Fluoride Varnish Application Research Articles

In the driving seat

Dental nurses Louise Smith and Faye Palethorpe talk to Fiona Elwood about moving up a gear in their career, their experiences of fluoride varnish application and prevention in practice

Single application of casein phosphopeptide-amorphous calcium phosphate paste-based paste prevents in vitro erosive wear

Abstract Aim: The purpose of this study was to evaluate, in vitro, the effect of a single application of a casein phosphopeptide-amorphous calcium phosphate paste (CPP-ACP) in comparison with a fluoride varnish, in enamel of bovine teeth, after erosive challenge using cola soft drink. Materials and Methods: Forty-five enamel specimens were obtained from bovine teeth, selected according to the surface hardness and randomly divided into three groups: G1 – Fluoride varnish, G2 – CPP-ACP-based paste, and G3 – Control, without any treatment. The enamel specimens were treated using each group material and subjected to three daily erosive challenges by immersion of the specimens in cola soft drink for 5 min, during 5 days. Between the erosive cycles, the enamel specimens were immersed in artificial saliva. The initial profilometry (prechallenge) and the final profilometry (postchallenge) were used to evaluate the enamel loss. Statistical Analysis: Data were analyzed using ANOVA and Tukey′s Test (P < 0.05). Results: The single application of CPP-ACP (G2: 4.17 ± 0.77 μm) resulted in less enamel loss compared to control (G3: 4.74 ± 0.52 μm) and higher enamel loss compared to fluoride varnish application (G1: 3.01 ± 0.45 μm) (P < 0.05). Conclusion: The CPP-ACP paste was effective in reducing enamel wear after erosive cycles, however, the best potential for erosion prevention was observed when using the fluoride varnish.

In Vitro Evaluation of Dentin Hydraulic Conductance After 980 nm Diode Laser Irradiation.

Dentin hypersensitivity treatments are based on the physical obliteration of the dentinal tubules to reduce hydraulic conductance. The aim of the present study is to evaluate the hydraulic conductance of bovine root dentin after irradiation with a 980-nm diode laser, with or without associated fluoride varnish. Sixty bovine root dentin specimens were divided into six groups (n = 10 in each group): G1, G3, and G5 (0.5 W, 0.7 W, and 1 W diode laser, respectively); G2, G4, and G6 (fluoride varnish application + 0.5 W, 0.7 W, and 1 W diode laser, respectively). The dentin hydraulic conductance was evaluated at four time periods with a fluxmeter: 1) with smear layer, 2) after 37% phosphoric acid etching, 3) after the treatments, and 4) after 6% citric acid challenge. After the dentinal fluid flow measurements, specimens were also evaluated for mineral composition using energy dispersive X-ray spectroscopy (EDS). Analysis demonstrated a better result with increased irradiation power (P < 0.001), especially if the diode laser irradiation was associated with the application of fluoride varnish (P < 0.001), ensuring a greater reduction in permeability. Considering the groups treated only with laser irradiation, the 1 W group was superior when compared with the 0.5 W and 0.7 W irradiated groups immediately after treatment (P < 0.001). After citric acid testing, all groups showed similar results, except when comparing the 1 W groups with the 0.5 W groups (P = 0.04). EDS results of the irradiated groups showed an increase in the proportion of calcium and phosphorus ions, which demonstrates a superficial composition modification after laser treatments. Laser irradiation of exposed dentin promoted significant reduction in the dentin hydraulic conductance, mainly with higher energy densities and association with fluoride varnish.

The Children's Oral Health Initiative: An intervention to address the challenges of dental caries in early childhood in Canada's First Nation and Inuit communities.

The objective of the Children's Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities. COHI targets preschool children; 5-7-year-olds; pregnant women; and parents/caregivers in FN/I communities. The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program's implementation and agree to support a community member to be trained as a COHI aide. Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children's teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries. COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services. The results demonstrate COHI's success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.

Can Fluoride or Tri-calcium Phosphate Varnishes alter Salivary and Plaque pH in Athletes who Consume Soft Drinks?

Background: Plaque and saliva pH are the main factors that facilitate the caries process. Consumption of acidic soft drinks is one of the factors responsible for pH changes in the oral cavity. Athletes commonly consume soft drinks. The purpose of this study was to evaluate the effects of two types of varnishes (fluoride and tri-calcium phosphate, TCP) on plaque and saliva pH of professional athletes who consume soft drinks. Methods: In this clinical study, 40 professional athletes aged 18-30 years were first randomly divided into two groups: Fluoride varnish (Sultan®, USA) and TCP varnish (3M®, ESPE, USA). At the first session, the baseline pH of plaque and saliva was measured using a plaque indicator kit (GC, USA) and pH meter (Hana, model AZ 8686, Italy). Then, the varnishes were applied. After 3 weeks, pH value of the participants was examined and varnishes were applied again, following by pH measurements at weeks 6 and 12. The data were analyzed using Repeated Measures ANOVA. Results: Applying fluoride varnish or TCP varnish did not cause any significant difference in saliva and plaque pH during the assessment periods (p>0.05).However, higher buffering capacity was observed among the athlete who had low pH at the baseline (p<0.05). Conclusion: Neither of the varnishes caused changes in plaque and saliva pH in this study. But the buffering capacity increased in athletes with low baseline pH.

Medical Providers' Oral Health Knowledgeability, Attitudes, and Practice Behaviors: An Opportunity for Interprofessional Collaboration

ObjectiveEvaluation of current knowledgeability, attitudes, and practice behaviors of medical providers from a large health care system toward oral health was undertaken as a pilot effort to better understand and integrate oral health into the overall health care delivery. MethodsInvitations to complete a 28-question survey, designed in a web-based platform (SurveyMonkey®), were emailed to 1407 medical multispecialty physicians, residents, and nurses within the health system. The questionnaire included sections on provider demographics, oral health knowledgeability and attitudes, and current practice conducting oral health screenings. ResultsA 14% (n = 199/1407) response rate was achieved for survey completion. There were 16% who reported good coverage of oral/dental health topics in their medical training curriculum. Competency level was <30% for identifying tooth decay and oral pathology. There were 95% who reported never applying fluoride varnish in their practice, while >80% answered knowledge-based questions correctly. Frequency rates for dental referral by the medical providers were 32% ‘frequently’ and 68% ‘infrequently.’ Perceptions of optimal frequency for conducting oral health assessment in their professional practices ranged from 69% indicating ‘frequently’ to 25% indicating ‘infrequently.’ ConclusionOverall, positive attitudes were observed toward incorporation of oral health examination into medical practice. The study identified lack of oral health treatment and infrequent referral by medical providers to dental providers. Results support likelihood for acceptance of care models that incorporate a medical/dental team-based approach complemented by oral health training for medical providers to enhance holistic health care delivery. Limitations of this pilot study include potential selection bias and lack of generalizability beyond our institution; further studies are planned in additional settings statewide to validate findings.

Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances-a prospective randomized controlled trial.

The development of white spot lesions around orthodontic brackets and gingivitis is a common problem during orthodontic treatment with fixed appliances. This prospective randomized double-blind controlled clinical trial investigated the preventive efficacy of a one-time application of two commonly used fluoride varnishes in patients with low to moderate caries risk. Ninety adolescent orthodontic patients with a low to moderate caries risk were prospectively randomized to three groups of 30 patients each: (1) standardized dental hygiene with fluoride toothpaste and one-time application of placebo varnish (control) or (2) of elmex® fluid or (3) of Fluor Protector S on all dental surfaces at the start of fixed therapy. The extent of enamel demineralization and gingivitis was determined with the ICDAS and the gingivitis index (GI) at baseline and after 4, 12, and 20weeks. Each treatment group showed a significant increase of the ICDAS index, but not of the GI over the course of time with no significant intergroup differences detectable. A one-time application of fluoride varnish at the start of orthodontic treatment did not provide any additional preventive advantage over sufficient dental hygiene with fluoride toothpaste with regard to formation of white spots and gingivitis in patients with a low to moderate caries risk. In dental practice, patients often receive an application of fluoride varnish at the start of orthodontic treatment with fixed appliances. However, the efficacy of this procedure is still unclear.

Effectiveness of Early Preventive Intervention with Semiannual Fluoride Varnish Application in Toddlers Living in High-Risk Areas: A Stratified Cluster-Randomized Controlled Trial

This study evaluated whether toddlers in an extended preventive program of semiannual fluoride varnish applications from 1 year of age had a lower incidence of caries than those undergoing a standard program. A cohort of 1-year-old children (n = 3,403) living in multicultural areas of low socioeconomic standing in Stockholm participated in a cluster-randomized controlled field trial with two parallel arms. The children attended 23 dental clinics. Using the ICDAS II criteria, the examiners recorded caries at baseline and after 1 and 2 years. The children in the reference group received a standardized oral health program once yearly between 1 and 3 years of age. The children in the test group received the same standard program supplemented with topical applications of fluoride varnish every 6 months. We compared the test group and the reference group for the prevalence and increment of caries. At baseline, 5% of the children had already developed caries (ICDAS II 1-6). We reexamined the children after 1 year (n = 2,675) and after 2 years (n = 2,536). Neither prevalence nor caries increment differed between the groups. At 3 years of age, 12% of the children had developed moderate and severe carious lesions (ICDAS II 3-6), with a mean increment of 0.5 (SD 2.4) in the test group and 0.6 (SD 2.2) in the reference group. In conclusion, semiannual professional applications of fluoride varnish, as a supplement to a standard oral health program, failed to reduce caries development in toddlers from high-risk communities.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.

New fluoride MI Varnish as root canal sealer: An in vitro analysis of bacterial leakage.

The aim of the present study was to evaluate and compare the sealing ability of root canal obturation after the application of fluoride varnish (MI Varnish) containing 5% sodium fluoride and casein phosphopeptide-amorphous calcium phosphate, fluoride varnish, and AH Plus and AH-Plus as root canal sealer by bacterial penetration test. Root canals of 65 single-rooted and single-canalled teeth were prepared. They were divided into three experimental groups (n = 15) and two control groups (n = 10). The root canal walls in Group I were coated with AH Plus, Group II were coated with AH Plus and fluoride varnish, and Group III were coated with fluoride varnish. All the teeth were obturated with gutta-percha using the lateral condensation technique. Enterococcus faecalis were used as test bacteria to determine the leakage during 100 days. The data were analyzed using log-rank test and Kaplan-Meier survival analysis. Group III showed significantly less bacterial penetration as compared to Group I (P = 0.01) and Group II (P = 0.03). However, there was no statistical significance between Groups I and II (P = 0.672). It can be concluded from the present study that fluoride varnish can be used as a root canal sealer. However, further in vitro and in vivo studies are required.

Molar-incisor hypomineralization (MIH): report of a severe case

The term molar-incisor hypomineralization describes an uncommon pathological entity characterized by the hypomineralization of permanent first molars and commonly affecting permanent incisors. In this paper we describe a case of a 9 years old female patient attended with severe dental sensibility, masticatory and phonetic difficulties. Clinical examination revealed severe enamel structural defects affecting all four permanent first molars and opaque stains affecting permanent incisors, besides caries lesions on posterior teeth and severe osseous basis discrepancy. Radiographic examination evidenced permanent first molars imbrication and shallow lesions on the enamel of these teeth. Therefore, molar-incisor hypomineralization was defined. After fluoride varnish applications, glass ionomer cement restorations and home performed fluoride mouthwash, patient continued to report dental sensibility. Molar-incisor hypomineralization is capable of led the affected patient through morbidity which results on quality of life decrease. Due to severe dentin exposure, therapeutic interventions aiming to reduce dental sensibility are not always effective.

Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.

Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.

A 12-Week Assessment of the Treatment of White Spot Lesions with CPP-ACP Paste and/or Fluoride Varnish.

This 12-week clinical study evaluated the impact of 10% CPP-ACP and 5% sodium fluoride varnish regimes on the regression of nonorthodontic white spot lesions (WSLs). The study included 21 children with 101 WSLs who were randomised into four treatment regimes: weekly clinical applications of fluoride varnish for the first month (FV); twice daily self-applications of CPP-ACP paste (CPP-ACP); weekly applications of fluoride varnish for the first month and twice daily self-applications of CPP-ACP paste (CPP-ACP-FV); and no intervention (control). All groups undertook a standard oral hygiene protocol and weekly consultation. Visual appraisals and laser fluorescence (LF) measurements were made in weeks one and twelve. The majority of WSLs in the control and FV groups exhibited no shift in appearance, whereas, in the CPP-ACP and CPP-ACP-FV groups, the lesions predominantly regressed. The visual and LF assessments indicated that the extent of remineralisation afforded by the treatments was of the following order: control ~ FV < CPP-ACP ~ CPP-ACP-FV. Self-applications of CPP-ACP paste as an adjunct to standard oral hygiene significantly improved the appearance and remineralisation of WSLs. No advantage was observed for the use of fluoride varnish as a supplement to either the standard or CPP-ACP-enhanced oral hygiene regimes.

Combined effect of fluoride varnish to Er:YAG or Nd:YAG laser on permeability of eroded root dentine

ObjectiveThis study evaluated the combined effect of fluoride varnish to Er:YAG or Nd:YAG laser on permeability of eroded root dentine. DesignSixty slabs of bovine root dentine (2×2×2mm) were eroded with citric acid 0.3% (pH 3.2) during 2h and then kept in artificial saliva during 24h. Specimens were randomly assigned in 6 groups (n=10), to receive the following treatments: fluoride varnish; fluoride varnish+Er:YAG laser; fluoride varnish+Nd:YAG laser; non-fluoride varnish; non-fluoride varnish+Er:YAG laser; non-fluoride varnish+Nd:YAG laser. The Er:YAG (100mJ, 3Hz) and Nd:YAG (70mJ, 15Hz) were applied for 10s. Specimens were subjected to further erosive challenges with citric acid 0.3% 4×/day, during 1min, for 5 days, remaining in artificial saliva between cycles. Dentin permeability was then assessed. Two-way ANOVA demonstrated no significant interaction between laser and varnish (p=0.858). ResultsNo effect was also detected for the main factor varnish (p=0.768), while permeability of eroded root dentin was significantly lower when such substrate was laser-irradiated, no matter the laser source (p<0.001). ConclusionsThis study concluded that Er:YAG and Nd:YAG lasers can be employed to control the permeability of eroded root dentin, regardless of fluoride varnish application.

Comparison of the caries-protective effect of fluoride varnish with treatment as usual in nursery school attendees receiving preventive oral health support through the Childsmile oral health improvement programme - the Protecting Teeth@3 Study: a randomised controlled trial.

BackgroundThe Scottish Government set out its policy on addressing the poor oral health of Scottish children in 2005. This led to the establishment of Childsmile, a national programme designed to improve the oral health of children in Scotland. One element of the programme promotes daily tooth brushing in all nurseries in Scotland (Childsmile Core). A second targeted component (Childsmile Nursery) offers twice-yearly application of fluoride varnish to children attending nurseries in deprived areas. Studies suggest that fluoride varnish application can reduce caries in both adult and child populations. This trial aims to explore the effectiveness and cost-effectiveness of additional preventive value fluoride varnish application compared to Childsmile Core.Methods/DesignThe Protecting Teeth@3 Study is an ongoing 2 year parallel group randomised treatment as usual controlled trial. Three-year-old children attending the ante pre-school year are randomised (1:1) to the intervention arm (fluoride varnish & treatment as usual) or the control arm (treatment as usual). Children in the intervention arm will have Duraphat® fluoride varnish painted on the primary tooth surfaces and will continue to receive treatment as usual: the core Childsmile Nursery intervention. Children in the treatment as usual arm will receive the same series of contacts, without the application of varnish and will also continue with the Childsmile Core intervention. Interventions are undertaken by Childsmile trained extended duty dental nurses at six-monthly intervals. Participants receive a baseline dental inspection in nursery and an endpoint inspection in Primary 1 at the age of 5 years old.We will use primary and secondary outcome measures to compare the effectiveness of Duraphat® fluoride varnish plus treatment as usual with treatment as usual only in preventing any further dental decay. We will also undertake a full economic evaluation of the trial.Trial registrationThis study is registered at ClinicalTrials.gov. Number: NCT01674933 (24 August 2012).Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0146-z) contains supplementary material, which is available to authorized users.

Patient-, organization-, and system-level barriers and facilitators to preventive oral health care: a convergent mixed-methods study in primary dental care.

BackgroundDental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care.MethodsA convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies.ResultsTheoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6–12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours.ConclusionsSpecific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0366-2) contains supplementary material, which is available to authorized users.

Timetable for oral prevention in childhood-a current opinion.

Dental caries in young children remains a public health problem particularly for children whose families are socioeconomically deprived. A child's first dental visit should be at approximately 12 months of age and this should facilitate the provision of anticipatory guidance concerning oral health and dental development to the child's parents/guardians. Compliance with dietary advice is of key importance and motivational interviewing shows promise in relation to parents adopting good oral health practices for their children. Twice daily toothbrushing using toothpaste that contains in the range of 1000- 1500ppmF is a most important preventive measure. It is important to use a minimal amount of toothpaste, insure that it is not swallowed, have parental or adult supervision during toothbrushing and avoid rinsing with water following brushing with toothpaste. The professional application of topical fluoride varnish twice yearly is a proven caries preventative measure. The application of pit and fissure sealants to teeth with deep pits and fissures is recommended.

Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up

Objectives: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. Methods: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. Results: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. Conclusions: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

Effect of two fluoride varnishes on the color stability of three resin-based restorative materials: an invitro study.

The aim of the present study was to evaluate the effect of two fluoride varnishes on color stability of three resin-based restorative materials. Fifty-four discs (14.5×1.7mm) were fabricated from A2 and A3 shades of a compomer (F2000), a flowable composite (Z350), and a hybrid composite (Z250), and incubated at 37°C for 48h. Dura Shield (colored) and Fluor Protector (colorless) fluoride varnishes were applied onto the discs. The coating was cleaned using a low-speed handpiece and nylon bristle brush after 24h of storage in distilled water. A second coating was then applied. A control group with no coating was immersed in distilled water and used. The CIE L*a*b* color scale was measured before the treatments and following each cleaning utilizing a spectrophotometer. The colored fluoride varnish exhibited the highest overall color change (∆E) after the first and the second cleaning procedures in all the materials. Among these, the greatest color change was observed in the A3 shade of F2000, followed by the A3 shade of Z-250. The ∆E was less than 3.3 in all groups, and was therefore clinically acceptable. Color changes following the application of fluoride varnishes were found to be clinically acceptable in all groups.

Fluoride Varnish Application in the Primary Care Setting. A Clinical Study.

The study objectives were twofold: 1. To examine how an intervention to apply fluoride varnish (FV) in a primary health setting to all young, low-income children was implemented and sustained and 2. To assess the feasibility of tracking medical care utilization in this population. The study included children age 1-5, insured through a government program, seen (7/1/2010-4/30/2012). Data on age, race, sex, clinic encounter, eligibility for and receipt of FV was obtained. The level of data in primary care, specialty care, urgent care and hospitalizations to assess feasibility of future patient tracking was also acquired.. Of 12,067 children, 85% received FV. Differences were found by age (youngest had highest rates). Small differences by race (81%-88%, highest in Blacks.) was found. No differences were found by sex. Ability to track over time was mixed. Approximately 50% had comprehensive data. However, primary care visit and hospitalization data was available on a larger percentage. FV programs can be introduced in the primary care setting and sustained. Further, long-term follow up is possible. Future study of such cohorts capturing health and cost benefits of oral health prevention efforts is needed.