Utilization of silver diamine fluoride by dentists in Canada: a review of the non-insured health benefits dental claims database.

Introduction: Dental caries is one of the most frequent chronic conditions in childhood. Silver diamine fluoride (SDF) is a recognized caries arresting agent, but its use is relatively new in Canada. SDF has the potential to arrest early childhood caries in young children and delay treatment until children can be seen in outpatient settings. In August 2020 the Non-Insured Health Benefits (NIHB) program of the Department of Indigenous Services Canada approved the following procedure “Topical application to hard tissue lesion(s) of an antimicrobial or remineralization agent (includes silver diamine fluoride)”. The purpose of this study was to investigate the utilization of SDF by Canadian dental providers for First Nations and Inuit Canadians with dental benefits through the NIHB program. Methods: The NIHB program provided data on all claims paid for the procedure “topical antimicrobials or remineralization agent/SDF” for children < 17 years and any other procedure claimed on the same date for the period from August 1, 2020 to July 31, 2022 in all Canadian provinces and territories with the exception of British Columbia, Newfoundland and Labrador, and Prince Edward Island. Claims made by general dentists, pediatric dentists, prosthodontists, and dental hygienists were included. The claims from August 2020 until July 2022 were arranged into eight,3 months, quarters. Rates of SDF application by province or territory were calculated. Data were analyzed using NCSS 2023 Statistical Software. Statistical analyses included descriptive statistics (frequencies, mean ± standard deviations (SD)). Results: There were 4,158 claims for SDF between August 1, 2020 and July 31, 2022 for 3,465 children <17 years of age. The mean age was 7.9 ± 4.0 years and 52.9% of those were female. The majority of claims, both for the initial claim (87.1%) and follow up visit claims, were made by general dentists. Most children had another procedure at the initial and follow up visits, with claims being for one or more assessment, non-restorative, restorative, or sedation procedures. Claims revealed that traditional restorative treatment was also performed on the same day of SDF application for nearly one third of patients. The province with the most initial claims for SDF was Manitoba (19.6%). However, Alberta was the highest province for follow-up claims for SDF. Nunavut and Northwest Territories had the highest rates of SDF claims for children (37.0/1,000) and (20.9/1,000) respectively. Quarter 8 had the highest number of initial claims (539) for SDF submitted. Claims appear to be lower during the period of November to January compared to the rest of the year. Conclusions: Data suggest that there has been an overall continuous increase in the number of claims submitted for SDF among registered First Nations and Inuit children. Claims for SDF have been submitted by providers in the majority of Canadian provinces and territories from August 2020 until July 2022. Although, Ontario and the Western provinces had the highest number of claims, Nunavut and the Northwest Territories had the highest rates of claims.

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