Costs and Resource Use Among Child Patients Receiving Silver Nitrate/Fluoride Varnish Caries Arrest.

PURPOSE: The purpose of this study was to assess the impact of silver nitrate/fluoride varnish (SN/FV) on care costs. METHODS: A retrospective matched cohort study, using Oregon Medicaid claims (January 1, 2012 to December 31, 2014) for patients younger than 21 years old, compared patients treated with SN/FV to matched patients not treated with SN/FV. The number of services and costs were compared using student's t test and generalized estimating equation (GEE) regression models. RESULTS: Patients treated with SN/FV (n equals 4,612) and matched patients treated conventionally (n equals 13,498) averaged 28±7 (SD) months of continuous eligibility based on initial treatment date. The number of first-year services and total services over an average of 28 months were higher for patients treated with SN/FV (10.6 versus 6.7 in year one; 19.3 versus 8.8 overall; P<0.0001). Excluding diagnostic/preventive services, costs were higher in patients treated conventionally than patients treated with SN/FV in the first year. Overall costs were similar ($698 versus $707; P=.52). The average number of services was 58 percent higher (95 percent confidence interval [CI] 1.54 to 1.63) for patients treated with SN/FV, but costs remained similar. CONCLUSION: Patients treated with silver nitrate/fluoride varnish accrued a greater number of services and higher total costs over approximately 28 months but lower treatment costs than patients treated conventionally.

The effect of veneers on cosmetic improvement.

OBJECTIVES: This clinical study was designed to compare the patient's opinion of the cosmetic improvement after the placement of direct composite and indirect porcelain veneers. METHODS: This retrospective study involved a survey of 145 patients (96 responses) each treated with 10 direct composite (Vitalescence) or 10 porcelain (Fortress) veneers. Patients subjectively evaluated multiple aspects of their smile using visual analogue scales before and after treatment for colour, shape, size, smile line and overall facial appearance. RESULTS: There were no statistical differences between the cosmetic improvement achieved for porcelain and composite (p > or = 0.05). Cost factors were not significant. Significant factors were: tooth conservation (p < or = 0.021), time (p < or = 0.012), repair costs (p < or = 0.009) and replacement costs (p < or = 0.024) and favoured the direct composite veneers over the porcelain veneers. Correlation findings relating to what patients feel as the key components of the smile for overall cosmetic improvement showed medium to high correlations (0.301 < or = r < or = 0.718) with tooth shape, colour and level of tooth display, gingival level, gingival symmetry and tooth whiteness. CONCLUSION: The choice of material (direct composite resin vs porcelain) when constructing maxillary anterior veneers does not significantly affect the patient's perception of cosmetic improvement. However, there was a preference towards accepting the composite veneer option. Overall aesthetic satisfaction is multifactorial. The results support the opinion that the more conservative composite veneers are justified and that, given the choice and information, patients may prefer this option.

Veneering of teeth. State of the art.

Veneering of discolored, malformed, poorly restored, or broken-down teeth is now a reality in routine dental practice. Various types of veneers have been described. The most commonly used veneer has been described in detail. Properly placed veneers should provide patients with years of inexpensive, esthetic service. They are satisfying to dentists and patients, and their use should be encouraged.