Children’s Hospital of Philadelphia increased the use of fluoride varnish eightfold in just one year

Caries prevention programs for children remain one of the most underappreciated yet critically important components of pediatric care. Despite the proven safety and efficacy of fluoride varnish as a caries prevention measure, its routine use in the clinical practice of pediatric dentists has remained extremely low for many years. New data from Children’s Hospital of Philadelphia (CHOP) demonstrate that a systemic, multi-level approach can radically change the situation in a short period of time.

The original problem: low fluoride varnish application rates

At the national level, fluoride varnish application rates during pediatric visits remain alarmingly low. Less than 10% of children insured under Medicaid and only about 5% of children with commercial insurance receive fluoride varnish as part of a preventive check-up. This occurs despite fluoride varnish being recognized as a safe, effective, and cost-efficient method for preventing early childhood caries.

The goal of CHOP’s initiative

To bridge this gap, CHOP researchers launched a comprehensive quality improvement initiative across the hospital’s entire pediatric network. The program was implemented from July 2023 to October 2024 and aimed to increase the frequency of fluoride varnish application for children aged 6 months to 6 years.

Initially, the program’s target was to increase the fluoride varnish application rate from 5% to 20%.

Multifactorial intervention: key program components

The initiative included a set of complementary measures aimed at changing clinical behavior and organizational processes. These measures consisted of:

• reminders and prompts within the electronic medical record,
• educational activities at the individual practice level,
• certification audits and compliance monitoring,
• financial incentives for healthcare departments.

This approach allowed for simultaneous impact on clinical, administrative, and motivational aspects of care delivery.

Results: significant exceeding of target indicators

Analysis of over 92,000 preventive visits demonstrated impressive results. The frequency of fluoride varnish application increased from 3.7% to 30.5%, which is more than eight times the baseline and significantly exceeds the planned target of 20%.

Furthermore, the proportion of children who received at least one fluoride varnish application within a year doubled — from 25% to over 50%.

Universality of the effect: equality in access to prevention

It is important to note that the positive effect of the program was observed across all patient groups, regardless of insurance type, race, or ethnicity. This underscores the initiative’s potential as a tool for reducing disparities in access to preventive dental care.

Scientific significance and prospects for scaling

The study results, published in the journal Pediatrics, demonstrate that targeted quality improvement programs can effectively integrate dental prevention into everyday pediatric practice. The developed model can serve as a foundation for implementing similar initiatives at the national level.

Findings

The experience of Children’s Hospital of Philadelphia clearly demonstrates that a systemic, structured, and interdisciplinary approach can significantly increase the coverage of children with effective preventive measures in the shortest possible time. Given the high prevalence of early childhood caries, such programs represent not merely an improvement in clinical practice but a strategic step toward strengthening public health.