Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Dr. Elise Schaller


Dr. Elise Schaller

Dr. Cathy Koetting

Dr. Laura Kuensting


Problem: Early childhood caries (ECC) is the most common chronic condition worldwide. Although the American Academy of Pediatrics (AAP) recommends all children through age five receive a fluoride treatment during well-child visits, this often does not happen. This project aimed to implement caries risk assessment (CRA) in the pediatric primary care setting and increase the rate of fluoride varnish applications and pediatric dental referrals.

Methods: An observational, descriptive study design was used to review retrospective data and collect prospective data on fluoride varnish applications in a pediatric primary care office located in a Midwestern suburban community. A validated CRA was implemented during the rooming process for a period of eight weeks, followed by offering a fluoride treatment.

Results: Retrospective data revealed only 20% of children meeting criteria received a fluoride varnish application. Out of 38 patients who completed a CRA, 79% received a fluoride treatment and 79% received referral to a pediatric dentist. During the study period, 169 patients meeting inclusion criteria did not complete a CRA; however, 25% of these patients still received a fluoride treatment. A two-tailed independent samples t-test on fluoride varnish applications was significant based on an alpha value of .05, t(360.49) = -4.27, p < .001, indicating a statistically significant difference between the pre- and post-intervention phases.

Implications for practice: Strict adherence to CRA administration on appropriate patients may increase the number of fluoride applications administered. Streamlining this process is necessary to increase adherence and ensure oral health is discussed when appropriate.

Additional Files

ADA CRA 0-6 years.pdf (224 kB)
Caries Risk Assessment Form