Rinse Program:
Outline
Administrative Guidelines

Tablet Program:
Outline
Administrative Guidelines

King Fluoride
School-Based Tablet Program
Administrative Guidelines

Individual schools and county health departments should determine the best way to provide a school-based fluoride tablet program.

1. Prior to Implementing the Fluoride Program
   
   
   
   1. Conduct a Parent Interest Survey
      With the school principal's permission, conduct a parent interest survey before making a final decision on whether to implement the program. This will provide concrete figures to use when presenting the program for consideration. The survey can be sent home with each child to be completed by a parent or guardian and returned to the teacher. A volunteer can compile the survey results.
      
      
   2. Receive Administrative Approval
      Seek approval and support for the program from the school principal, district superintendent, and /or district nurse. Arrange a presentation to the school board, PTA, or faculty, as appropriate.
      
      
   3. Distribute and Collect Consent Forms
      Oregon Public Health provides permission forms. Copies can be made of a sample permission form, which is available in Spanish, Russian, and other languages. Send permission forms home with all children age three and up. Request all permission forms be returned. Only those children who return a permission form signed by a parent or guardian are allowed to participate in the program. A signed permission form should be kept in each child's file or health record for the current school year. Include a fluoride permission form as part of the registration materials for all new students throughout the year.
      
      Remember: only those children who are NOT taking fluoride supplements at home and who DO NOT have a fluoridated water supply are eligible for the school program. Children whose homes are served by private wells must have their water tested for fluoride levels before participating. (See list of approved testing laboratories.)
      
      
      
   4. Obtain a Fluoride Prescription
      In order to initiate the program, the Oregon Public Health Oral Health Program needs a "standing order" fluoride prescription signed by the county health officer, a dentist, a doctor, physician assistant, or nurse practitioner. A copy of this form must be sent to the Oral Health Program. The original should be kept on file in the school district office.
      
      
      
   5. Supplies and Storage
      Mail your supply order form to the Oral Health Program, or contact us by phone if you have any questions, (971) 673-0252. Fluoride tablets, program forms, and program documents are provided at no cost to the schools or students. Secure a suitable storage area in a locked room or cupboard that is out of the reach of children and is maintained at room temperature. In compliance with Oregon Occupational Safety and Health Code, a Material Safety Data Sheet must be kept on file in your school.
      
      
      
   6. Recruit and Train Volunteers
      School nurses, teachers, aides, or parent volunteers can be trained easily to carry out all procedures of the tablet program. All those who will be responsible for the distribution of the fluoride should be trained in the storage, dispensing, and treatment of overdose of the fluoride tablets. All training materials are provided by the Oregon Public Health, Oral Health Program. This training is in accordance with the Food and Drug Administration's Statement on School-Based Use of Various Fluoride Preparations issued by the Dental Products Advisory Committee. Faculty or other volunteers designated by the school and trained in the dispensing of fluoride preparations in a school-based setting are not liable in a criminal action or for civil damages if the fluoride is administered in good faith and pursuant to written permission by the student's parents or guardian. This is in accordance with ORS 339.870 section 2, chapter 144, Oregon Laws 1997.
      
      
      
   7. Prepare Participant Roster
      Prepare individual class rosters with the name of each student with signed permission for each class participating in the program. Recording students' daily participation is helpful when compiling program statistics, which is requested from each school once per year. (See example.)
   
   
   
   
2. Implementing the Fluoride Tablet Program
   
   
   1. Fluoride Dose
      Fluoride tablets are available in two different strengths and are dispensed according to a child's age. Please be sure to choose the appropriate strength for the ages of your students.
      
      

      When fluoride in water supply is less than 0.3 ppm*
      
      

      • Ages 5 and under — 0.5 mg fluoride (= 1.1 mg sodium fluoride)
        
        
      • Ages 6 and up — 1.0 mg fluoride (= 2.2 mg sodium fluoride)
        
        
      • All children in primary blended classes that include 5 year olds should receive 0.5 mg fluoride (= 1.1 mg sodium fluoride).
        
        
      • DO NOT USE BOTH STRENGTHS OF FLUORIDE IN ONE CLASS ROOM and NEVER double up on fluoride tablets if you miss one day.
      
      
      
   2. When to Dispense Tablets
      
      
      • Children may not eat or drink for 30 minutes following ingestion of the fluoride tablets, so dispensing tablets immediately after a snack or lunch is a good idea.
        
        
      • In order to establish a routine and to prevent disruption, it is recommended that the tablets be dispensed at the same time each day.
      
      
      
   3. How to Administer
      
      
      1. The procedure should be explained thoroughly each day for the first few days of the program. The supervisor should emphasize to the students that the fluoride solution/saliva produced in their mouth as a result of chewing the tablet should not be swallowed until they are so directed.
         
         
      2. The designated supervisor (teacher, health aide, teacher's aide, volunteer parent, etc.) distributes a tablet to each student who is participating in the program as follows.
         
         
         1. Wash and dry hands thoroughly before dispensing tablets.
            
            
         2. Dispense in such a manner that hand contact is minimized.
            
            
         3. Children should only touch the tablet which is going into their mouths. (See the following for ideas.)
         
         
         

         Over the years, we have had a lot of questions on how to dispense the fluoride tablets to students. Here are some ideas that may work for you.
         
         

         1. Pour a tablet into the bottle cap and drop into the appropriate student's hand.
            
            
         2. Pour tablets onto a tray or paper towel, spread out the tablets. Students file by and take a tablet, touching only their tablet.
            
            
         3. Glue small paper cups to heavy tag board, write a student name on each cup, put one tablet in each cup.
            
            
         4. Use plastic ice cube trays, have one child's name in each cube space, put one tablet in each cube.
            
            
         5. Use an egg carton with one child's name on each hole to keep the tablets separate.
         
         
         
         
      3. Students put the tablet in their mouths at the same time and begin chewing for 30 seconds.
         
         
         
      4. The supervisor then signals the students to forcefully strain the resultant solution (tablet dissolved in saliva) between their teeth for 30 seconds.
         
         
         
      5. At the end of the one-minute chewing/swishing procedure the students are directed to swallow the solution.
         
         
         
      6. Should you forget one day, do NOT under any circumstances give students two tablets the next day to make up for the lost day. Give only one tablet per participating student per day.
         
         
         
      7. Remind the children not to eat or drink for 30 minutes.
         
         
         
      8. Record participation on the fluoride tablet participation record.
         
      
      
      
   4. Suspected Overdose
      

      All those who will be responsible for the distribution of the fluoride should be familiar with the procedure for overdose of fluoride tablets. A copy of the Treatment for Overdose of Fluoride Tablets should be available in each room where the tablets are distributed or stored.

      
      
      
      1. In the event that a child takes more than the recommended dose of fluoride, call the Poison Control Center, (503) 494-8968 or (800) 452-7165.
         
         
         
      2. If possible, tell Poison Control if it was 1.1 mg sodium fluoride (kindergarten dose) or 2.2 mg sodium fluoride. Also, if known, tell Poison Control the number of tablets taken and the approximate weight of the child.
         
         
         
      3. Report the incident to Oregon Public Health, Oral Health Program, (971) 673-0252.
      
      
      
   5. Valuable Health Promotion Program
      The Fluoride Tablet Program is an excellent example of a wellness program designed to teach students the benefits of prevention and healthy practice in their own lives. In order to develop a model for appropriate use, we request that the following points be emphasized as you present the program to the students:
      
      
      1. When taken as directed, fluoride tablets are helpful in preventing cavities.
         
         
      2. The tablets are to be dispensed only by a responsible adult.
         
         
      3. The tablets are being taken only with the consent of a parent or guardian.
      
      
      
      
   6. Toothbrushing
      Toothbrushing is not necessary before using the tablets. One toothbrush is provided once a year for each child who participates in the fluoride program. Some schools have a daily toothbrushing program; other schools use the toothbrushes as a reward to students for returning their permission forms.
      
      
      
   7. Classroom Oral Wellness Education
      Oregon Public Health, Oral Health Program has age-appropriate teaching materials and videos available for loan. If you would like more information, please call (971) 673-0252.

For More Information

• If you have questions about the tablet program, please contact (971) 673-0252.
  
  
• In compliance with Oregon Occupational Safety and Health Code, a Material Safety Data Sheet is available by calling (971) 673-0252.
  
  
• Oral health consultants are available in some areas, through Oregon Public Health, to provide oral health education presentations on various subjects and can help initiate a fluoride program in your school. Contact us to find out if a consultant is available in your county.

Thank you for your efforts and commitment to oral health in your community.

Adapted from the Multnomah County School/Community Dental Health Programs Tab Guide, October 1999.