P0792 - Improving Fluoride Application and Dental Care Education in the Pediatric Medical Home: A Quality Improvement Project

Background and

Objectives: Dental caries (cavities) are one of the most common chronic diseases in children in the United States (Dye BA, 2012). The American Academy of Pediatrics recommends periodic oral health risk assessment to prevent early caries and promote oral health (Section on Oral Health, 2019.) This Quality Improvement project focuses on early dental care and improving fluoride application in routine well child exams, ages 6 months to 3 years. Providing effective preventative dental education by a pediatrician in the primary care setting can improve overall oral health.

Methods: An office process mapping identified a gap in applying fluoride during Well Child exams. Plan-Do-Study-Act cycles focused on the idea of “A Pocket-full of Fluoride” to improve this gap. Parent education was completed using a one-page hand out.

Results: To determine baseline statistics, a survey of 100 children, ages 6 months to 3 years, was conducted. Results showed 92% of parents believe it is important to take care of baby teeth. Only 50% brushed their child’s teeth twice daily as recommended by the AAP. Sixty-four percent (64%) of children had fluoride applied in the previous 6 months.
After three Plan-Do-Study-Act cycles, > 95% of children had fluoride applied during targeted Well Child exams. The “pocket full of fluoride” campaign involved carrying fluoride into all Well Child exams and increased fluoride rates significantly. Parent education provided at all Well Child exams also improved understanding of dental care. After exams, surveys indicated parents intended to start brushing twice daily.

Discussion: Young children visit their pediatrician more often than they visit a dentist. More children can be reached for fluoride varnish and parent education by providing this service in the primary care medical home. A systematic approach to providing fluoride varnish increased rates to eligible children. Providing easy to understand oral health education and allowing ongoing discussion with parents improved daily brushing to meet recommended guidelines.
Future goals: Obtain grant money to continue fluoride varnish in children ages 3 years to 5 years as this age group is not currently covered by state insurance. Providing additional education to young children in the form of age appropriate books at each well visit supporting dental care.