Substituting silver diamine fluoride (SDF) for traditional restorative care in treating young children for tooth decay could significantly cut Medicaid spending over three years, the Pew Charitable Trusts reports, ranging from $2.1 million in Vermont to $48.5 million in North Carolina.
Silver stops the growth of bacteria, while fluoride strengthens the surface of damaged teeth. SDF can arrest the growth of decay without drilling or sedation while preventing new cavities from forming. Although relatively new to the United States, SDF treatment has been used in other countries for decades.
Pew reports that 9% of children between the ages of 2 and 5 have untreated decay, and 21% have experienced decay at some point. Rates are considerably higher for low-income children. Yet traditional treatments can cause significant stress for young children and their parents, often requiring deep sedation or general anesthesia.
Sedation comes with serious health risks, Pew notes, and the Food and Drug Administration has issued warnings about the use of sedation with pediatric patients. In addition to mitigating these risks, SDF offers an effective alternative to the use of a hand drill, which would help make dental visits less traumatic for children.
The study examined Medicaid claims data for children between the age of 1 and 5 in Alabama, Connecticut, Massachusetts, North Carolina, New Hampshire, South Carolina, and Vermont from 2010 to 2012 who had traditional restorative procedures such as fillings or crowns. It then compared per-visit Medicaid spending for a restorative visit including any associated sedation and anesthesia costs to the alternative SDF treatment.
The researchers calculated that if 50% of cavities were treated with SDF instead of the traditional approach, SDF could reduce the average per-restorative visit costs by $119 to $338, depending on the state. The size of the Medicaid population and varying reimbursement rates account for the difference in costs.
The costs associate with sedatives and anesthesia help explain why restorative visits can be so expensive. Per-visit costs across the states ranged from about $100 to $600 for those involving nitrous oxide and from about $1,000 to $5,000 when general anesthesia was used.
“For a young child with decay, the primary goal is to preserve the tooth until it falls out naturally or until we can manage the cavity without having to put the child under general anesthesia or use some form of sedation. That alone will not only reduce costs but reduce risks to the child,” said Scott Tomar, DMD, MPH, one of the study’s authors.
Despite growing evidence that SDF is a viable noninvasive alternative to traditional restorative treatment, less than 40% of state Medicaid programs reimburse for it as of April 2017, according to the American Academy of Pediatric Dentistry, which recommends its use for primary teeth in children and adolescents.
The ADA also endorses the use of SDF to arrest decay in primary teeth and, in some cases, permanent teeth. It additionally recommends applying SDF to decayed teeth twice yearly to maximize effectiveness. Since SDF leaves a permanent black stain on the area of the tooth where it is applied, some question its use for permanent teeth or teeth in the front of the mouth.
The Food and Drug Administration (FDA) approved SDF as a treatment for dental hypersensitivity for adults in 2014. Two years later, the FDA granted SDF its “breakthrough therapy” designation, signaling that it will expedite the clinical review process of SDF as a treatment to prevent and arrest decay.
Untreated decay in children can lead to pain, infection, missed school days, missed work days for parents, and other serious consequences, Pew says, but SDF can significantly improve the oral health of children while also helping states benefit from lower Medicaid expenditures.