Journal of the American Dental Association (1939) · 2025
Examining clinical, patient, and policy factors associated with silver diamine fluoride adoption in safety-net dental clinics.
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Clayton Callihan, Richardson Carson, Peng Juan, Whitlatch Katelyn, Meyer Beau
Аннотация
BACKGROUND: Increasingly, dentists are using silver diamine fluoride (SDF) to treat caries. Reimbursement policy may play a role in clinical decision making. The authors examined safety-net dentists' knowledge, attitudes, and practices related to SDF usage.
METHODS: A 55-item questionnaire was developed and administered electronically via the National Network for Oral Health Access listserv. The Consolidated Framework for Implementation Research guided questionnaire development, and the following 4 of 5 Consolidated Framework for Implementation Research domains were incorporated: the individual, the innovation, the inner clinical setting, and the outer setting. Questions focused on dentists' SDF use from personal, clinical, and policy perspectives. All items used a 5-point Likert scale (ranging from 1 [strongly disagree] through 5 [strongly agree]). Descriptive statistics were used to summarize the data.
RESULTS: Analysis included 158 responses; the response rate was 45.9%. Only 5.7% of respondents had never used SDF, and 23.4% used it more than once per day. The most common driver of SDF use was uncooperative patients (56%). Nearly two-thirds of respondents strongly agreed or agreed that their use of SDF has increased since their state Medicaid program began reimbursing for CDT 2024: Current Dental Terminology code D1354 (application of caries arresting medicament - per tooth). Respondents reported that a reasonable reimbursement amount for code D1354 was $44 (mean [SD], $43.79 [$25.07]).
CONCLUSIONS: Medicaid reimbursement policy has some influence on dentists' clinical decision making to use SDF, but clinical factors are key drivers of or barriers to use.
PRACTICAL IMPLICATIONS: SDF reimbursement policies can align more closely with evidence-based guidelines to support more optimal use. Dentists would use SDF more often if reimbursement policies had fewer limitations.
METHODS: A 55-item questionnaire was developed and administered electronically via the National Network for Oral Health Access listserv. The Consolidated Framework for Implementation Research guided questionnaire development, and the following 4 of 5 Consolidated Framework for Implementation Research domains were incorporated: the individual, the innovation, the inner clinical setting, and the outer setting. Questions focused on dentists' SDF use from personal, clinical, and policy perspectives. All items used a 5-point Likert scale (ranging from 1 [strongly disagree] through 5 [strongly agree]). Descriptive statistics were used to summarize the data.
RESULTS: Analysis included 158 responses; the response rate was 45.9%. Only 5.7% of respondents had never used SDF, and 23.4% used it more than once per day. The most common driver of SDF use was uncooperative patients (56%). Nearly two-thirds of respondents strongly agreed or agreed that their use of SDF has increased since their state Medicaid program began reimbursing for CDT 2024: Current Dental Terminology code D1354 (application of caries arresting medicament - per tooth). Respondents reported that a reasonable reimbursement amount for code D1354 was $44 (mean [SD], $43.79 [$25.07]).
CONCLUSIONS: Medicaid reimbursement policy has some influence on dentists' clinical decision making to use SDF, but clinical factors are key drivers of or barriers to use.
PRACTICAL IMPLICATIONS: SDF reimbursement policies can align more closely with evidence-based guidelines to support more optimal use. Dentists would use SDF more often if reimbursement policies had fewer limitations.