FLUORIDE VARNISH APPLICATION AS AN ORAL HEALTH INTERVENTION IN THE WELL-BABY CLINIC FOR CHILDREN AGED 1-5 YEARS AT QATAR UNIVERSITY HEALTH CENTER: A FEASIBILITY STUDY

Abstract

Background: Early childhood caries (ECC) is one of the most common chronic conditions affecting children worldwide. It is considered a significant public health problem in most communities, with over 530 million children worldwide suffering from dental caries in their primary teeth. Qatar has reported a prevalence of 89% among preschool children aged 4 to 5 years old. ECC is often left untreated, leading to physical, psychosocial, and economic consequences, and if severe, it can result in potentially life- threatening infections. ECC is preventable through proper diet counseling, oral health promotion, and simple preventive measures. Strategies for preventing ECC require a multidisciplinary approach and should be integrated into different settings. Professionally applied fluoride varnish (FV) containing 5% sodium fluoride has been proven effective in ECC prevention. In addition to the high prevalence of ECC in Qatar, community water supplies are not fluoridated, and attending multiple health-related appointments is a challenge for families at high dental caries risk. When these factors are considered together, they indicate that integrating oral health assessment and prevention into places where young children already go and in settings other than the dental clinic could be a promising strategy for dealing with the high prevalence of ECC. This study investigated the feasibility of providing FV application for children aged 1- 5 years and at moderate to high risk of developing ECC during their regular vaccination visits in the well-baby clinic at Qatar University Health Center using the Donabedian model for measuring the quality of care. Aim: This study aimed to test the feasibility of providing Fluoride Varnish (FV) application in the Well-baby clinic at Qatar University Health Center for children aged 1-5 years who are at risk (moderate to high) of dental caries during their regular vaccination visits. Methods: The design is a 3-month one-group feasibility study with a pre-and post-test design. All eligible participants (50 children) were at risk to dental caries and received the FV application intervention. Feasibility was assessed by examining the intervention’s acceptability, implementation, and practicality. Assessment methods included surveys of healthcare providers and parents, clinic logs and nurses’ notes, and a Cost Assessment Tool (CAT) adapted from EngenderHealth. Reporting followed the Template for Intervention Description and Replication (TIDieR) from the EQUATOR network (Enhancing the QUAlity and Transparency Of health Research). Results: The results showed that the intervention was acceptable to parents and their children. We reached 90.9% of the eligible children based on their contact information. Of the contacted parents, 93.1% confirmed participation, and 96.7% of those showed up to their appointments. The majority of parents (92%) had no concerns about FV safety, and all participating parents reported they would allow a well-trained nurse to provide the application to their children during their vaccination visits. In a small number of cases (12%), parents reported feelings of stickiness and unpleasant flavor by their children. Despite a high level of acceptability, implementation rates were lower than expected. Nurses performed the caries risk assessments on all participated children and completed FV applications for the vast majority (47 children; 94%), while pediatricians participated by adding the preventive FV application to the general and oral health promotion they already offer during the vaccination visits. In terms of the intervention practicality, the time utilized for completing the dental caries risk assessment was 1.09 ± 0.33 minutes, whereas 1.37 ± 0.62 minutes was the average time for completing one FV application. The direct cost for providing FV to children in the well-baby clinic at Qatar University Health Center was 15QR per application. The most frequently perceived barriers to implementing the intervention were: unavailability of instruments, insufficient supportive staff, lack of physical space, and providing the FV for those who rarely visit the health center. Conclusion: This study showed that integrating the FV application as a simple, cost- effective strategy for the primary prevention of dental caries in children less than five years old during their regular vaccination visits in a primary health care setting in Qatar is feasible after addressing gaps related primarily to the process inside the well-baby clinic. Increasing the appointment time by a minimum of 3 minutes, providing more structured mandatory oral health education and training to the providers, application of strategies to increase nurses’ adherence through reminding them of the oral assessment for each child, and affording enough staff to be able to carry out the intervention effectively without compromising the patient’s quality of medical care, all are limitations to be addressed by management before introducing the FV application in the well-baby clinic for children at risk of having dental caries.