Primary care clinicians may face barriers to using a topical fluoride varnish (TFV), including time constraints and the assumption that dentists are already administering it, according to a study recently published in JDR Clinical & Translational Research.
Some of the methods to meet these challenges may include having TFV supplies readily available in the exam room and having nursing staff deliver patient education, the authors wrote.
“Despite recommendations for topical fluoride varnish in primary medical care, application rates remain low due to time constraints, workflow inefficiencies, and unclear clinician roles,” wrote the authors, led by Dr. Stephanie A. Gill, MPH, of the Wright Center for Graduate Medical Education (JDR Clin Transl Res, June 17, 2025, Vol. 10:1 suppl).
To evaluate knowledge, attitudes, and perceived barriers and facilitators related to TFV use, the research team developed a 29-item survey and distributed it from June to July 2020 to outpatient family medicine clinicians at a mid-Atlantic academic health center. Eligible participants confirmed they were current primary care clinicians who see pediatric patients under six years of age, they wrote.
The 93 participants were physicians, advanced practice clinicians, and residents. Prior to survey development, the team conducted exploratory interviews with 10 clinicians, five with high and five with low TFV application rates.
The most reported barrier across all clinician types was lack of time to apply TFV (61%), followed by the belief that a dentist already applies it (47%), and concerns about affordability for uninsured families (46%).
The top facilitator for TFV application was having staff place the varnish in the exam room (92%), followed by nursing staff providing patient education (84%), and pre-visit planning with staff (76%), they wrote.
Nevertheless, the study had limitations. Although all attending physicians saw pediatric patients, their specialties were not recorded, so the study could not assess how specialty influenced TFV barriers or facilitators, the authors added.
“Addressing time constraints and workflow inefficiencies through team-based care models, integrating standardized protocols between medical and dental clinicians, and optimizing EHR documentation can improve coordination and application rates,” Gill and colleagues concluded.
