Abstract
A natural experiment was conducted to observe the adoption of silver diamine fluoride (SDF) by Medicaid-enrolled dentists in North Carolina (NC). The purpose of this study was to describe the sociocontextual and community health characteristics where dentists adopted SDF, determine the association between SDF use and general anesthesia (GA) use, and examine the changes in GA utilization following implementing SDF reimbursement. NC Medicaid initiated SDF reimbursement in 2016 for children ages 1 to 5 y. This cross-sectional time series study used aggregate NC Medicaid claims, including geographic data, from 2014 to 2018. All dentists who provided GA and/or SDF to children ages 1 to 5 y were included. County health ranking data described social and community health indicators. Descriptive statistics, spatial data techniques, and multivariable methods were used. From 2016 to 2018, the number of dentists using SDF increased from 35 to 258, or 637%, whereas the number of dentists using GA increased from 179 to 211, or 17%. SDF utilization spread outward from areas of good social and health indicators to areas of poorer indicators. SDF utilization increased from 0.35 to 0.65 per 1,000 children, whereas GA utilization decreased from 2.57 to 2.47 per 1,000 children. GA utilization was positively associated with SDF utilization and poorer county health ranking but did not change before and after SDF implementation. Early adopters of SDF in NC practiced in areas with positive social and community health indicators. Over time, SDF was adopted in resource-poor communities. It remains too early to determine the public health impacts of SDF treatment on GA utilization. Policy makers and clinicians can use the results of this study to develop geographically targeted interventions that could lead to clinically and cost-effective public health programs.
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