In this case, Dr. Brown decides to contact Jessie’s PNP to discuss her fluoride treatment. This is the first time that Dr. Brown has received a referral from a health clinic where they are applying fluoride varnish.

After discussion with Ms. Wilson, they agree to keep Jessie on systemic fluoride since she lives in an area with non-fluoridated water. Ms. Wilson also mentions that they have just started with fluoride varnish treatment at the health clinic and that the practitioners may benefit from further training and a consistent pediatric dentist to refer their patients. Dr. Brown offers to visit the health clinic to speak with practitioners that will be administering the fluoride varnish. In addition she provides a short inservice on oral exams for the young child and reinforces the guidance for oral hygiene practices for this patient population. By following up on this one patient’s treatment, Dr. Brown was able to establish a strong working relationship and referral network with this health clinic.

Oral Exams and Fluoride Varnish Application by Primary Pediatric Care Clinicians

A recent article published in Pediatrics, highlights the updated guidance by the US Preventive Services Task Force (USPSTF) on prevention of dental caries in preschool-aged children. In this review, it is acknowledged that primary care clinicians are more likely than dentists to have contact with children ages 5 years and younger in the United States. While the updated recommendation concludes there is not enough evidence to recommend for or against routine oral screening for dental caries performed by primary care clinicians in children 5 years or younger, it also states that given the noninvasive nature of an oral examination, the harms of these exams are expected to be minimal.

In addition, this current statement expands to include the recommendation that primary care providers apply fluoride varnish to the primary teeth of all children 5 years and younger starting at tooth eruption. Application of fluoride varnish is not currently commonly performed in many primary care offices (estimated at about 4% of practices in 2009). Primary care providers and other qualified staff may require some training before offering fluoride varnish. Pediatric dentists are well suited for this training.