Longitudinal Follow-up Comparing Future Care of Primary Teeth Treated with Silver Diammine Fluoride: A Private Dental Claims Review.

Purpose: The purpose of this study was to longitudinally evaluate follow-up treatment on primary teeth initially treated with silver diammine fluoride (SDF). Methods: This retrospective cohort evaluated private insurance (not Medicaid) claims data from 2018 to 2019 for children no older than 12 years with at least one primary tooth initially treated with SDF. Additional treatment per tooth was recorded over a follow-up of at least 24 months. Results: The mean and standard deviation (±SD) age of 46,884 patients was 5.7±2.3 and for SDF-treated teeth per patient was 2.6±2.1. Forty percent (95 percent confidence interval [95% CI] equals 39 to 40.7 percent) of teeth initially treated with SDF received additional treatment. The odds of SDF-treated teeth receiving future treatment significantly decreased with patient age by 22 percent per year (odds ratio equals 0.78; 95% CI equals 0.077 to 0.79; P<0.001). Pediatric dentists had only slightly lower odds than general dentists for providing additional treatment (0.91, P<0.001). Posterior teeth and teeth expected to exfoliate in two or more years had significantly higher odds of receiving additional treatment (2.47 and 1.27, respectively, P<0.001). Conclusions: Beginning at age four, patient age at placement of silver diammine fluoride was inversely proportional to future treatment provided. Posterior teeth and teeth expected to exfoliate in two or more years were more likely to receive additional treatment.

Silver diamine fluoride-associated delays in procedural sedation in young children: A retrospective cohort study.

BACKGROUND: This analysis evaluated the time to first sedation or general anesthesia (GA) encounter for children treated with and without silver diamine fluoride (SDF). METHODS: This retrospective cohort study used dental claims of privately insured children from birth through age 71 months with a sedation or GA claim from 2016 through 2020. The exposure was SDF use (yes, no). The outcome was time to first sedation or GA. Descriptive and multivariable negative binomial analysis was performed. The analysis tested the hypothesis that among children who received sedation or GA for their caries treatment, those who received SDF would show a longer time to first sedation or GA than children who did not. RESULTS: Among 175,824 children included, SDF use increased the time to first sedation or GA encounter by 63 days when treated by different dentists (405 days vs 342 days; P < .001) and by 91 days when treated by the same dentist (337 days vs 246 days; P < .001), after controlling for the effects of age at first encounter, sex, and region of the country. CONCLUSION: Children treated with SDF had a longer time to first sedation or GA, which was magnified when treatment was performed by the same dentist. PRACTICAL IMPLICATIONS: Within an individualized caries management plan, SDF could provide benefits for patients, dental offices, and health systems.

Trends in dental insurance claims in the United States in the context of the COVID-19 pandemic: A 3-year perspective (2019-2022).

OBJECTIVES: We showed in a previous analysis the patterns of disruption for private dental insurance claims in the United States caused by the SARS-CoV-2 pandemic in 2020. The present report examines trends during 2020 and 2021, that is, contrasting perspectives during 2019 with the acute phase of the pandemic in 2020, and 2021. METHODS: Private dental insurance paid claims from a data warehouse were obtained, encompassing a 5% random sample of records between January 2019 and December 2021 for child and adult insureds who filed a claim in 2019, 2020, and 2021. We classified claims into one of four categories based on the likelihood of being associated with urgent/emergency care. RESULTS: The precipitous reduction in dental care claims in March-June 2020 recovered to almost pre-pandemic levels by the fall of 2020. However, a downward decline in private dental insurance claims started in the late fall of 2020 and continued through 2021. Differential impacts in dental care categories-in terms of urgency of care-were evident 2021, closely resembling previous trends in 2020. CONCLUSIONS: Dental care claims from the first year of the 2020 SARS-CoV-2 pandemic were contrasted with perspectives in 2021. A downward trend in demand/availability changes in dental care insurance claims set in for 2021, perhaps linked to perceptions of the overall economic situation. Such downward trend has continued overall, even after considering seasonal changes and the acceleration of the pandemic during the Delta, Omicron, and other variants.

Financial Impact of COVID-19 on Dental Care for Pediatric Patients: a Dental Claims Review.

PURPOSE: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private dental insurance claims for pediatric dental care. METHODS: Commercial dental insurance claims for patients in the United States ages 18 and younger were obtained and analyzed. The claims dates ranged from January 1, 2019, to August 31, 2020. Total claims paid, average paid amount per visit, and the number of visits were compared between provider specialties and patient age groups from 2019 to 2020. RESULTS: Total paid claims and total number of visits per week were significantly lower in 2020 compared to 2019 from mid-March to mid-May (P<0.001). There were generally no differences from mid-May through August (P>0.15), except for significantly lower total paid claims and visits per week for "other" specialists in 2020 (P<0.005). The average paid amount per visit was significantly higher during the COVID shutdown period for 0-5 year-olds (P<0.001) but significantly lower for all other ages. CONCLUSIONS: Dental care was greatly reduced during the COVID shutdown period and was slower to recover for "other" specialties. Younger patients ages zero to five years had more expensive dental visits during the shutdown period.

Topical fluoride impact in future restorative dental procedures: A claim study.

BACKGROUND: Caries is one of the most prevalent diseases affecting children. Topical fluoride is used to decrease the incidence of caries. The purpose of this study was to investigate the impact of fluoride varnish and gel applications on future restorative dental treatment claims. METHODS: The data were obtained in conjunction with a dental data warehouse through a partnership agreement. A retrospective analysis of dental claims made from 2010 through 2018 was completed. Data were extracted for patients aged 1 through 8 years with topical fluoride application and its subsequent impact on restorative dental claims. RESULTS: Data for 672,889 patients were included in the analysis. Patients who received topical fluoride had significantly lower numbers (P < .001) of restorative procedures and extractions per year and significantly increased time (P < .001) to their first restorative procedure or extraction after the index visit than patients who did not receive topical fluoride. CONCLUSIONS: The application of fluoride varnishes and gels increased the time to future restorative and extraction dental claims and decreased the number of future restorative and extraction dental claims. PRACTICAL IMPLICATIONS: This study is important because it found that the use of topical fluoride decreased the number of future restorative and extraction dental claims.

Trends in dental insurance claims in the United States before and during the SARS-CoV-2 pandemic in 2020.

OBJECTIVES: The SARS-CoV-2 pandemic disrupted health care services. Previous reports estimated reductions in demand and supply of dental care services, but actual changes have not been reported. The present report depicts a perspective of trends in claims from private dental practice in the United States during 2019 and 2020. METHODS: Private dental insurance paid claims data from a data warehouse (encompassing 66+ carriers in the United States) were obtained for children and adults (treatments identified by their American Dental Association Code of Dental Procedures and Nomenclature [CDT]), encompassing a 5% random sample of all records between January 2019 and December 2020. A market-based treatment classification placed CDT codes into one of four categories based on the likelihood of being associated with urgent/emergency care. RESULTS: Claims for 3.8 million patients constituted the 5% random sample for analyses. Substantial drops in the provision of treatment items were quantified for a large segment of private dental insurance plans at a national level, showing differential impacts in dental care categories. CONCLUSIONS: Week-by-week, detailed descriptions of demand/availability changes in dental care throughout the first year of the 2020 SARS-CoV-2 pandemic were obtained through contrasting perspectives in 2019. Provision of dental care and associated impacts fluctuated over time subject to treatment urgency, but also modified as the weeks/months of dental office lockdowns ebbed in and out of the dental market.

Utilization of Silver Diamine Fluoride by Dentists in the United States: A Dental Claims Review.

Purpose: A Current Dental Terminology (CDT) code, D1354, for silver diamine fluoride was made effective on January 1, 2016. The purpose of this study was to investigate the utilization of silver diamine fluoride (SDF) by pediatric dentists (PDs) and general dentists (GDs) in the United States. Methods: Data were obtained from a commercial dental insurance claims warehouse in the United States. Deidentified data for CDT code D1354 were collected from January 2016 to July 2019. Descriptive statistics and chi-square tests were used. Results: A total of 321,726 D1354 claims were found. Data showed that SDF use measured by average monthly claims, unique number of dentists, and percent of paid claims increased each year. Patients zero to nine years old were the most likely to receive SDF treatment. SDF was significantly more likely to be placed on posterior teeth and in children zero to eight years old (P<0.001). PDs were more likely than GDs to submit claims for SDF in children (P<0.001). Conclusions: Silver diamine fluoride use is increasing, especially in patients age zero to nine years. Pediatric dentists are more likely to use SDF in children than general dentists. Posterior teeth receive the majority of SDF treatment.

Longevity of Primary Anterior Crown Restorations: A Retrospective Dental Claim Analysis.

Purpose: The purposes of this study were to: (1) examine the longevity of resin crowns (RCs), pre-veneered stainless steel crowns (PVSSCs), and stainless steel crowns (SSCs) in primary maxillary incisors in a nationwide sample of private insurance claims; and (2) explore whether longer survival rates are related to the type of treating practitioner.
Methods: Private dental insurance claims were obtained from a national data warehouse. The paid insurance claims (2005 to 2016) included the treatment provided, number of teeth treated at an appointment, patient's age, and type of dentist.
Results: All three restoration types had acceptable longevity; however, SSCs and PVSSCs had significantly better longevity than RCs, with no significant difference in longevity between SSCs and PVSSC. The most common restoration of choice was SSCs (48 percent), followed by RCs (29.8 percent) and PVSSCs (22.2 percent).
Conclusion: SSCs and PVSSCs had greater longevity than resin crowns. The survival rate after six years was higher than 90 percent for all types of restorations. Teeth restored with SSCs lasted longer when placed by pediatric dentists than those placed by general dentists.

Utilization of Stainless Steel Crowns by Pediatric and General Dentists.

Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainless steel crowns (SSCs) are used for extensive caries and offer greater longevity than other restorations; however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of this study was to evaluate utilization of stainless steel crowns among pediatric and general dentists by reviewing insurance claims. Methods: Data were obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the United States for children 12 years old and younger. Data were examined for treatment of the primary dentition using SSCs or direct restorations. A generalized linear mixed effects model tested differences in the utilization of SSCs by general dentists (GDs) versus pediatric dentists (PD). Results: The data included 107,487 GDs and 5,395 PDs. The records included 2,555,726 claims for direct restorations and 440,423 claims for SSCs. PDs are more likely to place SSCs compared to GDs (odds ratio equals 3.2; P<0.0001). Conclusions: Pediatric dentists are more likely to restore carious primary dentitions with stainless steel crowns than general dentists. Perhaps increased training at the dental undergraduate level and access to more continuing education courses for general dentists would increase the utilization of SSCs.

Survival analysis of metal crowns versus restorations in primary mandibular molars.

BACKGROUND: The effectiveness of stainless steel crowns (SSCs) versus direct restorations when placed in primary mandibular molars (teeth nos. L and S) is uncertain. The authors evaluated effectiveness by gauging longevity of treatment. METHODS: The authors obtained private dental insurance claims (2004-2016) from a national dental data warehouse. Paid insurance claims records (n = 1,323,489) included type of treating dentist, treatment placed, and patient age. RESULTS: Dentist specialty, type of treatment, and patient age were significant in predicting failure after the first restoration. The authors found high survival rates for all treatments (> 90%) after 5 years; however, as soon as within 3 years after treatment, SCCs had approximately 6% better survival. CONCLUSIONS: Teeth nos. L and S first treated with SSCs lasted longer without new treatment compared with teeth first treated with direct restorations; the difference was small. Teeth treated by pediatric dentists had better survival rates. PRACTICAL IMPLICATIONS: Primary mandibular first molars initially treated with SSCs lasted longer without new treatment compared with direct restorations. Overall dental care costs of the former were considerably higher.