P2B239: Implementation of Fluoride Varnish Application in an Urban Primary Care Clinic- a Tale of Healthier Teeth ​

Purpose/Objectives: Dental caries are the most common chronic disease of childhood in the United States. To help alleviate this burden, fluoride varnish has been shown to reduce the incidence of dental carries. The USPSTF recommends application of fluoride varnish by primary care clinicians to all patients under the age of 5 following their first tooth eruption. In Arizona, fluoride varnish is covered under AHCCCS (Arizona Health Care Cost Containment System) at Well Child Checks (WCC) until 24-months of age and must be applied by a provider. The aim of this quality improvement project was to offer fluoride varnish for >25% of WCC at ages of 12-, 18-, and 24-month at Phoenix Children’s Division of Primary, Complex Care and Adolescent Medicine by June 30, 2023.

Design/Methods: Since fluoride varnish is a new process for our clinic, we had to do several interventions before the varnish was even available for use. In October 2022, we ensured that all faculty physicians were trained through an online module. We created a team workflow utilizing our medical assistants (MAs) to place fluoride in the rooms of the appropriate WCCs. In November 2022, we presented our rationale to the Pharmacy and Therapeutics committee who approved fluoride use in our clinic. In December, we changed the EMR to include documentation of prior dental care, a fluoride procedure note, and check boxes of application or refusal in the plan. Parents were educated on the new process with an informational flier in Spanish and English from the Arizona Department of Health Services. In January, we created a video for residents demonstrating how to apply fluoride varnish, provide after care instructions, and document in the chart.

Results: From January to March 2023, we identified 190 potential well-child checks where fluoride varnish could be offered. Fluoride varnish was applied in 62 (32.6%) eligible visits, and was declined by family in 16 (8.4%) of eligible visits. Overall, fluoride varnish was offered in 41% of eligible visits (78/190)

Conclusion/Discussion: Applying fluoride varnish required approval from pharmacy staff, training of providers and ancillary staff, ordering product, and creation of materials for both families and providers. After completing these steps, we reviewed three months of data demonstrating fluoride application offered in over 40% of eligible visits, surpassing our initial goal of 25% of visits. Future interventions to help our clinic to continue to meet this benchmark include ensuring fluoride varnish is consistently accessible in the exam rooms and targeted training for providers with missed opportunities. Additionally, we are interested in evaluating equitable distribution of fluoride application amongst patient race, language, and type of insurance.