Changes in Children's Receipt of Fluoride Varnish During Medical Visits and the COVID-19 Pandemic.

Objective: Primary care medical providers are recommended to apply fluoride varnish to the teeth of young children to prevent tooth decay. The COVID-19 pandemic interrupted care delivery in health care settings and may have differentially impacted patients with different types of insurance. The objective of this study was to examine changes in children's receipt of fluoride varnish in the medical office during 2014-2022.

Methods: Using all-payer claims data from Massachusetts (2014-2022), we examined children's receipt of fluoride varnish during medical visits over time overall and by insurance-type. Because rates were highest in 2019, this was used as the reference year. We examined if results were driven by receipt (or non-receipt) of medical visits.

Results: Following growth from 2014 to 2019, the probability of a child receiving fluoride varnish in 2022 compared to 2019 was 2.4 (95% confidence interval (CI)= -3.5 to -1.3) percentage points (pp) lower for a child with private insurance and 6.0 (95% CI= -8.0 to -4.0) pp lower for a child with Medicaid, representing declines of 15% and 37%, respectively. We did not observe a similar decline in children's receipt of medical visits during this time and our findings on fluoride varnish receipt were similar when we controlled for receipt of medical visits.

Conclusions: Fluoride varnish receipt among young children declined precipitously during the COVID-19 pandemic and was not explained by declines in well-child medical visits. Declines were greater for children with Medicaid, erasing nearly a decade of progress in promotion of this evidence-based preventive service.