Managing High-Risk Root Caries with Silver Diamine Fluoride Application: A Markov Simulation Study

Background Dental caries are common oral health conditions among Medicaid beneficiaries. Silver diamine fluoride (SDF) has been applied to manage dental caries. Objectives To evaluate the cost-effectiveness of SDF application for managing high-risk root caries within the context of Medicaid, a Markov simulation model was adopted from a healthcare system perspective. Methods A 45-year-old subject with 21 residual teeth was simulated for 19 years. Twice-yearly 38% SDF application on the tooth surface at risk for caries was compared with 5% sodium fluoride (NaF) varnish in terms of effectiveness and cost. Tooth-years free of extraction were set as the effect. Results Compared with 5% NaF varnish, 38% SDF application was cost-effective, with a difference of 6.34 extraction-free tooth-years and an additional cost of $7798 (incremental cost-of-effectiveness ratio, $1229 per extraction-free tooth-year gained; incremental net monetary benefit, $309 355). One-way sensitivity analyses on SDF and NaF costs confirmed cost-effectiveness of SDF application over NaF varnish. Conclusions An integrated orosystemic care model is underscored to disseminate the benefits of SDF application as the Medicaid payment system shifts from fee-for-service to managed care. Semiannual 38% SDF application might reduce and delay tooth extraction due to root caries in statewide dental provider shortage areas, particularly “dental deserts,” where Medicaid-accepting dentists are not available.