Doctor of Nursing Practice (DNP) Projects

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Open Access

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Degree Program

Doctor of Nursing Practice

Degree Track

Family Nurse Practioner

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Month Degree Awarded



fluoride varnish, dental caries, children, primary teeth, pediatric, caries


Terrie Black

DNP Project Chair

Terrie Black

DNP Project Member Name

Pamela Aselton

DNP Project Outside Member Name

Ashley Miller


Purpose: The United States (U.S.) has a persistent problem of dental caries in primary teeth with a greater prevalence of dental caries found in minority and poor children. The majority of children in the U.S. experience dental caries in their primary teeth by age eight. This problem could be addressed by primary care providers applying fluoride varnish (FV) to children's teeth starting at the age of primary tooth eruption. The causes of dental caries in children’s primary teeth are multifactorial and therefore require multiple interventions. Around the world providers are utilizing FV as an effective and easily administered strategy. This author implemented a quality improvement project of a FV application program in a Vermont pediatric practice, based on a United States Preventive Services Task Force (USPSTF) guideline.

Methods: After thorough preparation a staff training in FV application was done for providers and staff along with the pre-project questionnaire. The DNP student consulted with providers, registered nurses (RNs), the billing person and the office receptionist to determine the number of eligible patients who received FV. Qualitative data about facilitators and barriers to FV application were collected. At the conclusion of 4 months a post-questionnaire was done and a debrief of the project.

Results: Fluoride varnish was applied during well child check-ups (WCC) for children aged 9, 18, 24, and 30 months. Over the course of the project study 56% of patients received FV at their WCCs. Findings included: the staffs thorough understanding of pediatric dental health issues, ease of adding FV application to the flow of WCCs, positive reception by parents, FV as a meaningful use quality measure for AthenaNet, Electronic Health Record (EHR), increased oral health education, consistent reimbursement for the treatment.

Conclusion: This quality improvement project successfully introduced a FV application program to a pediatric practice. Fluoride varnish was applied during WCCs for children aged 9, 18, 24, and 30 months. Future suggestions include implementing similar programs in larger, more urban practices, considering safety studies to include children in the 6 to 12 month age range, and cohort studies to assess the efficacy of FV application programs.

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