Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries.
BACKGROUND
Staff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past.


METHODS
In a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM.


RESULTS
In 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period.


CONCLUSIONS
Fluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation. Practical Implications Fluoride use reduces the need for future restorations in adults at high risk of experiencing caries.
Dr. Gibson is the director, Veterans Affairs Oral Health Quality Group, Veterans Health Administration Office of Dentistry, Washington, and a staff dentist, Dental Service, Veterans Health Care System of the Ozarks, Fayetteville, Ark. Address correspondence to Dr. Gibson at Dental Service (160), Veterans Health Care System of the Ozarks, 1100 N. College Ave., Fayetteville, Ark. 72703, gretchen.gibson@va.gov.
Gretchen
G
Gibson
M Marianne
MM
Jurasic
Carolyn J
CJ
Wehler
Michelle B
MB
Orner
Martha E
ME
Nunn
Elizabeth
E
Nuñez
Terry G
TG
O'Toole
Patricia E
PE
Arola
Susan C
SC
Bestgen
Judith A
JA
Jones
D000328:Adult; D002327:Cariostatic Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000592:standards; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control*; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005260:Female; D005459:Fluorides / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data
D002327:Cariostatic Agents; D005459:Fluorides
Performance measure; caries; caries prevention; fluoride; restoration