A trans-disciplinary approach to implement a fluoride varnish protocol in a community health setting

In Massachusetts, 25% of children experience dental caries by the time they start kindergarten. Children under the age of 3 are more likely to visit their pediatrician than a dentist; therefore, a pediatric visit is a logical place for decay prevention to begin. As part of a transdisciplinary course at Boston University, a team of dental, medical, and public health students joined the Pediatric Clinic at Boston's South End Community Health Center to address this issue. Using the Challenge Model, as established by Management Sciences for Health, students and staff defined a challenge, obstacles, and a measurable result for the project: to deliver a piloted, standardized protocol for applying fluoride varnish to children under the age of 5 years in the pediatric clinic. Providers were trained to apply fluoride varnish through a web-based training followed by a student led post-training question/answer session and supervised pilot week. A total of 43 children received fluoride varnish, of which 76% of targeted children received fluoride varnish. After analysis of the strengths and weaknesses of the pilot week, a protocol for applying fluoride varnish was created. Throughout the week, providers became increasingly comfortable applying fluoride varnish despite obstacles such as short appointment times, competing provider responsibilities and missed appointments. The success of the pilot week and the integration of oral health prevention efforts into routine care in the pediatric clinic demonstrated the effectiveness of the student led community health initiative.