Third-party reimbursement and use of fluoride varnish in adults among general dentists in Washington state

Background, Studies have indicated that a minority of dentists regularly use fluoride varnish to control caries. To increase the use of this new technology, Washington Dental Service, or WDS, began reimbursing dentists for providing fluoride varnish in January 1996. The aim of the authors' study was to determine whether reimbursement increased dentists' use of fluoride varnish. Methods, In the fall of 1995, the authors asked a random sample of 532 general dentists in Washington state to complete a mail questionnaire on their use of caries control services. The survey was conducted before the institution of payment for fluoride varnish use, and dentists were unaware that fluoride varnish use would be a paid service in January 1996. In the fall of 1997. the same dentists were asked to complete a second questionnaire on the same topic. Results, About 32 percent of dentists used fluoride varnish regularly before WDS started reimbursement for the service. Two years after reimbursement began, about 44 percent of dentists regularly used fluoride varnish (P = .004). Dentists' rates of use of other caries-control services (chlorhexidine rinses for caries control and adult pit-and-fissure sealants) did not change. Dentists' reasons for not using fluoride varnish included lack of awareness, lack of convincing evidence of a favorable cost:benefit ratio, patients' rejection of the service and low caries risk among adult patients. Conclusions, After fluoride varnish became a covered benefit, the use of fluoride varnish among general dentists increased after two years, but a majority of dentists still had not adopted the technology. The increase in use may be due to reimbursement, as well as other factors. Practice Implications, Reimbursement by itself cannot increase dentists' use of caries control services.