Prevalence of receipt of fluoride varnish application in the medical setting and Its associated factors
Creators: name: Tandon, Mary C.
Publisher: name: University of Iowa
Year: 2025
Subjects: Childhood Caries
Fluoride Varnish
Medical Setting
Prevalence
public abstract

description: Dental caries is a prevalent disease in children and can have a negative impact on a child’s quality of life, including aspects such as pain, difficulty eating, and missed school days. Fluoride varnish (FV) applications are an effective preventive strategy for this disease. Young children often do not have the opportunity to visit a dentist. Therefore, the United States Preventive Services Task Force has recommended the application of FV by medical providers. FV in medical settings offers an additional opportunity for caries prevention beyond the dental office, but few studies have assessed its use in medical settings.
description: The main research purposes of this study were to determine 1) the cross-sectional prevalence of receipt of FV application in the medical setting among study children ages 12 to 116 months during 20 short time periods, 2) the cumulative prevalence of receipt of FV application in the medical setting among study children from ages 12 to 116 months during four 18-month time periods, and 3) the factors associated with the receipt of FV application in the medical setting from 12-30 months of age.
description: After Institutional Review Board approval, 1,326 primary caregiver/child dyads were enrolled in 2012-2013 when the child was about 12 months of age for a study to develop a caries risk assessment tool to be used in medical offices. Enrollment was conducted at three sites: Duke University, Indiana University, and the University of Iowa, with the data coordinating center at the University of Michigan. Children received dental examinations and parents completed detailed self-administered questionnaires at baseline, and at the children’s ages of 30, 48, 78, 96, and 114 months that asked about FV application in the medical setting and other things. Approximately every four months between examinations, intermediate questionnaires asked the same question about FV application in the medical setting. Time period 1 was when the children were aged 12 months to 2.5 years. Time Period 2 was when the children were age 2.5 Years to 4 years. Time Period 3 was when the children were age 6.5 Years to 8 Years. Time Period 4 was when the children were age 8 Years to 9.5 Years.
description: Cross-sectional prevalence of children’s receipt of FV application in the medical setting during 20 time periods, as well as the cumulative prevalence for four 18-month time periods, were determined. Descriptive statistical analyses were conducted for 19 demographic, child, and primary caregiver factors at the child’s age of 2.5 years. Bivariate logistic regression analyses were conducted to determine factors singly associated with the child’s receipt of FV application in the medical setting. The outcome variable was dichotomized as no receipt of FV application in the medical setting (0% of questionnaire responses) vs. receipt of 1 or more FV applications in the medical setting receipt (20-100% of questionnaire responses). A significance level of α=0.05 was used to determine a significant bivariate association. A multivariable backward stepwise logistic regression with variable selection based on Akaike Information Criterion (AIC) model fit results was conducted to determine factors associated with receipt of FV in the medical setting. The model with the lowest AIC and all models within 2 units were determined to be the models with best fit for the data.
description: The majority of children aged 2.5 years were white (51%), non-Hispanic (87%), and Medicaid-insured (54%). The cumulative prevalence of receipt of FV applications in the medical setting was 20.4% for child’s age of 12-30 months, 12.9% for 30-48 months, 6.4% for 78-96 months, and 1.9% for 96 to 114 months. The distribution of the percentages of responses with FV application in the medical setting from 12-30 months was: 80% had no FV (0%), 6% had 20-33% of responses with FV, 9% had 40-67% with FV, and 5% had 75-100% of responses with FV. This study showed that the highest cumulative prevalence of FV application in the medical setting at 20.4% was during time period 1 when the children were approximately 12 months to 2.5 years old, with decreasing cumulative prevalences (12.9%, 6.4%, and 1.9%) as the children aged. This study’s multivariable regression modeling based on AIC showed that the factors associated with receipt of FV application in the medical setting were child’s non-Hispanic ethnicity, child enrolled in Medicaid, primary caregiver’s infrequent dentist visits, lower household income, child’s lack of cavities and/or fillings, child’s use (throughout the day) of a bottle or sippy cup, and child’s infrequent dentist visits.
description: In conclusion, the prevalence of FV application in the medical setting is low and the prevalence decreased as the children aged, despite professional recommendations. This study assessed the factors associated with receipt of FV application in the medical setting and the results showed that many children with known high caries risk factors did not receive this preventive measure. Additional research is needed to better understand the patterns of use of FV application in the medical setting, as well as provider, child, and primary caregiver factors associated with its use. These results about patterns of receipt of FV and associated factors can then be used to increase caries prevention through expanded use of FV application in the medical setting.