Silver Diamine Fluoride (SDF) and Medicaid Policy: Improving Pediatric Oral Health

Modified Project Summary/Abstract Section Dental caries continues its decades-long reign as the most chronic condition of childhood—nearly 40% of kindergarteners and 60% of adolescents have the disease. Both the overall disease prevalence and rates of untreated disease are greatest among low-income families, children living in rural areas, and those with Medicaid insurance. Medicaid-enrolled children experience greater burden of disease and have a more difficult time accessing care. Silver diamine fluoride (SDF) is an effective treatment for dental caries, and it can be especially useful in limited resource settings or in clinics with limited capacity to treat Medicaid enrollees. Clinical guidelines suggest SDF can be used to defer or avoid future dental treatment. Originally cleared for use in the United States in 2014, the American Dental Association developed a procedure code for SDF use and reimbursement in 2015. In 2017, 13 state Medicaid programs reimbursed SDF, increasing to 43 in 2023. Despite these clinical guidelines and Medicaid policies, it remains unknown if variation in Medicaid reimbursement policies across states impacts dentist use and patient outcomes following SDF treatment. Prior studies have focused primarily on the clinical effectiveness of SDF treatment in arresting disease on the tooth-level rather than population oral health outcomes. The proposed multistage mixed methods study will determine the role of Medicaid policies in supporting the use of SDF to reduce downstream caries-related treatments. Using national Medicaid data and qualitative interviews with dentists with the highest and lowest use of SDF, we will 1) determine the impact of Medicaid SDF reimbursement policies on A) downstream state-level oral health outcomes, and B) provider adoption of SDF treatment using a staggered adoption difference-in-difference approach, 2) identify specific combinations of clinical, provider, and community factors associated with increased or attenuated SDF efficacy using an ensemble classifier machine learning technique, and 3) identify clinical, personal, and policy drivers influencing the clinical decision to use SDF for Medicaid-participating dentist using qualitative interviews. Our proposed study will identify how reimbursement policies contribute to improving caries treatment and reducing more expensive treatments that have suboptimal outcomes among Medicaid-enrolled children, which aligns with NIDCR Strategic Priority to accelerate the translation of new discoveries into practices that improve oral health outcomes for all individuals and communities. Project Number: 1R01DE034379-01A1 | Fiscal Year: 2025 | NIH Institute/Center: National Institute of Dental and Craniofacial Research (NIDCR) | Principal Investigator: BEAU MEYER | Institution: OHIO STATE UNIVERSITY, Columbus, OH | Award Amount: $693,179 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-G (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11221514