P2.203: Implementing Fluoride Varnish Application into Primary Care Clinical Practice

Purpose/Objectives: Determine the efficacy in which we decreased dental caries in those under 5 years of age in our practice since the initiation of fluoride varnish applications in November 2021.

Dental fluoride varnish has been proven to reduce the incidence of dental caries. The patient population at our facility is 80% Medicaid and is at elevated risk for developing dental caries. The American Academy of Pediatrics recommends starting fluoride varnish as early as 6 months. University Medical Center Pediatrics began providing fluoride varnishes in November 2021.

Design/Methods: This study was conducted by retroactive chart review of patients identified as having a diagnosis of dental caries or those who had received fluoride varnish. Reports were generated by searching the clinical billing data for the diagnosis code for dental caries (ICD-10 code K02.9, dental caries, unspecified) and procedure code for fluoride varnish (CPT code D1206). Data was obtained from 2018 through August 31, 2024. We compared the incidence of dental caries in our patients in those who had received fluoride varnish and those who had not received it. For those that did receive fluoride varnish, we looked at the number of fluoride varnish applications performed in clinic and the percentage that did not develop dental caries.  We also looked at our rate of dental caries prior to the implementation of fluoride varnish.

Results: We found that from 2018 -2021 (prior to the initiation of fluoride varnish application in our practice), 3.17% of our patients under 5 years had dental caries. After our practitioners started applying fluoride, 2.07% of patients under the age of 5 years old were diagnosed with caries. When comparing the incidence of dental caries from 2018 – 2020 (prior to introduction of fluoride varnish) to the incidence of dental caries from 2022 – August 2024 (after introduction of fluoride varnish), there was a statistically significant decrease in the rate of dental caries (p value 0.031). From 2022 – August 2024, there was a statistically significant difference (p value 0.047) between the percentage of patients who had been diagnosed with dental caries and had not received fluoride varnish (1.53%) versus those that had been diagnosed with dental caries and did receive fluoride varnish (0.54%).   
  
Since 2021, we have applied fluoride 1,916 times. Of those who received fluoride at least once, 97.21% did not go on to have dental caries. 100% of those who had 3 or more applications of fluoride did not develop cavities.

Conclusion/Discussion: Implementing new practice habits can be very difficult. Our practice appears to have implemented the service of applying topical fluoride well. We have significantly decreased the rate of dental caries in our practice.