Dentist blog from Delta Dental

Tag: children’s dental health

Too few kids are getting fluoride treatments: What you can do

Dental fluoride treatments are among the most effective and efficient techniques for hindering tooth decay in children. But despite their proven effectiveness, and despite the fact that such treatments are often covered by insurance, too few children are getting them.

Very few privately insured young children receive recommended dental fluoride treatments at health wellness visits, according to a study published in the Journal of the American Medical Association (JAMA) Network Open. The study’s analysis of more than 328,000 well-child visits for privately insured 2- to 5-year-olds found that fluoride treatment was done in fewer than 5% of visits between 2016 and 2018.

Parental refusal and clinical intervention strategies

One common reason that children aren’t getting fluoride treatments is parental refusal. In a survey, nearly 80% of dentists said they believed fluoride refusal was a problem. In one study, refusal of fluoride was found to be correlated with refusal of vaccines, and as many as 51.5% of parents refused topical fluoride treatments.

“Tooth decay is the number one disease of early childhood, and fluoride plays a critical role in strengthening the enamel and preventing cavities,” said Dr. Jessica Buehler, Director of Dental Affairs at Delta Dental. “Unfortunately, in today’s world of information overload and patients getting their news through social media, there are many families that oppose or do not understand the value and importance of fluoride.” 

Reasons for parental refusal

Parental attitudes and beliefs about health are important determinants of fluoride refusal. Most common is the belief that fluoride is unsafe. Such concerns are often spread and amplified through social networks, the media and the internet. Other factors may include religious beliefs, a desire for autonomy and concerns about the true intent of fluoride treatments.

Clinical interventions

The following clinical strategies can help you improve communication with parents about topical fluoride treatments:

  • Assess parents’ knowledge, beliefs and attitudes early. Screen for possible fluoride hesitancy at the start of preventive visits by asking open-ended, non-judgmental questions, such as “Do you have any questions for me about fluoride?” This can help you assess beliefs and start a conversation.
  • Ensure your team is prepared. Make sure your staff of dental assistants and hygienists understands how fluoride works and why it’s important, as they will likely be the ones applying fluoride treatments. Acknowledge that parental refusal can be a problem and assure your staff that you are there to support them. “Auxiliary staff should not engage in an argument when a parent refuses fluoride,” suggested Dr. Buehler. “They should inform the dentist so that she or he can answer any questions the family may have.”
  • Obtain information about why parents are refusing fluoride. Avoid a pro-fluoride “sales pitch.” Instead, ask questions about what’s motivating a parent’s decision to opt out. Listening is key and can help build trust. Reassure the parent that you respect their health care decisions. Some parents may reconsider their decision after several discussions over time. Document conversations with parents so that future discussions can be framed appropriately.
  • Incorporate specific caries risk factors into discussions. Provide parents with an explanation of why fluoride is important based on the unique risk factors associated with each child. For instance, white spot lesions on the child’s teeth should be pointed out to the parent, with a description on how fluoride helps to prevent white spots from turning into cavities that require fillings.
  • Discuss alternative fluoride sources and behavioral strategies. Parents who refuse fluoride during dental and medical visits may be open to use of at-home fluoride products. Discuss alternative sources of fluoride that could be used at home, like fluoridated toothpastes and fluoride mouthwashes. Remind parents about the benefits and safety of fluoride in water. For parents who refuse all fluoride-containing products and water, emphasize that reducing dietary sugars and acids becomes even more critical in managing caries risk.

Fluoride treatments, your pediatric patients and you

Fluoride varnish is recommended by the U.S. Preventive Task Force and the American Academy of Pediatrics for all infants and children starting at tooth eruption through age five years. All children in this age category should receive fluoride varnish application at least once every six months, according to the recommendation. Most private insurers cover the procedure, and coverage with no cost-share for families is mandatory under the Affordable Care Act.

Most Delta Dental PPO™ and DeltaCare® USA plans cover fluoride treatments for children up to age 12, and many cover such treatments up to age 18, and for adults, as well. The specific codes for fluoride treatments are:

  • D1206 Topical application of fluoride varnish
  • D1208 Topical application of fluoride excluding varnish

Preventive dental care is important at any age, and we encourage you to give regular fluoride treatments to your pediatric patients. Developing a clinical workflow that includes fluoride application can greatly improve the oral health of children within your practice.

4 ways to help reduce patients’ fear of the dentist

Fear of visiting the dentist affects up to a nearly a quarter of people worldwide. It’s very likely that some of the patients you see every day are experiencing anxiety while they’re in your office. Here are four things you can do to help patients who are feeling afraid or stressed during visits.

Know the difference between anxiety and fear

When it comes to anxiety and fear, the difference is a matter of degree. Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure, according to the American Psychological Association. But phobia is a persistent, excessive, unrealistic fear of an object, person, animal, activity or situation. A patient that feels nervous about the prospect of needing fillings but is able to undergo the procedure has anxiety. In contrast, a patient that is so afraid of needing fillings that they won’t even go to the dentist’s office has phobia.

There are many reasons why patients might experience anxiety at the thought of going to the dentist. If they haven’t been in a while, they may be afraid of learning about potential problems they may have developed, like cavities or gum disease, or worried that they will be judged for their lax behavior, like not brushing, flossing or visiting the dentist more regularly. They may be concerned about the potential costs if they require extensive treatment.

You can help address some of the causes of mild anxiety by providing a supportive environment, not scolding patients for sub-optimum at-home care or offering flexible payment options for high-cost procedures. Patients with dental phobias, however, may require more in order to feel comfortable.

Know the underlying causes and signs of fear

When treating a patient who has dental phobias, it’s important not to take their fear personally. The stress and fear that they feel isn’t being caused by you, but by an underlying issue. Dental phobias can have many causes, such as:

  • Traumatic experiences with dental care or other forms of health care (making sure kids have a positive experience at the dentist is a great way to avoid fears later in life)
  • Generalized anxiety, depression or post-traumatic stress disorders
  • Fear of a loss of autonomy and control
  • Trust issues or fear of betrayal
  • Other fears, such as agoraphobia (fear of being in situations that might cause panic, helplessness or embarrassment) or claustrophobia (fear of enclosed spaces)

Patients who are experiencing high levels of fear or anxiety may exhibit the following signs:

  • Sweating
  • Visible distress, tension, crying or signs of panic
  • Inappropriate emotional responses, such as withdrawal, excessive humor or aggression

By being able to identify the signs of fear, you can help patients who may not openly express any emotional or physical discomfort they’re feeling.

Emphasize communication and put the patients’ needs first

Communication is essential when it comes to working with patients to help them overcome their dental anxiety. You can ask open-ended questions like “How are you doing?” to determine the severity of the fear and anxiety they’re currently experiencing. There are even standardized questionnaires such as Corah’s Dental Anxiety Scale (PDF) and the Modified Dental Anxiety Scale (PDF) that you can share with patients at the beginning of their visits to help identify the specific issues they might be feeling anxious about.

Once you know what patients are specifically afraid of, work with them to alleviate their fears.

  • For patients who would feel more secure knowing exactly what to expect during their visit, go slowly and explain what instruments you’ll be using and why.
  • For patients who would rather distract themselves while receiving care, you can keep tablets at your practice for streaming videos or music. You can also encourage patients to bring their own such devices.
  • For patients open to alternative methods of stress relief, try aromatherapy, weighted blankets, guided meditation or toys to keep their hands busy.
  • Finally, let patients know that nitrous oxide gas, oral sedation and IV sedation are available to put them in a more relaxed mental state. Note that your patients’ plans may not cover this usage of sedatives and it could increase their out-of-pocket costs.

Sometimes the patient needs more help than you can give them

Despite your best efforts, some patients may simply experience greater fear and anxiety than you can help them cope with. Sedation may help them to deal with pressing dental needs, but professional therapy may be necessary for them to overcome their fears of visiting the dentist. Patients may even prefer to see a therapist, as a study of dental patients with severe anxiety and fear, found that those patients reported feeling more comfortable with behavioral therapy than sedation.

For patients who want professional help overcoming their fear of dentistry, it may be helpful to develop relationships with psychologists and therapists near your office that you can recommend to patients. If you don’t know any, you can also refer patients to professional organizations like the American Psychological Association.

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