167 - Dental outcome evaluation of a fluoride varnish quality improvement program

Purpose: To determine the association between fluoride varnish (FV) exposure and dental outcomes among children who received FV at a medical practice participating in Quality Improvement (QI) project compared to at a dental practice or non-QI-engaged medical practice, or to children never receiving FV.

Methods: We used a subset of Ohio Medicaid eligibility and claims data from 2015 to 2019 to compare dental treatment outcomes among four groups: children aged 1 to 5 years old who received FV from a QI-participating medical provider, non-QI participating medical provider, dental provider, and never received FV over the study period. Analysis included descriptive statistics and regression methods.

Results: Among 98,001 children included in the study, the majority were male (51.1%), white (50.5%), qualified for Medicaid by income-based criteria (98.8%), and lived in a metropolitan area (71.1%). The highest proportion received FV from dental practices (49.2%), followed by non-QI-engaged medical practices (20.8%). Children who received FV at QI practices were 32 times more likely to have had a preventive dental visit compared to those with no recorded receipt of FV (IRR=31.9, 95% CI: 30.8-33.0, P-value <.0001). Children who received FV at QI practices were significantly less likely to have caries-related treatment than those who received FV at dental practices (OR=0.3, 95%CI: 0.3-0.4) or non-QI participating practices (OR=0.4, 95% CI: 0.3-0.4). Compared to children who received FV at dental practices, children who received FV at QI practices were significantly less likely to have GA for dental surgery (OR=0.2, 95% CI: 0.1-0.5). There was no statistically significant difference in emergency department utilization among the groups.

Conclusions: Children seen at medical practices participating in QI activities around FV application appear to have increased uptake of preventive dental services and a resulting decrease in dental caries and more extensive dental surgery requiring general anesthesia.