Weekly Fluoride Mouthrinse Program

Dear Parent:

The Iowa Department of Public Health is providing direction and materials to conduct a preventive dental health program at Northeast Hamilton School for children in grades 1 through 5.

The children will be involved in the initiation of the “Catch a Smile” fluoride mouthrinse program. Each week, under supervision, the children will rinse with a 0.2% sodium fluoride mouthrinse. In addition, children in 1st, 2nd, and 4th grades will receive toothbrushes, and dental health instruction with special emphasis on oral hygiene techniques.

This program is a supplement, and does not interfere with the regular dental care your child is receiving. It should not take the place of regular dental care by your dentist or daily oral hygiene. The “Catch a Smile” program will provide additional benefit to any preventive treatment already received. It has been proven that use of a weekly fluoride mouthrinse is effective in reducing tooth decay.

PLEASE RETURN THIS COMPLETED FORM.

Sincerely,

J. Ose, Northeast Hamilton School Nurse

____________________________________
(Name of Child)

____________________________________            _______________________
(Teacher)                                (Grade)

_________    I want my child to participate in the weekly fluoride mouthrinsing procedure.

_________    I DO NOT want my child to participate in the weekly fluoride mouthrinsing procedure.


______________________        ________________________________________
(Date)                    (Parent or Guardian)