Mouthrinse Fluoride Manual Including: proper techniques for storing, mixing and dispensing the fluoride mouthrinse materials and the guidelines for distributing and supervising the rinse. VOLUNTEER'S SIGNATURE DATE COORDINATOR'S SIGNATURE DATE