Philadelphia, September 18, 2025 – In a groundbreaking study that may revolutionize pediatric dental care, researchers at the Children’s Hospital of Philadelphia (CHOP) have demonstrated that a comprehensive, multifaceted intervention markedly improved dental fluoride varnish application rates across a large pediatric healthcare network. Their findings, published in the prestigious journal Pediatrics, reveal a significant enhancement in preventive dental care that transcended socio-economic and racial boundaries, showcasing an effective model for widespread implementation.
Dental caries, commonly known as tooth decay, remains one of the most prevalent chronic childhood diseases worldwide. Fluoride varnish application is a scientifically supported, safe, and non-invasive method recognized for its ability to strengthen tooth enamel and prevent cavities in young children. Despite clinical guidelines endorsing its use, along with insurance coverage that removes financial barriers, national rates of varnish application within pediatric primary care settings have remained stubbornly low—particularly among traditionally underserved populations.
Prior to this intervention, fewer than 10 percent of children insured through Medicaid and a mere 5 percent of commercially insured children received dental fluoride varnish during pediatric visits. This gap in preventive care contributes to persistent disparities in oral health, leading to significant long-term consequences for affected children, including pain, infection, and impaired quality of life. The CHOP research team sought to address this critical public health issue through a quality improvement initiative aimed at transforming clinical practice patterns.
The study, carried out over a 15-month period from July 2023 to October 2024, employed a multi-pronged strategy to enhance varnish application rates. Central to this approach were electronic health record (EHR) prompts designed to remind clinicians to apply fluoride varnish during well-child visits. Additional components included practice-level education sessions aimed at increasing staff knowledge and engagement, systematic certification audits to maintain high standards of care, and targeted financial incentives to motivate sustained adoption.
A total of 92,056 eligible preventive care visits were analyzed during the study, providing a robust data set to assess the intervention’s efficacy. Remarkably, the proportion of visits where fluoride varnish was applied surged from a baseline of 3.7 percent to an impressive 30.5 percent by the conclusion of the project, surpassing the initial goal of 20 percent. This increase was not only statistically significant but also clinically meaningful, with over half of the children receiving varnish annually compared with only a quarter before the study began.
Crucially, improvements in varnish application were observed across all subgroups regardless of insurance type, race, or ethnicity, highlighting the intervention’s equitable impact. Implementation expanded from six initial network sites to all 33 pediatric practices within the CHOP network, representing a comprehensive transformation in preventive dental service delivery. The study further documented increased maintenance reimbursement from insurers, suggesting that stakeholder incentives can align effectively with improved clinical outcomes.
Senior author Brian Jenssen, MD, Associate Director of Clinical Impact at CHOP’s Clinical Futures program and a practicing pediatrician, emphasized the significance of these results. “Our data demonstrates that relatively straightforward quality improvement strategies, when systematically applied, can yield dramatic improvements in an important yet underutilized preventive health service,” he stated. “This model offers a practical roadmap for not only sustaining but scaling these advances nationally, which could have profound implications for child oral health.”
The success of this initiative underscores the untapped potential of integrating evidence-based preventive interventions into primary care workflows. By leveraging technology such as EHR prompts, enhancing provider education, and aligning financial incentives, healthcare systems can overcome entrenched barriers that have historically limited the reach of dental varnish application. These findings advocate for policy and practice reforms to embed similar approaches into pediatric care broadly.
Moreover, the study highlights the critical importance of addressing health disparities through targeted quality improvement initiatives. The uniform improvements across differing demographic groups affirm that equitable care can be achieved with deliberate, data-driven strategies. This aligns with broader public health goals aimed at reducing oral health inequities and improving lifelong health trajectories for vulnerable pediatric populations.
Fluoride varnish’s unique role as a safe, efficient, and cost-effective preventive tool makes it an ideal candidate for widespread adoption in pediatric settings. The CHOP study’s success may serve as a catalyst for other institutions and healthcare networks to reevaluate and enhance their preventive oral health protocols. If scaled nationally, such efforts hold transformative potential to reduce childhood dental caries and associated comorbidities on a large scale.
The implications of this research extend beyond dental care alone. It exemplifies how quality improvement science can be operationalized effectively in real-world clinical environments using multifaceted interventions. This study thus contributes valuable insights into mechanisms that drive practice change, clinician engagement, and health outcome improvements within complex healthcare systems.
Children’s Hospital of Philadelphia, the oldest pediatric hospital in the United States and a leader in pediatric clinical care and research, continues to pioneer initiatives that blend clinical innovation with system-wide improvements. This study, through its rigorous methodology and compelling outcomes, enhances the institution’s legacy of advancing child health. It also underscores the vital intersection of clinical practice, health policy, and research aimed at improving preventive care standards.
As this research gains traction among pediatric and dental professionals nationwide, it has the potential to alter clinical norms and expectations. By making dental varnish applications a routine part of pediatric preventive care, health systems can play a pivotal role in combating childhood dental decay—a condition that burdens families, healthcare providers, and society. The CHOP model offers a powerful example of how targeted intervention can effect rapid and sustained change in health care delivery.
In sum, the CHOP research presents a compelling, evidence-based framework for improving dental fluoride varnish rates that can be replicated across diverse pediatric care settings. This advancement represents a major step toward closing the gap in preventive oral health services and ensuring all children have access to vital interventions that safeguard their dental health and overall well-being.
Subject of Research: People
Article Title: Increasing Dental Varnish Rates in a Large Pediatric Care Network: A Quality Improvement Effort
News Publication Date: 18-Sep-2025
Web References: https://dx.doi.org/10.1542/peds.2025.069877
References: Jenssen et al, Pediatrics, DOI: 10.1542/peds.2025.069877
Keywords: Dental care, Hospitals, Medical facilities, Medical economics, Health care delivery, Pediatrics
