Relative Effectiveness of School-Based versus Clinic-Based Fluoride Varnish Application

Area of Science:

• Dental Public Health
• Pediatric Dentistry
• Preventive Dentistry

Background:

• Fluoride varnish (FV) application is a key preventive measure for early childhood caries (ECC).
• Evaluating the comparative effectiveness of different delivery settings (school-based vs. clinic-based) is crucial for optimizing oral health programs.

Purpose of the Study:

• To investigate the relative effectiveness of school-based versus clinic-based fluoride varnish (FV) application within a single public health program in Taiwan.
• To assess the association between FV application setting and the occurrence of caries-related treatments and ECC in primary molars.

Main Methods:

• A population-based analysis (Phase 1) using Taiwan's National Health Insurance Research Database (NHIRB) of 347,544 children born in 2015-2016.
• A fieldwork cohort (Phase 2) of 1,479 children examined for ECC, with data linked to NHIRB.
• Logistic regression analysis to determine associations between FV application setting and caries outcomes.

Main Results:

• School-based FV application was associated with significantly higher odds of dental restoration, endodontic treatment, and tooth extraction compared to clinic-based application (P < 0.0001).
• The risk of ECC was initially higher with school-based FV application (P < 0.05), but this association diminished after covariate adjustment.
• These differences were more pronounced in urbanized areas.

Conclusions:

• Clinic-based fluoride varnish (FV) application demonstrates superior effectiveness in reducing caries-related treatments for primary molars.
• Findings suggest that clinic-based FV application is more beneficial, especially in urban settings.
• Consideration should be given to supplementing school-based FV programs with clinic-based services for enhanced caries prevention.