FAQs for dental staff

If you have further questions, you may find the General Frequently Asked Questions for Childsmile professionals helpful.

Question: NHS Boards have introduced local variation into the post titles of Childsmile staff. What is the national position in relation to this?

Answer: Several Boards have adopted the term Oral Health Support Worker as opposed to Dental Health Support Worker. This is an individual Board decision. However, all national resources and guidance will refer to the national post titles of Extended Duty Dental Nurse and Dental Health Support Worker.

Question: Can a dental practice deliver Childsmile interventions in the absence of a dental nurse who has undergone Childsmile training?

Answer: Yes. The Childsmile programme advocates a team approach to delivering a package of care that is tailored to the needs of the individual child. This should be delivered by the most appropriate member of the team.

Question: Can the dentist apply the fluoride varnish as part of the check-up as opposed to the Extended Duty Dental Nurse (EDDN)?

Answer: Yes. In many instances the dentist may find it quicker to apply the fluoride varnish as part of a check-up. However, most practices organise the EDDN to apply the fluoride varnish and deliver the oral health education sessions at interim visits to the child’s annual check-up.

Question: My practice does not have a Nurse who has undertaken the Childsmile training. Does the Dentist need to carry out Childsmile Interventions: toothbrushing demonstration, dietary advice, apply fluoride varnish interventions?

Answer: The SDR outlines the Childsmile interventions that are required to be delivered. These may be done by any member of the team who is appropriately trained dentist, hygienist/therapist.

Question: Is there any potential risk to the child in receipt of a further two fluoride varnish applications as part of the targeted Childsmile Nursery or Childsmile School programmes?

Answer: No. Childsmile aims to apply fluoride varnish four times a year to children at increased risk of developing dental caries. This dose is well within the safe limits for acute toxicity levels (even if two applications were on the same day) or chronic ingestion resulting in fluorosis.

Furthermore, most of the teeth and certainly the six anterior teeth, will have calcified by the age of 3.5 years. The optimum benefit would be four doses equally spaced throughout the year.

To read more about Fluoride varnish go to the Why use fluoride varnish? and Fluoride Varnish and Childsmile pages.

Question: Can a dental nurse run Childsmile sessions in practice and apply fluoride varnish if there is no dentist on the premises?

Answer: There may be some circumstances (often due to pressure on space) when a practice may find it more convenient to organise Childsmile sessions when a dentist is away and there is a free surgery. There is no reason why a dental nurse who has completed Childsmile training should not offer Childsmile sessions in these circumstances although it is important that there are always other staff who are in the premises who can provide support in the event of an emergency (see FAQ on emergencies).

Question: Is it alright to use a varnish other than Duraphat in my practice or am I restricted to using Duraphat alone?

Answer: Duraphat is the only fluoride varnish licensed for use as a preventive product in the UK so is always the varnish of choice in the Childsmile programme. If you choose to use another fluoride varnish (containing sodium fluoride 22,600 ppm) then you must have a sound clinical reason for doing so as you would be using it ‘off label’ and our advice is that, in those circumstances, you must give an explanation to the parent/guardian as to why you are using an ‘off label’ product and record this in the notes. You would also assume all responsibility for any adverse event associated with an alternative varnish – whether it is applied by a dentist or a suitably trained dental nurse.

It is likely that the main reason for considering the use of an alternative to Duraphat would be when a patient has an established allergy to colophony (a constituent of pink sticking plaster) and again, this should be clearly explained to the parent/guardian and recorded in the patient notes.

In the nursery and school setting the only fluoride varnish that can be used by Childsmile dental nurses is Duraphat.

Question: Are EDDNs who have undertaken the Childsmile course trained to manage dental emergencies?

Answer: Childsmile dental nurse training includes the management of common dental emergencies and each practice should also ensure that the General Dental Council principles are met, namely that:

  • at least two people are always available within the working environment to deal with medical emergencies when treatment is planned to take place; and
  • all members of staff (not just those team members registered with the General Dental Council) know their role if there is a medical emergency; and
  • all members of staff who might be involved in dealing with a medical emergency are trained and prepared to deal with such an emergency at any time, and practise together regularly in a simulated emergency so that they know exactly what to do.

Question: Are the arrangements for consent and non-parental supervision of children in Childsmile practice consistent with other areas of clinical care?

Answer: Young children will not be able to give consent to the application of fluoride varnish and they may at times be accompanied on a practice visit by another adult relative or friend. The important principle is that consent can only be given by a parent or legal guardian and practices should therefore always have suitable arrangements in place to ensure that this is obtained and updated as appropriate, whether the child is receiving preventive or clinical care.