Nearly One in Four Children Dropped Out of Public Fluoride Varnish Programs

Edited by Hygienetown staff

Public fluoride varnish programs lost close to a quarter of enrolled children before they completed repeated applications, according to a mixed-methods systematic review published online Sept. 15 in the International Journal of Paediatric Dentistry.

Reviewers screened 3,616 records and included 22 studies covering children under 18 in multi-ethnic high-income countries. Meta-analysis across 14,455 children produced a pooled attrition rate of 23%, with a 95% confidence interval of 8% to 43%.

Barriers appeared at four levels. Among children, reviewers identified behavioral distress, sensory aversion, and temporary medical exclusions. Family-level barriers included caregiver capacity, health literacy, and mobility.

At the provider level, the review pointed to workforce constraints, gaps in training, role boundaries that limited task-sharing, and weak coordination with schools and community organizations. System-level barriers included inequitable reach to high-risk groups and geographic constraints.

Facilitators ran in the opposite direction. Programs retained children better when they used culturally safe, relationship-based engagement, shared tasks across roles, delivered care in schools or community settings with active follow-up, and applied child-centered engagement strategies.

Nathan Zeyang-Liu, Rahul Gupta, Joseph Chiang, and Jolanta Aleksejuniene of the Faculty of Dentistry at the University of British Columbia conducted the review. It followed PRISMA 2020 guidelines and was registered with PROSPERO under CRD420251044425.

The authors concluded that adherence and attrition are shaped by interacting determinants across all four levels, and that retention deserves consideration when programs are designed rather than only when they are evaluated. The confidence interval around the pooled attrition figure was wide, and the included studies spanned high-income countries generally rather than any single national program.

Sources:
International Journal of Paediatric Dentistry, “Adherence and Attrition in Public Fluoride Varnish Programs: A Mixed-Methods Systematic Review,” published online Sept. 15, 2026: doi.org/10.1111/ipd.70144
PubMed record, PMID 42745331: pubmed.ncbi.nlm.nih.gov/42745331