Fluoride varnish use in primary care: what do providers think?

Area of Science:

• Pediatric Health
• Public Health
• Dental Caries Prevention

Background:

• State Medicaid programs reimburse for fluoride varnish application in pediatric settings.
• Limited understanding exists regarding factors influencing fluoride varnish adoption in primary care physician (PCP) offices.

Purpose of the Study:

• To conduct an in-depth case study on the diffusion of fluoride varnish in 12 pediatric, family medicine, and nurse practitioner offices.
• To identify factors that encourage or impede the implementation of fluoride varnish in primary care.

Main Methods:

• Focus groups were conducted with providers and staff in 12 medical practices trained in fluoride varnish application.
• Discussions covered training acquisition, perceived PCP role in oral health, practice-level oral health issues, training specifics, and adoption barriers/facilitators.
• Content analysis of professionally transcribed focus group data was performed.

Main Results:

• Three key themes emerged: preexisting factors, communication, and logistics.
• PCPs' public health involvement and concerns about patient access to dental care influenced training adoption.
• Effective implementation was linked to staff inclusion in decision-making, training quality, patient identification systems, and visit timing.

Conclusions:

• Successful fluoride varnish adoption in medical practices requires PCP and staff commitment, motivating training, and adequate referral systems.
• PCP engagement with fluoride varnish facilitates discussions on preventive oral health with families.
• Recommendations are provided for program planners and PCP offices to promote fluoride varnish diffusion.