Abstract
BackgroundTo determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.).MethodsIn 1999, 53 dental offices in Washington Dental Service's capitation dental plan were invited to participate in the study, and consenting offices were randomized to intervention (n = 9) and control (n = 10) groups. Offices recruited 689 capitation children aged 6–14 and at risk for caries, who were followed for 2 years. Intervention offices received provider education and fee-for-service reimbursement for delivering fluoride varnish and sealants. Insurance records were used to calculate office service rates for fluoride, sealants, and restorations. Parents completed mail surveys after follow-up to measure their children's dental utilization, dental satisfaction, dental fear and oral health status. Regression models estimated differences in service rates between intervention and control offices, and compared survey measures between groups.ResultsNineteen offices (34%) consented to participate in the study. Fluoride and sealant rates were greater in the intervention offices than the control offices, but the differences were not statistically significant. Restoration rates were lower in the intervention offices than the control offices. Parents in the intervention group reported their children had less dental fear than control group parents.ConclusionDue to low dentist participation the study lacked power to detect an intervention effect on dentists' delivery of caries-control services. The intervention may have reduced children's dental fear.
Highlights
To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.)
Accurate records of dentists' delivery of fluoride varnish did not exist before the study, and we assumed dentist delivery of fluoride varnish was similar to other dentists in Washington state[3,8]
Otherwise no statistically significant differences existed between participating and nonparticipating dentists at baseline for the following characteristics: percentage solo practitioners (75% vs. 72%, respectively); average number of hygienists (1.06 vs. .69); average number of assistants (3.04 vs. 2.67); average number of operatories (4.92 vs. 4.31); electronic submission of dental claims (46% vs. 34%); computer in office (79% vs. 86%); accepting new patients (92% vs. 90%); average percent of children with sealants based on Washington Dental Service (WDS) records (10% vs. 15%)
Summary
To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.). Scientific advances and new, effective caries-control services have emerged for preventing caries, [1,2] yet most general dentists have not adopted them[3]. One approach to increase dentist adoption of new, cariescontrol services is to pay dentists for providing them. When fluoride varnish became a covered benefit in a fee-for-service dental plan in 1996, most dentists did not adopt the technology, [8] suggesting that stronger interventions are necessary to increase dentist adoption of caries-control services
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