76 - Improving Fluoride Varnish Application Rates in a Med-Peds Resident Primary Care Clinic: A Quality Improvement Initiative

Publication Number: 4074.76

Dana J. Paine, Ohio State University College of Medicine, Columbus, OH, United States; Rachel Levenseller, Nationwide Children's Hospital, Columbus, OH, United States; James Lim, Ohio State University College of Medicine, Columbus, OH, United States; Allison Rossetti, Nationwide Children's Hospital, Columbus, OH, United States; Megan Brundrett, Nationwide Children's Hospital, Powell, OH, United States

Background: Dental caries affect nearly half of all children and disproportionately impact those from minority and low socioeconomic backgrounds due to limited access to care and barriers to preventive practices. Fluoride varnish application every six months is a well-established guideline endorsed by the American Academy of Pediatrics and the American Dental Association to reduce the risk of caries. Implementing fluoride application at well-child visits can help meet this guideline, especially for patients with limited access to dental care. Despite its proven efficacy, implementation in our internal medicine-pediatric primary care clinic remained inconsistent due to barriers such as lack of continuity, competing visit priorities, and limited provider awareness.

Objective: To increase fluoride varnish application rates during well-child visits for patients aged 1 to 5 years-old from a baseline of 36% to 65% and sustain this improvement over six months in an internal medicine-pediatric resident clinic.

Design/Methods: Using the Model for Improvement, the resident team developed a key driver diagram and implemented targeted interventions through multiple Plan-Do-Study-Act cycles. Interventions included resident education sessions, creation of patient education materials, quarterly individualized performance feedback, and integration of electronic medical record (EMR) prompts to facilitate fluoride application during visits.

Results: An average of 29 visits per month met criteria for fluoride application in children 1- to 5-years-old without a primary dental home. Following implementation, fluoride application rates increased from 36% to an average of 68% over six months. This improvement was sustained over the subsequent 16 months.

Conclusion(s): This quality improvement initiative demonstrates that structured, team-based interventions can significantly improve adherence to preventive dental care in a resident clinic. By incorporating fluoride application into routine workflows, education, and leveraging EMR tools, resident clinics can overcome systemic barriers and improve care delivery for vulnerable pediatric populations. Sustained improvement over 16 months highlights the potential for long-term practice change. These findings support broader implementation of similar strategies across residency programs and primary care settings to reduce oral health disparities and promote equity in preventive care.