Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Laura L. Kuensting


Laura L. Kuensting, DNP, APRN, PCNS-BC, CPNP, CPEN

Carla Beckerle, DNP, APRN, AGNP-BC

Jennifer Jacklin, MSN, APRN, CPNP



Problem: Early childhood caries (ECC) is the most common chronic disease of childhood and fluoride is key to prevention. A major barrier to dental care for children is lack of access to a dental provider. Current practice recommendations include the application of fluoride varnish (FV) in the primary care setting. The purpose of this quality improvement initiative was to evaluate the number of FV applications in a Midwestern, suburban pediatric primary care practice.

Methods: An observational, descriptive design utilizing retrospective medical record reviews for children aged 12-, 18-, 24-, and 36-months who experienced well-child visits between April 1st, 2019 through May 15th, 2019.

Results: A total of 103 patients (N=103) experienced well-child visits in the six-week period. Of the examinations, 56 (54%) were evaluated by the MD and 47 (46%) were evaluated by the NP. Most children (n=76; 74%) did not receive FV, but there were 27 (26%) patients who did. Of those who received a FV application, two were provided by the MD (n=2; 7%) and 25 (n=25; 93%) were provided by the NP. The NP provided significantly more applications despite the MD evaluating more patients (p < .001). The average FV cost was $2.00 and reimbursement was $15.30.

Implications For Practice: FV applications of 26% in the primary care office when combined with those reporting visits to a dentist resulted in about 75% of children having preventive treatment by the age of 36-months. In addition, FV applications may provide an additional source of revenue while providing quality healthcare.