PCR025: Evaluation of Fluoride Varnish Implementation for Well Child Visits in a Family Practice Residency Clinic

Fabiana Kotovicz, MD; Jessica Kram, MPH; Kristin Randa, DO; Madelyn Pickle, DO; Melissa Grube, MD; Carl Bellinger, DO; Catherine de Grandville, MD; Marianne Klumph, MA; Dennis Baumgardner, MD

Abstract

Context: Dental decay is the most common chronic disease in children, with racial minorities and children living in poverty having the highest prevalence. Dental fluoride varnish, a protective coating painted on teeth to help prevent caries, requires no special equipment and can be applied in <2 minutes. Per the USPSTF and American Academy of Pediatrics, dental varnish application should be considered every 3-6 months during well child exams. Objective: Evaluate incorporation of fluoride varnish applications in well child visits. Study Design: Mixed-methods. Setting: Two residency clinics in Milwaukee, WI. Population studied: 6 month - 6 year well child visits, pre/post-provider survey. Intervention: Dental varnish application protocol was implemented in July–Sept. 2019. All providers completed the STFM Smiles for Life Module 6. Outcome measures: Pre/post-surveys were conducted to identify provider’s opinions including importance, sustainability, and barriers to implementation of a dental varnish protocol. Well child visit data from 7/1/19 1/15/20 (period 1) and 1/16/20 - 12/31/20 (period 2; representing COVID pandemic) was compared for both clinics regarding rates of preventative visits with fluoride dental varnish applied. A Z-test for Equality of Two Proportions was used to compare rates. Pre/post-survey answers were analyzed using 2-sample T–tests. Results: 1,984 well child visits in study period; 369 (19%) with varnish application. During period 1, 25% of visits at clinic 1 and 16% of visits at clinic 2 included a varnish application. There was no significant difference in application rates between periods (clinic 1=22% visits and clinic 2=15%). During the Covid-19 pandemic varnish applications decreased from 18.6 to 8.1 per month at clinic 1 (p<0.01), but increased from 12.5 to 15.2 per month at clinic 2 (p=0.18). Our pre/post-surveys identified the same barriers to application (not enough training/time, unsure where to find supplies). Except for percentage of eligible patients seen for well child exams including fluoride varnish (63% v. 35% p<0.01), no other survey responses were significantly different. Conclusions: Dental fluoride varnish application can be successfully implemented into academic primary care clinics to reach children most at risk, but not without challenges. Results of further surveys can be used to streamline protocols for sustainability. Optimized processes may be adapted by others to decrease health disparities.
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Jack Westfall
jwestfall@aafp.org 11/19/2021

oral health as part of primary care. nice. the mouth actually is part of the body. terrific poster and abstract. thanks

William R. Phillips
wphllps@uw.edu 11/21/2021

Oral healthcare, prevention and fluoride varnish can be an important part of routine primary care in our family medicine clinic. Our experience has been that it goes more smoothly after it simply becomes one of the expected - by all, moms, HAs, docs, kids - components of every well-child visit.Nicely presented posted. Love your video. It's a harsh criticism of our colleagues in dentistry, who say they care about whole patient care, that they refuse to do this in their offices and leave it for family doctors to do it at the lowest level of compensation.. - Bill

Rod Erickson
11/22/2021

We've found this to be relatively low priority among many of our primary care clinicians. If it is to become widely adapted it should become routine and done by staff with support from clinicians. Great topic. Hi Dennis.

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/22/2021

Really appreciate seeing a focus on children AND dental health - a strong primary care project. I particularly appreciate that conclusion that this can help decrease health disparities.

Andy Pasternak
avpiv711@sbcglobal.net 11/26/2021

I'll admit- I didn't even know this was something a FP doc could do. Thanks for opening my eyes!

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