Barriers and Facilitators to Delivery of Fluoride Varnish Application in Pediatric Well-Child Visits: A Post-Implementation Analysis.

Abstract

Early childhood caries affects many children, posing risks to dental and overall health. Fluoride varnish application during pediatric well-child visits has demonstrated efficacy in mitigating decay, yet rates remain notably low among medical providers. This study delves into the details of fluoride varnish adoption and delivery in pediatric practices and identifies associated barriers and facilitators by employing the updated Consolidated Framework for Implementation Research. Semi-structured interviews were the primary research method, involving participants from diverse roles within medical practices in Georgia that had previously implemented fluoride varnish application. Interviews covered aspects such as the participant's role, background in fluoride varnish application, understanding of evidence supporting fluoride varnish, factors influencing the process, and the impact on their practice. The partnerships and connections that introduced providers to fluoride varnish application and their knowledge of the evidence base led to its adoption in medical practices. Integration of fluoride varnish application into electronic health records, the motivation providers felt from understanding the patient needs related to oral health, and strategies for engaging patients served as important facilitators. Important barriers encompassed the low relative priority of fluoride varnish application compared to other demands during well-child visits, parent beliefs, and patient resistance. This study details important barriers and facilitators to initial adoption and consistent delivery of fluoride varnish application in primary care well-child visits. In practices not currently offering fluoride varnish, findings may guide and facilitate adoption, while in practices offering fluoride varnish, findings may help optimize delivery and further integration of the innovation into workflows.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-025-00160-y.