Reimbursement policies and insurance coverage limitations may affect dentists’ decisions to prescribe silver diamine fluoride (SDF) to prevent caries, according to a study recently published in the Journal of the American Dental Association.
Furthermore, dentists indicated they would be more likely to use SDF if reimbursement policies were less restrictive, and many reported that their use of SDF increased after their state Medicaid programs began covering applications, the authors wrote.
“Dentists reported that policy restrictions do have some impact on their use of SDF,” wrote the authors, led by Dr. Callihan Clayton of the Ohio State University College of Dentistry (JADA, December 18, 2025).
To assess safety-net dentists’ knowledge, attitudes, and practices related to SDF, researchers developed a questionnaire and distributed it through the National Network for Oral Health Access, yielding 111 responses. The questionnaire incorporated the domains of the individual, the innovation, the inner clinical setting, and the outer setting, they wrote.
Individual-level questions examined dentists’ experience with SDF, their adoption of clinical innovations, and their willingness to recommend SDF. Innovation-related questions evaluated dentists’ knowledge and the perceived risks and benefits of SDF. Inner and outer setting questions explored how SDF is used in clinics, including application practices, barriers and facilitators to use, Medicaid reimbursement policies, and perceptions of reimbursement amounts.
Only 5.7% of respondents reported never using SDF, while 23.4% said they used it more than once per day. Most dentists were extremely familiar with SDF (88%) and confident in their ability to use it (93%). Clinically, 96% agreed that the benefits of SDF outweigh the risks, with reported use ranging from once per day (38%) to once per week (28%) or once per month (28%), they wrote.
Reimbursement policy strongly influenced SDF use, with about 60% reporting increased use since state Medicaid programs began reimbursement. Dentists indicated they would use SDF more often if reimbursement restrictions were eased, particularly with limits on application frequency (60%), number of teeth per visit (45%), and the timing of restoration after SDF (42%).
However, the study had limitations. Incomplete responses that lacked demographic and practice details limited the ability to conduct a more detailed analysis of the individual and inner setting domains, the authors added.
“SDF reimbursement policies can align more closely with evidence-based guidelines to support more optimal use,” they concluded.
