Caries Risk Assessment, Fluoride Varnish, and Counseling

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Implementation Tips

Caries Risk Assessment, Fluoride Varnish, and Counseling Varnish Application Implementation Tips

Educate all staff, including front desk personnel, on caries risk assessment and the value of fluoride varnish.

  • Train all clinicians on application procedures.
  • Identify a varnish champion who answers questions, understands billing issues, assigns tasks, orders varnish, and maintains supplies.
  • Divide tasks among staff to avoid overburdening one person.
  • Store supplies in exam rooms or in a portable kit.
  • CPT code effective January 2015 for fluoride varnish application is 99188
    • Suggest to append a Z modifier for preventive services (e.g. Prophylactic fluoride administration Z29.3).
    • Excel spreadsheet with state-specific information can be found on the AAP website. Click here
  • Update billing forms and Electronic Medical record with varnish code(s).
  • Have copies of educational handouts preprinted for parents.

References

Goff SL, Gilson CF, DeCou E, Dick AW, Geissler KH, Dalal M, Kranz AM. Barriers and Facilitators to Optimal Fluoride Varnish Application. Acad Pediatr. 2024; 24(5):755-764.

Lewis C, Lynch H, Richardson L. Fluoride Varnish Use in Primary Care: What Do Providers Think? Pediatrics 2005;115:e69–e76. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-1330.

Slade GD, Rozier RG, Zeldin LP, Margolis PA. Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trial. BMC Health Services Research 2007, 7:176. View site here.

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