Quality Improvement in Primary Care Improves Dental Utilization and Oral Health Outcomes in Children

Quality Improvement in Primary Care Improves Dental Utilization and Oral Health Outcomes in Children 1024 680 JoAnna Pendergrass, DVM
toddler brushing teeth

Quality improvement provides an effective, standardized approach to increasing pediatric dental utilization and improving oral health outcomes in primary care settings.

According to a recent study by pediatric dentist David Danesh, DMD, MPH, MS, and his research team at Nationwide Children’s Hospital, children receiving fluoride varnish at medical practices with an oral health quality improvement (QI) program experienced better oral health outcomes than children receiving this preventive dental service at medical practices without an oral health QI program and dental practices.

Study results were published in the Journal of Public Health Management and Practice.1

“Fluoride varnish is a highly concentrated form of fluoride that sticks to teeth and makes fluoride directly available to the tooth surface, preventing cavities,” says Beau Meyer, DDS, MPH, senior study author and pediatric dentist at Nationwide Children’s.

Because physician visits are more common than dental visits for children2, especially very young children, several professional organizations recommend that primary care physicians and pediatricians perform preventive oral health services in children. However, studies have identified barriers to implementing this recommendation, including inadequate oral health training and insufficient local dentists in a child’s insurance network.

QI standardizes processes and has been used throughout the country to integrate oral health care into the primary care setting, with such successes as improved quality of care, optimization of fluoride varnish application and reduced time to initial dental visits.

“QI benefits the entire medical team, and training medical providers on QI can improve oral health outcomes,” says Dr. Danesh.

The researchers conducted a 5-year retrospective analysis (2014 to 2019) that included 98,001 children aged 1 to 5 on Medicaid through Partners for Kids® (PFK), an accountable care organization in Ohio.

The children had at least one well visit between 2015 and 2017 and received fluoride varnish at one of three categories of practices:

  1. QI-medical practice (n=3,425)
  2. Non-QI medical practice (n=20,412)
  3. Dental practice (n=48,212)

Approximately 27,000 (27.5%) of the children did not receive fluoride varnish.

The researchers used PFK’s dental claim data to collect demographic information and analyze two outcome measures: dental utilization (e.g., cavity-related treatment visit) and dental expenditures.

Key study results demonstrated the benefits of QI in medical practices. For example, children in the QI group had a higher rate of preventive dental visits and fewer cavity-related treatment visits than those in the non-QI medical practice and dental practice groups.

Also, dental treatment requiring general anesthesia was less common in the QI group than in the dental practice group.

Mean expenditures for fluoride varnish application were higher for the dental practice group than the QI and non-QI medical practice groups.

In their publication, the researchers noted several practical implications of oral health-related QI in primary care, including improved oral health outcomes in children, lower dental expenditures and fewer cavity-related visits.

One potential area of future study is identifying factors, such as social determinants of health, that influence a practice’s decision to participate in QI.

“Cavities are a problem that dentists cannot solve on their own. When health systems use QI to increase the integration of oral care in a pediatric primary care setting, we have a great opportunity to improve pediatric oral health,” says Dr. Meyer.




  1. Danesh DO, Peng J, Hammersmith KJ, Gowda C, Maciejewski H, Amini H, Wapner AW, Meyer BD. Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement. Journal of Public Health Management and Practice. 2023 Mar-Apr;29(2):186-195.
  2. Manski R, Rohde F, Ricks T. Trends in the Number and Percentage of the Population with Any Dental or Medical Visits, 2003-2018; 2021. https://meps.ahrq.gov/mepsweb/data_files/publications/st537/stat537.pdf.

Image credit: Adobe Stock

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.