title: Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.
abstract: OBJECTIVE
  Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years.
  
  
  METHODS
  Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle.
  
  
  RESULTS
  In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits.
  
  
  CONCLUSIONS
  With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.
authors.affiliation: Contra Costa Regional Medical Center, Martinez, California; Diane.Dooley@hsd.cccounty.us.
authors.forename: Diane
authors.initials: D
authors.lastname: Dooley
authors.affiliation: Diablo Valley College, Pleasant Hill, California; and.
authors.forename: Nicolette M
authors.initials: NM
authors.lastname: Moultrie
authors.affiliation: Departments of Preventive and Restorative Dental Sciences and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Heckman
authors.affiliation: Departments of Preventive and Restorative Dental Sciences and.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Gansky
authors.affiliation: Family and Community Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Potter
authors.affiliation: Departments of Preventive and Restorative Dental Sciences and.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Walsh
mesh_terms: D002140:California; D002648:Child; D002654:Child Care; D002675:Child, Preschool; D003731:Dental Caries / Q000517:prevention & control*; D005260:Female; D005460:Fluorides, Topical / Q000008:administration & dosage*; D006267:Health Education, Dental / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009909:Oral Health / Q000706:statistics & numerical data*; D064876:Safety-net Providers / Q000706:statistics & numerical data*
chemical_list: D005460:Fluorides, Topical