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Bass T, Hill CM, Cully JL, Li SR, Chi DL. A cross-sectional study of physicians on fluoride-related beliefs and practices, and experiences with fluoride-hesitant caregivers. PLoS One 2024; 19:e0307085. [PMID: 39028748 PMCID: PMC11259263 DOI: 10.1371/journal.pone.0307085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/29/2024] [Indexed: 07/21/2024] Open
Abstract
The goal of this study was to describe medical providers' fluoride-related beliefs and practices, experiences with fluoride-hesitant caregivers, and barriers to incorporating oral health activities into their practice. In this cross-sectional study, we specifically tested the hypothesis of whether these factors differed between pediatric and family medicine providers. A 39-item online survey was administered to a convenience sample of pediatric and family medicine providers in Washington state and Ohio (U.S.A.). Responses to the fluoride survey were compared between pediatric and family medicine providers with a chi-square test (α = 0.05). Of the 354 study participants, 45% were pediatric providers and 55% were family medicine providers. About 61.9% of providers believed fluoridated water was highly effective at preventing tooth decay while only 29.1% believed prescription fluoride supplements were highly effective. Nearly all providers recommend over-the-counter fluoride toothpaste (87.3%), 44.1% apply topical fluoride in clinic, and 30.8% prescribe fluoride supplements. Most providers reported fluoride hesitancy was a small problem or not a problem (82.5%) and the most common concerns patients raise about fluoride were similar to those raised about vaccines. Lack of time was the most commonly reported barrier to incorporating oral health into practice, which was more commonly reported by family medicine providers than pediatric providers (65.6% vs. 50.3%; p = .005). Pediatric and family medicine providers have early and frequent access to children before children visit a dentist. Improving the use of fluorides through children's medical visits could improve pediatric oral health and reduce oral health inequities, especially for vulnerable populations at increased risk for tooth decay.
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Affiliation(s)
- Tiffany Bass
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
| | - Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jennifer L. Cully
- Division of Oral Health, Children’s National Hospital, Washington, DC, United States of America
- Department of Pediatrics, George Washington University, Washington, DC, United States of America
| | - Sophie R. Li
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Donald L. Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
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Lukac PJ, Bell D, Sreedharan P, Gornbein JA, Lerner C. The Application of Dental Fluoride Varnish in Children: A Low Cost, High-Value Implementation Aided by Passive Clinical Decision Support. Appl Clin Inform 2023; 14:245-253. [PMID: 36634698 PMCID: PMC10060097 DOI: 10.1055/a-2011-8167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Fluoride is vital in the prevention of dental caries in children. In 2014, the U.S. Preventive Services Task Force deemed fluoride varnish a recommended preventive service (grade B). Electronic health record-based clinical decision support (CDS) tools have shown variable ability to alter physicians' ordering behaviors. OBJECTIVES This study aimed to increase the application of fluoride varnish in children while analyzing the effect of two passive CDS tools-an order set and a note template. METHODS Data on outpatient pediatric visits over an 18-month period before and after CDS implementation (October 15, 2020-April 15, 2022) were queried, while trends in application rate of fluoride were examined. We constructed a multiple logistic regression model with a primary outcome of whether a patient received fluoride at his/her visit. The primary predictor was a "phase" variable representing the CDS implemented. Physician interaction with CDS as well as the financial effects of the resulting service use were also examined. RESULTS There were 3,049 well-child visits of children aged 12 months to 5 years. The addition of a fluoride order to a "Well Child Check" order set led to a 10.6% increase in ordering over physician education alone (25.4 vs. 14.8%, p = 0.001), while the insertion of fluoride-specific text to drop-down lists in clinical notes led to a 6.2% increase (31.5 vs. 25.4%, p = 0.005). Whether a patient received topical fluoride was positively associated with order set implementation (odds ratio [OR] = 5.87, 95% confidence interval [CI]: 4.20-8.21) and fluoride-specific drop-down lists (OR = 7.81, 95% CI: 5.41-11.28). Female providers were more likely to use order sets when ordering fluoride (56.2 vs. 40.9% for males, p ≤ 0.0001). Added revenue totaled $15,084. CONCLUSION The targeted use of order sets and note templates was positively associated with the ordering of topical fluoride by physicians.
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Affiliation(s)
- Paul J. Lukac
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
- Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States
| | - Douglas Bell
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Priya Sreedharan
- Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States
| | - Jeffrey A. Gornbein
- Department of Biostatics, School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
| | - Carlos Lerner
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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Nantanee R, Sriratanaban J. Cost‐effectiveness and estimated net monetary benefits of a fluoride varnish application program during well‐child visits by 9‐ to 30‐month‐old children in three areas of Thailand. Community Dent Oral Epidemiol 2022; 51:512-518. [DOI: 10.1111/cdoe.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/10/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ratichanok Nantanee
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Department of Pediatric Dentistry, Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Thailand Research Center for Health Services System, Faculty of Medicine Chulalongkorn University Bangkok Thailand
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Goff SL, Gahlon G, Geissler KH, Dick AW, Kranz AM. Variation in Current Guidelines for Fluoride Varnish Application for Young Children in Medical Settings in the United States. Front Public Health 2022; 10:785296. [PMID: 35309203 PMCID: PMC8930922 DOI: 10.3389/fpubh.2022.785296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background The United States Preventive Services Task Force recommends that medical providers apply fluoride varnish (FV) to the teeth of all children under 6 years of age, but fewer than 10% of eligible children receive FV as recommended. Prior studies suggest that variation in clinical guidelines is associated with low uptake of other evidence-based health-related interventions, but consistency of national guidelines for the delivery of FV in medical settings is unknown. Methods Eligible guidelines for application of FV in medical settings for children under 6 years of age were published in the past 10 years by national pediatric or dental professional organizations or by national public health entities. Guidelines were identified using the search terms fluoride varnish + [application; guidelines, or recommendations; children or pediatric; American Academy of Pediatrics (AAP); American Academy of Pediatric Dentistry] and a search of Guideline Central. Details of the guidelines were extracted and compared. Results Ten guidelines met inclusion criteria. Guidelines differed in terms of periodicity recommendations and whether FV was indicated for children with a dental home or level of risk of dental caries. Conclusion Numerous recommendations about FV delivery in medical settings are available to pediatric medical providers. Further study is warranted to determine whether the variation across current guidelines detected in this study may contribute to low FV application rates in medical settings.
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Affiliation(s)
- Sarah L. Goff
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
- *Correspondence: Sarah L. Goff
| | | | - Kimberley H. Geissler
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
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Turska-Szybka A, Gozdowski D, Twetman S, Olczak-Kowalczyk D. Clinical Effect of Two Fluoride Varnishes in Caries-Active Preschool Children: A Randomized Controlled Trial. Caries Res 2021; 55:137-143. [PMID: 33706305 DOI: 10.1159/000514168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
The prevention of dental caries in preschool children is a priority for dental services. The aim of the study was to investigate the caries-preventive effect of 2 fluoride varnishes in caries-active preschool children, and then compare the outcome with a non-varnish control group. After screening, 180 preschool children aged 36-71 months, with at least 1 noncavitated lesion, were enrolled and randomly allocated into 3 parallel groups, namely A: 1.5% ammonium fluoride varnish (Fluor Protector S), B: 5% NaF varnish (Duraphat), and C: professional tooth-cleaning. All children were recalled every third month for intervention and their parents were instructed to have them brush their teeth with a 1,000-ppm fluoride toothpaste twice daily. Caries were recorded at baseline and after 12 months by a calibrated examiner and the incidence was scored on noncavitated (d2) and cavitated (d3) level. We tested differences between the groups with the χ2 and two-sided t tests. One hundred and seventy-two children (95.6%) completed the trial and 56 (32.6%) and 35 (19.2%) developed new d2 and d3 lesions, respectively. Both varnishes reduced the incidence of caries compared with the control group, but there was no significant difference between group A and group B. Compared with group C, the relative risk for developing cavitated lesions was 0.39 (95% CI 0.22-0.62) in group A and 0.26 (95% CI 0.14-0.50) in group B. The total prevented fraction (Δd2d3mft) for group A and group B was 19.9 and 22.5% (p < 0.05), respectively. No adverse effects were observed or reported during the study period. In conclusion, the 2 fluoride varnishes demonstrated an equal capacity to reduce the incidence of caries in caries-active preschool children over a 12-month period in comparison with a control group.
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Affiliation(s)
- Anna Turska-Szybka
- Department of Paediatric Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Gozdowski
- Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Science, Warsaw, Poland
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Roth LT. A Resident-Led QI Project to Improve Dental Health at a Primary Care Pediatric Practice. J Grad Med Educ 2020; 12:571-577. [PMID: 33149826 PMCID: PMC7594796 DOI: 10.4300/jgme-d-19-00959.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/19/2020] [Accepted: 07/09/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Dental caries are the most common chronic condition of childhood and have significant medical, psychological, and financial consequences. The American Academy of Pediatrics (AAP) recommends primary care physicians apply fluoride varnish (FV) every 3 to 6 months from tooth emergence through age 5. OBJECTIVE Through a resident-led quality improvement (QI) project, we aimed to provide FV to 50% of patients ages 1 through 5 who did not have a dental visit in the preceding 6 months or receive FV elsewhere in the past month. METHODS From May 2017 through April 2018, we conducted 7 monthly plan-do-study-act cycles to improve our primary outcome measure (FV application), secondary outcome measure (percentage of patients who had routine dental care), and process measure (percentage of dental referrals). Balancing measures included time taken away from other clinical priorities and reimbursement rates. RESULTS Fluoride varnish application improved from 3.6% to 44% with a 54% peak. The percentage of patients under 6 who had seen a dentist in the past 6 months increased from 30% to 47%. The percentage of dental referrals increased from 17% to 33%. CONCLUSIONS Application of FV is a quick, cost-effective way for primary care providers to improve dental health. This resident-led QI project increased rates of FV application, dental referrals, and dental visits while meeting ACGME guidelines for experiential learning in QI. By adapting to state-specific guidelines and workflows of each clinic, this QI project could be nationally reproduced to improve adherence to AAP and United States Preventive Services Task Force guidelines.
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Lambert RF, Yu A, Orrell C, Haberer JE. Perceived oral health interventions by medical providers in Gugulethu, South Africa. PLoS One 2020; 15:e0233437. [PMID: 32453785 PMCID: PMC7250410 DOI: 10.1371/journal.pone.0233437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/05/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction The purpose of this study was to explore factors that impact patients’ ability to access high quality, expeditious oral health care by understanding medical professionals’ knowledge of oral health, the care they provide to patients presenting with oral health complaints, and their perceptions of potential interventions to improve oral health care delivery. Methods We conducted in depth qualitative interviews, which were analyzed using an inductive content analytical approach. The study was conducted in Gugulethu, a community located outside of Cape Town, South Africa. Local public sector health services provided free-of-charge are the main source of primary health and dental care for this population. Participants included the following medical providers: doctors, clinical nurse practitioners, professional nurses, and health promoters. Results Identified themes fell within the three broad subject areas: oral health knowledge, patient care, and potential interventions. Themes within oral health knowledge included (1) personal responsibility for hygiene, (2) routine oral health care, (3) lack of knowledge among medical professionals, (4) poverty, and (5) an oral-systemic connection. Participants cited both ‘clinical care knowledge’ and/or ‘uncertainty’ about patient care for oral health complaints. Participants independently suggested interventions in three broad areas: (1) education, (2) expanded provider roles, and (3) colocation of services. Conclusions Our findings suggest that a variety of interventions, ranging from high to low resource investment, may impact access to and utilization of oral health services and thereby result in improved patient care. Future studies should develop and evaluate the suggested interventions in a range of care settings.
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Affiliation(s)
- R. Frederick Lambert
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, United States of America
| | - Amy Yu
- Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, United States of America
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
- * E-mail:
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Chiba FY, Garbin CAS, Saliba TA, Garbin AJÍ, Moimaz SAS. Effect of Chlorhexidine and Fluoride Varnishes on Streptococcus mutans Count and Dental Plaque Index. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n4p371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractThe control of dental plaque by chemical means can be a valuable auxiliary resource for individuals who have difficulties in performing dental plaque control through regular oral hygiene procedures. The aim of this study was to evaluate the effect of chlorhexidine and fluorine varnishes on the levels of Streptococcus mutans (S. mutans) present in the dental biofilm and on the dental plaque index. The study was carried out in a sample comprised thirty-nine schoolchildren between 13 and 15 years of age, distributed into 2 groups. Group I received a single layer of varnish with chlorhexidine and thymol on the maxillary right first molar. Group II received the application of varnish with fluoride following the same methodology. S. mutans count and dental plaque index recording were performed 7 days before the application and 7, 15 and 30 days after the treatment. It was observed that chlorhexidine and fluoride varnishes significantly reduced the number of S. mutans in dental plaque for 30 days (p<0.05). There was no difference between the varnishes. With regard to the dental plaque index, there was no alteration in any of the experimental time periods for both groups. It was concluded that varnishes, mainly those that contain fluoride, can be an interesting alternative for the prevention of dental caries in collective oral health programs. Keywords: Chlorhexidine. Fluorides. Dental Plaque. ResumoO controle da placa dental por meios químicos pode ser um valioso recurso auxiliar para indivíduos que apresentam dificuldades em realizar o controle da placa dental por meio de procedimentos regulares de higiene bucal. O objetivo neste estudo foi avaliar o efeito dos vernizes de clorexidina e de flúor sobre os níveis de Streptococcus mutans (S. mutans) presentes no biofilme dental e sobre o índice de placa dental. O estudo foi realizado em uma amostra composta por 39 escolares, entre 13 e 15 anos de idade, distribuídos em 2 grupos. O grupo I recebeu uma única aplicação de verniz com clorexidina e timol no primeiro molar superior direito. O grupo II recebeu a aplicação de verniz com flúor seguindo a mesma metodologia. A contagem de S. mutans e o índice de placa dental foram registrados 7 dias antes da aplicação e 7, 15 e 30 dias após o tratamento. Observou-se que os vernizes de clorexidina e flúor reduziram significativamente o número de S. mutans na placa dental por 30 dias (p <0,05). Não houve diferença entre os vernizes. Com relação ao índice de placa dental, não houve alteração em nenhum dos períodos experimentais para ambos os grupos. Concluiu-se que os vernizes, principalmente aqueles que contêm flúor, podem ser uma alternativa interessante para a prevenção da cárie dentária em programas coletivos de saúde bucal. Palavras-chave: Clorexidina. Fluoretos. Placa Dentária.
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