Fluoride varnish application, a quality improvement project implemented in a rural pediatric practice
1VA Medical Center White River Junction, Vermont.
Objectives:
The United States has a public health crisis of dental caries in children's primary teeth. Fifty-five percent of children have dental caries by age 8. The majority of these children are nonwhite and poor. Caries could be decreased by 40% if fluoride varnish (FV) application started with tooth eruption.
Design And Sample:
A four-month FV application QI project was implemented in a rural pediatric practice. The staff was trained by the Vermont Department of Health using the From the First Tooth protocol. Children aged 9, 18, 24, and 30 months.
Measures:
Pre- and postproject questionnaires were completed. A caries risk tool assessed a child's risk and access to dental care. Completed FV applications were recorded and staff interviewed weekly.
Intervention:
FV application was offered at well child checks (WCCs).
Results:
Fifty-six percent of sample patients received FV at their WCCs. Qualitative themes included the following: reasons subjects did/did not receive FV, ease of FV application, increased oral hygiene education, visit flow, application time, older children's FV need, and billing issues.
Conclusion:
This economical, FV application program can be readily implemented by nurse practitioners and nurses in pediatric practices where children have inadequate dental care.
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