Education and Utilization of Risk Assessment Tools and Fluoride Varnish for the Pediatric Population in Primary Care Residency Training Sites

Background: A pediatric oral health survey of the Mayo Clinic Enterprise providers found that 95% of respondents had patients with difficulty accessing dental care and 76% of them identified dental disease as a significant problem for their patients. Many clinicians expressed interest in learning how to apply fluoride varnish and complete an oral health risk assessment. Objectives: Pediatric and Family Medicine residency faculty at MCR and UMN/MCHS Mankato partnered to develop a pediatric oral health curriculum to increase residents’ knowledge of pediatric oral health; and to implement an oral health risk assessment tool with application of fluoride varnish when indicated in the residency continuity clinic.  Methods: Residents completed the Society for Teachers of Family Medicine (STFM) Smiles for Life (SFL) modules 2 and 6 to gain foundational knowledge of pediatric oral health. We conducted a hands-on training workshop for residents in MCR; and residents, faculty and nurses in Mankato.  We implemented oral health risk assessments and risk-based application of fluoride varnish at well child visits ages 4 months through 5 years. Results: Rates of fluoride varnish applications in UMN/MCHS Mankato increased from 0 to 75% of eligible children over the first 3 months of the intervention. In MCR, pediatric residents applied 60 fluoride varnishes over the first 8 months of the intervention. Conclusion: Targeting residents and allied health staff increased oral health prevention in the primary care setting. Interdisciplinary teaching lead to the development of oral health nurse-driven protocols and created a culture of oral health prevention at each site.