The Affordable Care Act requires insurance coverage for the service during well-child visits to a medical practitioner.

Despite required insurance coverage for this treatment, a University of Massachusetts Amherst research found that just 5% of well-child visits for privately insured young children included a recommended application of tooth fluoride varnish. A fluoride varnish may help prevent dental decay, which affects almost a quarter of children aged 2 to 5 and over half of those aged 6 to 8 in the United States, according to previous research. The U.S. Preventive Task Force and the American Academy of Pediatrics endorsed this evidence-based treatment for privately insured children in a new study published on August 30 in JAMA Network Open. Fewer than 8% of Medicaid-covered 1- to 5-year-olds get fluoride varnish in medical settings, according to previous studies.

As main author Kimberley Geissler of the UMass Amherst School of Public Health and Health Sciences notes, commercial insurance coverage was required in 2015 under the Affordable Care Act with no cost-sharing from families while Medicaid has paid for fluoride varnish treatments for over a decade. As Geissler puts it, “most youngsters aren’t receiving fluoride varnish treatments in the physician office. “Since Medicaid-covered children have historically had lower death rates, I wasn’t shocked. However, because of this, I was unhappy that the rate was not greater. This is optional for doctors, much like a mammogram. Although it’s suggested and beneficial to do so, we wanted to know whether and how frequently they really did it..”

Medical expert and UMass Amherst assistant professor Dr. Sarah Goff adds that understanding that Medicaid and commercially insured individuals have extremely low rates of fluoride varnish administration is significant because it indicates that larger, system-level obstacles exist. To understand what kinds of items are presenting obstacles to administering fluoride varnish and create ways to overcome these barriers, I’m enthusiastic about our future steps as a health-services researcher and primary care physician.”

Medical practitioners aren’t putting fluoride varnish to children’s teeth during well-child visits, according to the JAMA research, which is part of a broader Massachusetts investigation. An annual dental appointment, where this service might also be given, is the only place where a kid under the age of 5 gets preventative therapy. Senior RAND Corporation author Ashley Kranz was part of the study team that looked at data for privately insured young children in Connecticut, Maine, New Hampshire and Rhode Island from 2016 to 2018. There were 328,661 well-child visits in the four states included in the study’s sample. Younger children were more likely to have fluoride varnish applied. An examination of the data revealed that children under the age of 2 were almost 8 percentage points more likely than children over the age of 5 to get fluoride varnish.

Rhode Island had the highest regression-adjusted probability of 8.7 percent for the use of fluoride varnish. In terms of regression-adjusted likelihood, New Hampshire had the lowest rate at 2.2%. As one “hopeful conclusion,” Geissler says the research shows an increase in the regression-adjusted likelihood of applying fluoride varnish in 2018 from 3.6 percent in 2016. This is still a modest number, but it has increased with time, according to her. “Although improvements over time were promising,” the research finds, “extremely low rates of fluoride varnish in medical settings indicate significant extension of this service in medical settings is essential for improving children’s dental health and general well-being.”

Journal Reference : Kimberley H. Geissler, Andrew W. Dick, Sarah L. Goff, Christopher Whaley, Ashley M. Kranz. Dental Fluoride Varnish Application During Medical Visits Among Children Who Are Privately InsuredJAMA Network Open, 2021; 4 (8): e2122953 DOI: 10.1001/jamanetworkopen.2021.22953

Categories: Dental