Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation

Background. Young children of pre-school age may find a minimal intervention (fluoride varnish application) difficult to tolerate.
Aim. To determine the significant predictors for refusing a fluoride varnish application from child, parental and nurse behaviour factors.
Design. Data included videos from 238 children (52% female, aged 3–5 years) receiving a fluoride varnish application in a Scottish nursery school setting. The St Andrews Behavioural Interaction Scheme (SABICS) was used for video coding and retrieved child refusal status, initial anxious behaviour, and nurse behaviour. A parental survey collected parent’s dental anxiety [Modified Dental Anxiety Scale (MDAS)] and the child’s home behaviour [Strengths and Difficulties Questionnaire (SDQ)]. Child demographics, dental status, and previous varnish application experience were recorded. Multivariate binary logistic regression
was applied to predict child refusal of the varnish application.
Results. The response rate was 79%. Twelve children refused. The significant predictors of varnish refusal included initial anxious child behaviour (b = 5.14, P = 0.001), no previous varnish application (b = 3.89, P = 0.04), and no nurse praise (b = 1.06, P = 0.02). Information giving (P = 0.06) and reassurance (P = 0.08) were borderline significant.
Conclusion. Initial anxiety behaviour, previous varnish experience, and not using praise by the nursing staff predicted fluoride varnish application refusal.