Preventive dental services were not effectively targeted to high-risk groups

Objectives: To: (1) quantify incidence of preventive dental services (in-office fluoride application and dental cleaning (prophylaxis)); (2) determine if these services are effectively targeted to patients with highest need; and (3) quantify the role of practice characteristics and patient-level factors in service receipt. Methods: Data were taken from a population-based prospective cohort study called the Florida Dental Care Study. Participants were 873 adults who had at least one tooth at baseline, 743 of whom provided 48-month data. In-person interviews and clinical examinations were conducted biennially, with 6-monthly telephone interviews in between. Analysis was limited to persons with at least one dental visit of any type during follow-up, which comprised 87% of the sample. Dental records were abstracted afterward and practices that served participants completed questionnaires. Results: Only 9% of persons received at least one fluoride application; 75% received a dental cleaning. In bivariate analyses, those with high need were actually less likely to have received preventive services during follow-up. In multivariable analyses, characteristics of the practice in which the subject received care were very strongly related to fluoride receipt, independent of patient-specific characteristics. Conclusions: One preventive procedure was very common; the other was very uncommon. However, practices did not effectively target high-risk patients for either procedure. Instead, both services were typically received by persons with the least need for them. These findings are consistent with the conclusion that practitioners greatly influenced delivery of fluoride services, with substantial contributions also made by patient-level predisposing and enabling factors for both preventive services. Supported by NIH DE-11020, DE-12457, DE-14164, and DE-16747.