CHOP researchers unveil framework for boosting children's oral health

Researchers from Children's Hospital of Philadelphia (CHOP) demonstrated how a multifaceted intervention approach significantly improved the rate of dental varnish applications to help strengthen tooth enamel and prevent decay. The results exceeded the goal for the study, and improvements were consistent across insurance plans, race and ethnicity, providing an important framework for keeping teeth healthy. The findings were published today in the journal Pediatrics.

Dental fluoride varnish is a safe and effective procedure used to reduce the risk of cavities in children with no risk of fluorosis. Despite clinical guidelines and coverage by commercial and Medicaid insurance with no co-pays for families, national varnish rates remain low. Fewer than 10 percent of children with Medicaid insurance and 5% of children with commercial insurance receive any dental varnish at their pediatrician's office.

In this study, conducted from July 2023 to October 2024, researchers developed a quality improvement initiative aimed at improving dental varnish rates for all children regardless of insurance status. A variety of methods were implemented, including electronic health record prompts, practice-level education, certifications audits and financial incentives. The aim was to increase the dental varnish application rates for children aged 6 months to 5.99 years from 5 percent to 20 percent after one year of intervention, while also increasing dental varnish rates for all children regardless of insurance type, race or ethnicity.

Over the course of 92,056 eligible preventive care visits, varnish application increased from 3.7 percent pre-intervention to 30.5 percent, exceeding the 20 percent target. More than 50 percent of children received varnish annually compared with 25 percent at baseline. Across network sites, adoption of these practices increased from 6 sites to all 33 practices. Additionally, maintenance reimbursement from insurance increased and improvements were seen across child insurance, race and ethnicity.

Our study shows that with a few quality improvement strategies, we can significantly improve the rates of dental fluoride varnish application across a pediatric network and may have an easy-to-implement model that could help improve rates at a national level."

Brian Jenssen, MD, Primary Care Pediatrician, Division of General Pediatrics, Children's Hospital of Philadelphia

Brian Jenssen is also the Associate Director of Clinical Impact at Clinical Futures at CHOP.