Implementing Pediatric Fluoride Varnish Application in a Rural Primary Care Medical Office: A Feasibility Study

Flotation Behavior and Adsorption Mechanism of Phenylpropyl Hydroxamic Acid As Collector Agent in Separation of Fluorite from Calcite

The hydroxylamine method involves the synthesis of a new hydroxamic acid collector, i.e., phenylpropyl hydroxamic acid (PHA), from methyl cinnamic hydroxamic acid. Flotation test results show that PHA exhibits good selective collection ability. The adsorption mechanism of PHA is investigated using the zeta potential, Fourier transform infrared spectroscopy (FTIR), and X-ray photoelectron spectroscopy (XPS). The results show that PHA formed a new Ca-O bond with Ca²⁺ on the fluorite surface via chemical adsorption. A new five-element chelated hydroxamate group may have formed in Ca on the fluorite surface. The PHA selectivity is fully explained via density functional theory (DFT) calculations, and an adsorption model is established.

Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement

OBJECTIVES

To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice.

DESIGN

Retrospective claims-based analysis cohort study.

SETTING

Children with Medicaid insurance through an Ohio pediatric accountable care organization.

PARTICIPANTS

Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017.

INTERVENTION

FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider.

MAIN OUTCOME MEASURE

Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes.

RESULTS

The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4).

CONCLUSIONS

Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.

An Assessment of Pediatric Primary Care Providers’ and Parents’ Dental Health Knowledge and Practices

INTRODUCTION

One in five children aged < 5 years has experienced caries, making it the most prevalent chronic disease in childhood. The failure to address a child's dental health can lead to short-term and long-term complications and problems with permanent dentition. Primary care pediatric providers are in the position to participate in the prevention of caries because of the frequency they see young children before establishing a dental home.

METHOD

A retrospective chart review and two surveys were developed to collect data from health care providers and parents of children aged < 6 years about their dental health knowledge and practices.

RESULTS

While providers report being comfortable discussing dental health with patients, review of medical records shows inconsistent discussion and documentation of dental health.

DISCUSSION

There appears to be a lack of education regarding dental health among parents and health care providers. Primary care providers are not effectively communicating the importance of childhood dental health and are not routinely documenting dental health information.

Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting

Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.