Fluoride varnish application rates in young children has room for improvement

Fluoride varnish application is recommended during well-child visits for children aged 1 to 5 years, but in reality may not always work.

Fluoride varnish is an important tool to reduce tooth decay, which occurs in nearly 25% of children aged 2 to 5 years and over 50% of children aged 6 to 8 years. Current recommendations from the US Preventive Services Task Force say that clinicians should apply the varnish to young children’s teeth at well-child visit to 5 years of age, as nearly all children aged younger than 6 years have preventive care visits, but only 1 in 3 have an annual dental visit. How many children who are privately insured are receiving fluoride varnish at well-child medical visits?1

The investigators used data from children who were privately insured from 2016 to 2018 in Maine, Connecticut, New Hampshire, and Rhode Island, found through payer-claims databases. The sample was limited to children aged 1 to 5 years and had a visit coded as well-child and also had coding for fluoride varnish application on the same date.

There were 328,661 well-child visits for children aged 1 to 5 years included in the sample. Among these visits, 15,756 had a fluoride varnish application. The application was more common among visits for the younger children. For example, a 2-year-old child was 7.7 percentage points (95% CI, 5.9 percentage points -9.4 percentage points) more likely to be given fluoride varnish than a 5-year-old child. There was improvement in the likelihood of application from 2016 to 2018, with the adjusted probability increasing from 3.6% (95% CI, 2.8%-4.4%) to 5.8% (95% CI, 4.5%-7.1%). Among the 4 states included in the study, fluoride varnish application was most common in Rhode Island, with an adjusted probability of (95% CI, 5.1%-12.4%) and New Hampshire had a far lower adjusted probability of 2.2% (95% CI, 1.2%-3.3%).

The investigators concluded that although there is mandatory insurance coverage for fluoride varnish applications in the medical setting, that fewer than 5% of well-child visits for privately insured young children received it. They noted that there was some improvement in the rates of application, but a substantial push would be needed to expand the service in pediatric practice, to improve oral care and reduce the risk of dental caries.


1. Geissler K, Dick A, Goff S, Whaley C, Kranz A. Dental fluoride varnish application during medical visits among children who are privately insured. JAMA Netw Open. 2021;4(8):e2122953. doi:10.1001/jamanetworkopen.2021.22953