Bridging the Health Equity Gap: Innovative PA and Dental Student Fluoride Varnish Training

Dental caries are preventable yet remain one of the most common chronic diseases [1]. Untreated dental disease negatively impacts quality of life and results in pain, leading to school absence and malnourishment [2]. The American Dental Association advocates the first dental visit by age one, followed by biannual visits [2]. Unfortunately, data reveals 3.6% of 1-year-old infants have an established dental home [3], highlighting a paucity in crucial oral health guidance. Topical fluoride application, particularly fluoride varnish, is shown to be effective in caries prevention; clinical trials have reported a 70% caries risk reduction [4]. State Medicaid programs have reimbursed in-office fluoride varnish applications since 2017 [5], yet states vary in utility of this intervention. Sixteen states report < 2% of eligible Medicaid-enrollees received fluoride varnish in a non-dental setting, whereas only three states reported ≥ 20% of eligible Medicaid-enrollees receiving fluoride varnish [5]. Primary care providers (PCPs) see 88.8% of infants and 1-year-olds annually [3] and can effectively bridge this gap. Equipping PCPs with fluoride varnish application skills, knowledge of diet, and oral hygiene counseling empowers oral health promotion. Grant funding by nccPA Health Foundation and Arizona Delta Dental supported the unique, interprofessional opportunity, with physician assistant (PA) faculty, dental faculty, and students, to address this gap through hands-on oral health training of PA students. This innovative program included an interactive 90-min didactic session highlighting: the impact of oral health on systemic health, caries disease progression, and the preventative benefits of topical fluoride. Dental students and faculty taught fluoride varnish application skills, while also highlighting the importance of nutrition and culture with a focus on oral health from an equity lens. Students were given university cafe credits to gain awareness of the potential challenges of purchasing anticariogenic foods, with attention to cultural sensitivity, cost, and access. Students engaged in community outreach, assembling hundreds of oral health products, including patient education resources. Items were utilized for service-learning activities while caring for patients experiencing homelessness. The workshop effectively emphasized the importance of PCPs prioritizing preventative health, healthy eating, and health equity. PA students were invited to complete a survey focused on the relevance of this activity to primary care PA practice. The response rate was 84% (79/94) and demonstrated 100% of survey participants strongly agreed or agreed that the training taught skills relevant for a primary care PA (Table 1). In addition to skill training, this workshop demonstrated the critical implications of oral health within primary care practice, the benefits of interprofessional collaboration, and the value of gaining hands-on, practical knowledge through an interactive interdisciplinary experience. PAs and other PCPs play an integral role in oral health promotion. What went well included the students’ receptivity to learning with and from one another, the appreciation of collaboration, along with the increased awareness of nutrition and anticariogenic properties of food. One area for improvement would be to avoid scheduling fluoride varnish application immediately prior to the lunch hour. Lessons learned include the students’ appreciation of hands-on, relevant, and engaging activities. Early exposure to interprofessional teamwork facilitates greater awareness of the importance of working together to support equity and community health. The authors thank nccPA Health Foundation and Arizona Delta Dental for providing funding for this project. The authors declare no conflicts of interest.