{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T10:50:10Z","timestamp":1777805410405,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100005866","name":"Far Eastern Memorial Hospital","doi-asserted-by":"publisher","award":["113DN06"],"award-info":[{"award-number":["113DN06"]}],"id":[{"id":"10.13039\/501100005866","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW112-OH-H-113-112001"],"award-info":[{"award-number":["MOHW112-OH-H-113-112001"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011913","name":"Kaohsiung Veterans General Hospital","doi-asserted-by":"publisher","award":["VGHKS-113-107"],"award-info":[{"award-number":["VGHKS-113-107"]}],"id":[{"id":"10.13039\/501100011913","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JDR Clinical &amp; Translational Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This study investigated the relative effectiveness of school-based versus clinic-based fluoride varnish (FV) application within a single program in Taiwan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data for the phase 1 study (population-based analysis) were extracted from Taiwan\u2019s National Health Insurance Research Database (NHIRB). The phase 1 cohort included 347,544 children born in 2015 or 2016 who received FV application services at school, in a dental clinic, or in both settings. FV services were recorded using specific codes: 88 and 89 for school-based FV application and 81 and 87 for clinic-based FV application. During follow-up, primary molars were assessed for caries-related treatments. The phase 2 (fieldwork) cohort included 1,479 children examined for early childhood caries (ECC). Their data were linked to the NHIRB to obtain corresponding data on the FV application. In both phases, logistic regression was performed to determine the associations of application setting with the odds of caries-related treatments and ECC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The odds of the following treatments were significantly higher with school-based FV application than with clinic-based FV application (all\n                      <jats:underline>P<\/jats:underline>\n                      s &lt; 0.0001): dental restoration (odds ratio [OR] = 1.09; 95% confidence interval [CI], 1.06\u20131.11), endodontic treatment (OR = 1.21; 95% CI, 1.16\u20131.26), and tooth extraction (OR = 1.33; 95% CI, 1.25\u20131.42). This difference was particularly prominent in moderately and highly urbanized areas. Furthermore, the risk of ECC was higher with school-based FV application (OR = 1.52; 95% CI, 1.10\u20132.11;\n                      <jats:underline>P<\/jats:underline>\n                      &lt; 0.05) than with school-based FV application. However, after covariate adjustment, both groups had similar risk estimates (OR = 1.03; 95% CI, 0.71\u20131.50).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Clinic-based FV application significantly reduces the likelihood of caries-related treatments for primary molars. Future studies should consider our findings when evaluating the effectiveness of FV application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Knowledge Transfer Statement:<\/jats:title>\n                    <jats:p>Compared with school-based FV application, clinic-based FV application significantly reduced the likelihood of caries-related treatments, particularly among children residing in urban areas. For children who received only school-based FV application services, dentists may recommend additional clinic-based FV application services. Our findings may guide future studies aimed at evaluating the effectiveness of FV application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23800844261435921","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T06:23:04Z","timestamp":1777270984000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Relative Effectiveness of School-Based versus Clinic-Based Fluoride Varnish Application"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8391-4558","authenticated-orcid":false,"given":"P-Y.","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Dentistry, College of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D-Y.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Dentistry, College of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Family Dentistry and Oral Diagnosis, Tri-Service General Hospital, Taipei, Taiwan"},{"name":"School of Dentistry, National Defense Medical Center, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P-Y.","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Dentistry, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan"},{"name":"Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L-Y.","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Dentistry, College of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,26]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Chi LY Lin PY Wang J Chu YR Chang YM. 2019. Can government-supported preventive fluoride varnish application service reduce pulp-involved primary molars? J Public Health Dent. 79(3):238\u2013245. https:\/\/doi.org\/10.1111\/jphd.12319","DOI":"10.1111\/jphd.12319"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Costa SM et al. 2012. A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health. 9(10):3540\u20133574. https:\/\/doi.org\/10.3390\/ijerph9103540","DOI":"10.3390\/ijerph9103540"},{"key":"e_1_3_3_4_1","unstructured":"Department of Oral Health. 2025. Utilization of government-supported fluoride varnish application services. Ministry of Health and Welfare; [accessed 2025 Aug 13]. https:\/\/dep.mohw.gov.tw\/DOOH\/lp-6543-124.html [Chinese]"},{"key":"e_1_3_3_5_1","unstructured":"Finlayson TL et al. 2018. Child caregiver and family factors associated with child dental utilization among Mexican migrant families in California. Community Dent Health. 35(2):89\u201394. https:\/\/doi.org\/10.1922\/CDH_4201Finlayson06"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"GBD 2021 Oral Disorders Collaborators. 2025. Trends in the global regional and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 405(10482):897\u2013910. https:\/\/doi.org\/10.1016\/S0140-6736(24)02811-3","DOI":"10.1016\/S0140-6736(24)02811-3"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Griffin SO et al. 2025. Effectiveness of school fluoride delivery programs: a community guide systematic review. Am J Prev Med. 69(1):107633. https:\/\/doi.org\/10.1016\/j.amepre.2025.04.003","DOI":"10.1016\/j.amepre.2025.04.003"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Janusz CB et al. 2024. A cost-effectiveness analysis of population-level dental caries prevention strategies in US children. Acad Pediatr. 24(5):765\u2013775. https:\/\/doi.org\/10.1016\/j.acap.2024.02.006","DOI":"10.1016\/j.acap.2024.02.006"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Kidd JB et al. 2020. Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland. BMJ Open. 10(11):e038116. https:\/\/doi.org\/10.1136\/bmjopen-2020-038116","DOI":"10.1136\/bmjopen-2020-038116"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Lam PPY Chua H Ekambaram M Lo ECM Yiu CKY. 2022. Risk predictors of early childhood caries increment-a systematic review and meta-analysis. J Evid Based Dent Pract. 22(3):101732. https:\/\/doi.org\/10.1016\/j.jebdp.2022.101732","DOI":"10.1016\/j.jebdp.2022.101732"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Lin PY et al. 2022. Association between population-based fluoride varnish application services and dental caries experience among schoolchildren in Taiwan. J Formos Med Assoc. 121(5):986\u2013994. https:\/\/doi.org\/10.1016\/j.jfma.2021.07.016","DOI":"10.1016\/j.jfma.2021.07.016"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Lin PY et al. 2023a. Decline in dental caries experience among schoolchildren in Taiwan 2012-2020. Community Dent Oral Epidemiol. 51(3):519\u2013526. https:\/\/doi.org\/10.1111\/cdoe.12823","DOI":"10.1111\/cdoe.12823"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Lin YC et al. 2023b. Comparing individual- family- and community-level effects on the oral health of preschool children: a multilevel analysis of national survey data. BMC Oral Health. 23(1):353. https:\/\/doi.org\/10.1186\/s12903-023-03077-w","DOI":"10.1186\/s12903-023-03077-w"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Luo H et al. 2021. Rural-urban differences in dental service utilization and dental service procedures received among US adults: results from the 2016 Medical Expenditure Panel Survey. J Rural Health. 37(3):655\u2013666. https:\/\/doi.org\/10.1111\/jrh.12500","DOI":"10.1111\/jrh.12500"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Macpherson LM et al. 2010. Childsmile: the national child oral health improvement programme in Scotland. Part 1: establishment and development. Br Dent J. 209(2):73\u201378. https:\/\/doi.org\/10.1038\/sj.bdj.2010.628","DOI":"10.1038\/sj.bdj.2010.628"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Patel NS et al. 2025. A review of early childhood caries: risk factors management and policy recommendations. Cureus. 17(5):e83767. https:\/\/doi.org\/10.7759\/cureus.83767","DOI":"10.7759\/cureus.83767"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"Pitts N et al. 2019. Early childhood caries: IAPD Bangkok Declaration. Int J Paediatr Dent. 29(3):384\u2013386. https:\/\/doi.org\/10.1111\/ipd.12490","DOI":"10.1111\/ipd.12490"},{"issue":"6","key":"e_1_3_3_18_1","first-page":"59","volume":"39","author":"Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies","year":"2017","unstructured":"Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. 2017. Pediatr Dent. 39(6):59\u201361.","journal-title":"Pediatr Dent"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Qui\u00f1onez RB Stearns SC Talekar BS Rozier RG Downs SM. 2006. Simulating cost-effectiveness of fluoride varnish during well-child visits for Medicaid-enrolled children. Arch Pediatr Adolesc Med. 160(2):164\u2013170. https:\/\/doi.org\/10.1001\/archpedi.160.2.164","DOI":"10.1001\/archpedi.160.2.164"},{"key":"e_1_3_3_20_1","doi-asserted-by":"crossref","unstructured":"Rebelo MAB Rebelo Vieira JM Pereira JV Quadros LN Vettore MV. 2019. Does oral health influence school performance and school attendance? A systematic review and meta-analysis. Int J Paediatr Dent. 29(2):138\u2013148. https:\/\/doi.org\/10.1111\/ipd.12441","DOI":"10.1111\/ipd.12441"},{"key":"e_1_3_3_21_1","unstructured":"Research Center for Humanities and Social Sciences. 2023. The typology of townships in Taiwan in 2023. Academia Sinica; [accessed 2025 Jul 31]. https:\/\/srod.survey.sinica.edu.tw\/wp-content\/uploads\/2024\/01\/2023%E5%B9%B4%E5%8F%B0%E7%81%A3%E9%84%89%E9%8E%AE%E5%B8%82%E5%8D%80%E9%A1%9E%E5%9E%8B%E4%B9%8B%E7%A0%94%E6%9E%90.pdf [Chinese]"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Ross AJ et al. 2023. Evaluating Childsmile Scotland\u2019s national oral health improvement programme for children. Community Dent Oral Epidemiol. 51(1):133\u2013138. https:\/\/doi.org\/10.1111\/cdoe.12790","DOI":"10.1111\/cdoe.12790"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"Schwendicke F et al. 2018. Cost-effectiveness of caries-preventive fluoride varnish applications in clinic settings among patients of low moderate and high risk. Community Dent Oral Epidemiol. 46(1):8\u201316. https:\/\/doi.org\/10.1111\/cdoe.12320","DOI":"10.1111\/cdoe.12320"},{"key":"e_1_3_3_24_1","unstructured":"Sharifi AB Aali N Farokhzadi M. 2025. A systematic review of dental caries experience in preschool children is it related to a child\u2019s place of residence and family income? Eurasian J Chem Med Pet Res. 4(3):310\u2013318. https:\/\/doi.org\/10.5281\/zenodo.17171252"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Shirzad M Taghdisi MH Dehdari T Abolghasemi J. 2016. Oral health education program among pre-school children: an application of health-promoting schools approach. Health Promot Perspect. 6(3):164\u2013170. https:\/\/doi.org\/10.15171\/hpp.2016.26","DOI":"10.15171\/hpp.2016.26"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"Uribe SE Innes N Maldupa I. 2021. The global prevalence of early childhood caries: a systematic review with meta-analysis using the WHO diagnostic criteria. Int J Paediatr Dent. 31(6):817\u2013830. https:\/\/doi.org\/10.1111\/ipd.12783","DOI":"10.1111\/ipd.12783"},{"key":"e_1_3_3_27_1","doi-asserted-by":"crossref","unstructured":"Wang PH. 2023. Overview of the policies of oral health promotion for children in Taiwan. J Formos Med Assoc. 122(3):200\u2013201. https:\/\/doi.org\/10.1016\/j.jfma.2022.08.004","DOI":"10.1016\/j.jfma.2022.08.004"},{"key":"e_1_3_3_28_1","doi-asserted-by":"crossref","unstructured":"Wen PC Lee CB Chang YH Ku LE Li CY. 2017. Demographic and rural-urban variations in dental service utilization in Taiwan. Rural Remote Health. 17(3):4161. https:\/\/doi.org\/10.22605\/RRH4161","DOI":"10.22605\/RRH4161"},{"key":"e_1_3_3_29_1","doi-asserted-by":"crossref","unstructured":"Wong AW et al. 2015. Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial. BMC Oral Health. 15:162. https:\/\/doi.org\/10.1186\/s12903-015-0148-x","DOI":"10.1186\/s12903-015-0148-x"},{"key":"e_1_3_3_30_1","volume-title":"Oral health surveys: basic methods","author":"World Health Organization","year":"2013","unstructured":"World Health Organization. 2013. Oral health surveys: basic methods. 5th ed. World Health Organization.","edition":"5"}],"container-title":["JDR Clinical &amp; Translational Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23800844261435921","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23800844261435921","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23800844261435921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T20:43:03Z","timestamp":1777495383000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23800844261435921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,26]]},"references-count":29,"alternative-id":["10.1177\/23800844261435921"],"URL":"https:\/\/doi.org\/10.1177\/23800844261435921","relation":{},"ISSN":["2380-0844","2380-0852"],"issn-type":[{"value":"2380-0844","type":"print"},{"value":"2380-0852","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,26]]},"article-number":"23800844261435921"}}