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

This study investigated the relative effectiveness of school-based versus clinic-based fluoride varnish (FV) application within a single program in Taiwan.

Data for the phase 1 study (population-based analysis) were extracted from Taiwan's National Health Insurance Research Database (NHIRB). The phase 1 cohort included 347,544 children born in 2015 or 2016 who received FV application services at school, in a dental clinic, or in both settings. FV services were recorded using specific codes: 88 and 89 for school-based FV application and 81 and 87 for clinic-based FV application. During follow-up, primary molars were assessed for caries-related treatments. The phase 2 (fieldwork) cohort included 1,479 children examined for early childhood caries (ECC). Their data were linked to the NHIRB to obtain corresponding data on the FV application. In both phases, logistic regression was performed to determine the associations of application setting with the odds of caries-related treatments and ECC.

The odds of the following treatments were significantly higher with school-based FV application than with clinic-based FV application (all Ps < 0.0001): dental restoration (odds ratio [OR] = 1.09; 95% confidence interval [CI], 1.06-1.11), endodontic treatment (OR = 1.21; 95% CI, 1.16-1.26), and tooth extraction (OR = 1.33; 95% CI, 1.25-1.42). This difference was particularly prominent in moderately and highly urbanized areas. Furthermore, the risk of ECC was higher with school-based FV application (OR = 1.52; 95% CI, 1.10-2.11; P < 0.05) than with school-based FV application. However, after covariate adjustment, both groups had similar risk estimates (OR = 1.03; 95% CI, 0.71-1.50).

Clinic-based FV application significantly reduces the likelihood of caries-related treatments for primary molars. Future studies should consider our findings when evaluating the effectiveness of FV application.Knowledge Transfer Statement:Compared with school-based FV application, clinic-based FV application significantly reduced the likelihood of caries-related treatments, particularly among children residing in urban areas. For children who received only school-based FV application services, dentists may recommend additional clinic-based FV application services. Our findings may guide future studies aimed at evaluating the effectiveness of FV application.