KIDS Smiles: Program Review of Health Department-based Fluoride Varnish Initiative

Background: There is strong evidence that fluoride varnish (FlV) application multiple times annually to primary teeth has a substantial impact on lowering the onset/progression of carious lesions. Objective: The KIDS Smiles program trained public health nurses who are allowed under Kentucky law to apply FlV within the context of well-child visits. Methods: Since 2005 over 1400 Kentucky Department of Public Health nurses have participated in an oral health education program. Health departments across Kentucky were supplied FlV kits, and reimbursed $15 for each documented FlV application. Program evaluation included 22 programs; selection criteria included number of kits requested during 2007-08 and distribution across the state. Approximately 10% of children's charts were evaluated for demographics, number of fluoride applications, and caries presentation. Results: In 2007-2008 42,175 kits were provided. Preliminary findings suggested 3 principal outcomes: (i)while the FlV were shipped to health departments, the majority of children were not receiving multiple applications during the year; (ii)there appeared a substantial differentiation in the likelihood of children <3.5 versus >3.5yo in receiving FlV. For children <3.5 only about ¨ø received 1 varnish treatment; the percentage dropped substantially for multiple applications. In contrast, about 85-90% of children >3.5 received one treatment; however, the number with multiple treatments declined substantially; (iii)captured data regarding the prevalence and extent of dental caries, as well as measuring impact of FlV was not feasible. Preliminary results indicated public health nurses were not able to obtain accurate information regarding caries experiences. Conclusions: Inconsistent application of FlV is due to multiple factors. Barriers included interference with other well-child visit procedures, incomplete understanding by the nurses, and population mobility. New strategic approaches are needed to improve FlV application and to generate caries experience data as critical outcome measures for this program. Support from Kentucky Department of Public Health and University of Kentucky.