L. Fiset et al., Third-party reimbursement and use of fluoride varnish in adults among general dentists in Washington state, J AM DENT A, 131(7), 2000, pp. 961-968
Background, Studies have indicated that a minority of dentists regularly us
e fluoride varnish to control caries. To increase the use of this new techn
ology, Washington Dental Service, or WDS, began reimbursing dentists for pr
oviding fluoride varnish in January 1996. The aim of the authors' study was
to determine whether reimbursement increased dentists' use of fluoride var
nish.
Methods, In the fall of 1995, the authors asked a random sample of 532 gene
ral dentists in Washington state to complete a mail questionnaire on their
use of caries control services. The survey was conducted before the institu
tion of payment for fluoride varnish use, and dentists were unaware that fl
uoride varnish use would be a paid service in January 1996. In the fall of
1997. the same dentists were asked to complete a second questionnaire on th
e same topic.
Results, About 32 percent of dentists used fluoride varnish regularly befor
e WDS started reimbursement for the service. Two years after reimbursement
began, about 44 percent of dentists regularly used fluoride varnish (P = .0
04). Dentists' rates of use of other caries-control services (chlorhexidine
rinses for caries control and adult pit-and-fissure sealants) did not chan
ge. Dentists' reasons for not using fluoride varnish included lack of aware
ness, lack of convincing evidence of a favorable cost:benefit ratio, patien
ts' rejection of the service and low caries risk among adult patients.
Conclusions, After fluoride varnish became a covered benefit, the use of fl
uoride varnish among general dentists increased after two years, but a majo
rity of dentists still had not adopted the technology. The increase in use
may be due to reimbursement, as well as other factors.
Practice Implications, Reimbursement by itself cannot increase dentists' us
e of caries control services.