Amalgam or composite in pediatric dentistry: Analysis of private insurance claims data.

BACKGROUND: Advancements in dental materials and changing parental preferences are modifying the frequency of use of restorative materials. This insurance claims analysis examined the trends in the use of amalgam and resin composite in the United States. METHODS: Commercial dental insurance claims were analyzed to compare 505,994 restorations, corresponding with procedure codes for 1-, 2-, and 3-surface amalgam or resin restorations. Paid claims collected nationwide from January 2010 through March 2020 were analyzed. Data for children aged 3 through 12 years were used, resulting in 219,632 unique patient identification numbers. Generalized estimating equation models applied to logistic regression were used. All tests were conducted using a 2-sided 5% significance level. RESULTS: In general, girls were less likely to receive amalgam than boys. A $20,000 increase in median household income was associated with a 16% decrease in the odds of amalgam being placed. Pediatric dentists (performing 15.1% of all restorations) were not as likely as general dentists (18.4%) to use amalgam. Having more surfaces in a restoration was associated with higher probability of amalgam placement. The percentage of amalgam restorations was higher for 2010 (26.9%) than for 2011 through 2020, and this pattern recurred in several of the years analyzed. Generally, patient age at time of amalgam restoration increased over time. CONCLUSION: The use of amalgam is trending down; the sharpest decline was noted in 2014. Pediatric dentists were less likely to use amalgam than general dentists. Girls and patients with higher socioeconomic status were less likely to have amalgam. PRACTICAL IMPLICATIONS: The findings of this study can inform and support clinical decisions and the formation of public policies.

Insurance claim data trends in pulpal therapy for pediatric patients.

BACKGROUND: The purpose of this study was to identify differences in usage trends for 2 specific pulpal therapy treatments in pediatric patients during an 11-year period from January 1, 2010, through December 31, 2020. METHODS: Insurance data claims for children aged 2 through 12 years undergoing a pulpotomy or a pulpectomy performed by a general dentist (GD) or pediatric dentist (PD) from 2010 through 2020 were extracted from a dental data warehouse. The state where the provider was located was included in the extracted claim. RESULTS: Rates of undergoing a pulpotomy or pulpectomy declined from 2010 through 2020 (odds ratio [OR], 0.978 or 0.946, respectively; P < .001). PDs were more likely to perform pulpotomies than GDs (OR, 1.393; P < .001), but PDs were less likely to perform pulpectomies than GDs (OR, 0.225; P < .001). Younger patient age was a significant predictor for undergoing pulpotomy treatment for both GDs and PDs (ORs, 0.850 and 0.892, respectively; P < .001). With increasing patient age, PDs had increased odds of performing a pulpectomy (OR, 1.030; P < .001) and GDs had decreased odds of performing a pulpectomy (OR, 0.995; P = .04). When examining effects according to American Academy of Pediatric Dentistry national membership districts, the trends remained consistent with those above. CONCLUSIONS: The percentage of children undergoing pulpotomy and pulpectomy therapy declined from 2010 through 2020 among both GDs and PDs. PRACTICAL IMPLICATIONS: These changes in pulpal therapy practice might indicate a teaching change in pulpal therapy guidelines, suggesting that less invasive pulpal therapy can be used rather than pulpotomies or pulpectomies.

Prescription of bite-wing and panoramic radiographs in pediatric dental patients: An assessment of current trends and provider compliance.

BACKGROUND: The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic radiographs (PRs) for pediatric and adolescent dental patients after the implementation of the most recent guidelines from the American Dental Association and US Food and Drug Administration. METHODS: The authors accessed paid insurance claims data for all 50 states from January 1, 2013, through June 30, 2019, for patients 18 years and younger and extracted a 5% random sample population. The authors performed statistical analyses to evaluate various imaging metrics for pediatric dentists (PDs) and general practitioners (GPs). RESULTS: A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits. The average (standard deviation [SD]) time interval between bite-wing examinations ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7) months (P < .0001). When divided by age group, 3.5% of all bite-wings were obtained from patients aged 0 through 4 years. For PRs, the authors included 286,824 images in this study. The average (SD) time interval between PRs ordered for the same patient was 3.4 (1.3) years for PDs and 3.3 (1.4) years for GPs. One percent of all PRs were ordered for patients aged 0 through 4 years, with 403 images attributed to PDs and 2,348 to GPs. CONCLUSIONS: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. PRACTICAL IMPLICATIONS: Inclusion of patient caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.

Success Rates of Pulpotomies Performed by General Dentists Versus Pediatric Dentists: A Claims Data Analysis.

Purpose: The purpose of this study was to examine if there are differences in the success rate of primary teeth treated with pulpotomies performed by general dentists (GDs) versus pediatric dentists (PDs), using submitted paid insurance dental claims. The extraction time after pulpotomy was examined. Methods: Data for this study were obtained from a private dental insurance claims warehouse. The insurance claims data were retrieved, and a retrospective analysis was performed over seven years (2008 to 2015). The survival rate was estimated using proportional hazard survival analysis. Results: The total number of paid dental claims that used the CDT code for pulpotomy was 401,638. For teeth that received pulpotomy, the average time between pulpotomy and extraction was 1.1 years if the pulpotomies were performed by GDs. The average time was 1.3 years if the pulpotomies were performed by PDs (P<0.0001). GDs had an extraction rate of 7.83 percent after pulpotomies and the placement of stainless steel crowns, while PDs had an extraction rate of 4.09 percent. Conclusions: There is a significant difference in the success rate of teeth treated with pulpotomies performed by pediatric dentists versus general dentists, with pulpotomies performed by the former having a longer survival rate.

Prescription of Panoramic Radiographs in Children: A Health Services Assessment of Current Guidelines.

PURPOSE: To (1) determine adherence to guidelines when prescribing panoramic radiographs (PR) for patients 18 y.o. and younger; and 2) compare PR prescriptions between general dentists (GPs) and pediatric dentists (PDs). METHODS: A retrospective analysis of insurance claims included codes for PRs and associated codes for two cities between 2008 and 2015. Chi-square tests ascertained the likelihood of a PR being associated within three days of routine exams. RESULTS: A total of 81,699 pediatric patients were seen by 2,077 GPs and 103 PDs. There were 11,993 PRs, 119,068 routine exams (7,343 associated with a PR), 13,819 orthodontic procedures (378 associated with a PR), 798 third molar procedures (172 associated with a PR), and 16,636 procedures for acute problems (1,670 associated with a PR). Patients aged eight years old and younger had the largest discrepancy between GPs and PDs. GPs prescribed proportionally more films in patients five years old and younger, but PDs prescribed more in seven and eight year olds. Nine- to 18 year olds. had more similar patterns between GPs and PDs, except for 14- to 15 year olds, when GPs prescribed more. CONCLUSIONS: GPs prescribed PR in patients younger than five years old more often and were somewhat less likely to follow guidelines.