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Published on: December 31, 2017
Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System
Diane Dooley1, Nicolette M Moultrie2, Barbara Heckman3
1Contra Costa Regional Medical Center, Martinez, California; Diane.Dooley@hsd.cccounty.us.
Insights
Routine fluoride varnish (FV) applications during well-child visits significantly increased preventive dental care for young children. This intervention effectively reduced early childhood caries (ECC) in a low-income pediatric population.
Area of Science:
- Public Health
- Pediatric Dentistry
- Health Services Research
Background:
- Early childhood caries (ECC) poses a significant threat to low-income pediatric populations with limited dental care access.
- Pediatricians identified high ECC rates and barriers to dental care among their patient population.
- An interdisciplinary partnership was formed to address this public health issue.
Purpose of the Study:
- To implement and evaluate the integration of routine topical fluoride varnish (FV) applications into well-child visits for children aged 1-5 years.
- To improve oral health outcomes and reduce ECC in a vulnerable pediatric population.
- To establish a sustainable model for preventive dental interventions within primary care settings.
Main Methods:
- A 3-year implementation process involving policy development, educational material creation, and system support.
- A pilot study in two health centers informed refinements to the implementation plan.
- System-wide training and ongoing provider feedback facilitated widespread adoption across eight health centers.
Main Results:
- Achieved 95% FV application rate among eligible children by August 2012.
- Sustained a high FV application rate of 97% by April 2014.
- Demonstrated successful integration of oral health interventions into primary care well visits.
Conclusions:
- Safety net institutions can successfully integrate routine FV applications and oral health education into well-child visits.
- Institutional commitment and academic partnerships are crucial for implementing preventive dental strategies.
- This model effectively reduces ECC and improves oral health for underserved children.
Background And Objective:
Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years.
Methods:
Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle.
Results:
In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits.
Conclusions:
With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.
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