Randomized controlled trial of an oral health promotion program in a large, urban safety-net health care system effectively expands access to preventive dental care

Background: Caries, a common childhood disease, is preventable, yet access to preventive dental care (PDC) is limited for disadvantaged children. Objective: To examine the provision of PDC by medical providers after participation in an oral health promotion program (OHPP). Design/Methods: We implemented a staged intervention in an urban safety-net health system with 8 federally-qualified health centers (FQHCs). Four FQHCs received the OHPP in 2009 (intervention) and 4 in 2011 (controls). OHPP consisted of an oral health training regarding PDC (including fluoride varnish application (FVA)) and quarterly practice coaching. We measured OHPP adoption by 1) comparing FVA in children receiving care in the intervention vs. control FQHCs in 2011 and 2) FVA in children 18-, 30- and 42-months of age in 2013. Descriptive statistics, Wilcoxon rank-sum and Chi-square tests were used. Results: 1) A random sample of 421 children receiving care in the 4 intervention/4 control FQHCs were recruited. They were 40.6 months old, Hispanic (91.2% intervention/86.4% control, p=0.14) and insured by Medicaid/SCHIP (90.2% intervention/85.6% control, p=0.17). Children from intervention FQHCs were more likely to have received a FVA (mean=1.4 FVA (N=296, Range=0 to 7) than children from control FQHCs (mean= 0.4 FVA (N=124, Range=0 to 4)) (p<0.0001). 2) 79% of 18-month old children receiving care in any FQHCs had received at ≥ 1 FVA; 62% of 30-month old children had received ≥ 2; and 38% of 42-month old children had received ≥ 3. Conclusions: A structured OHPP program effectively engaged medical providers in the provision of PDC to children.