Jarvie Journal - College of Dental Medicine - Columbia University

Volume 56, Spring 2013
Caries Risk Assessment Utilization by Pediatric and General Dentists
Iva LeRoy 1 , Agelina Paek 2 , Athanasios Zavras 3*
1 Columbia-New York Presbyterian Hospital, Residency Program in Pediatric Dentistry, 2, 3 Section of Social and
Behavioral Sciences; all within Columbia University College of Dental Medicine, New York, NY; *Faculty Mentor
Introduction: Caries management by risk assessment (CAMBRA) represents an approach to preventing and treating
dental caries. The risk assessment and the emphasis on the whole disease process, not just the cavitated stage of lesion
progression, differentiates CAMBRA from the traditional restorative approach in treating dental caries. Furthermore,
CAMBRA attempts to change caries management from the current and predominant one-size-fits-all approach to an
individualized risk-based care. While the evidence indicates management of caries by risk assessment is an effective
approach to prevent and treat caries, there is concern that risk assessment has been under-utilized in the clinical
setting.
Objective: This study explores whether pediatric and general dentists utilize two services in caries assessment by risk
assessment: collection of microorganisms for culture and sensitivity (D0415) and caries susceptibility tests (D0425).
Specifically, the aim of this paper is to assess the percentage of general and pediatric dentists who perform D0415 and
D0425 on the pediatric population, the likihood of submitting claims for same, and whether the likelihood of
performing D0415 and D0425 would increase if dentists received insurance reimbursement for these services.
Materials & Methods: Delta Dental insurance company (hereinafter “Dental Dental”) provided data on dental claims
for two services: collection of microorganisms for culture and sensitivity (D0415) and caries susceptibility tests
(D0425) submitted between 2008-2011 by general and pediatric dentists for patients under 6 years of age in the five
states where they conduct the most business (CA, NY, TX, PA & FL). In addition to the data provided by Delta
Dental, general and pediatric dentists were surveyed. A random sample of 500 general dentists from Manhattan and
120 pediatric dentists from New York State were selected. All participants were given a questionnaire regarding the
likelihood of performing D0415 & D0425 for a hypothetical patient. Pediatric dentists were additionally surveyed
regarding whether the likelihood of performing D0415 & D0425 would increase if they received insurance
reimbursement for these services.
Results & Conclusions: When surveyed, the majority of general and pediatric dentists (89% and 88%, respectively)
do not take a collection of microorganism for culture and sensitivity (D0415). Further, 67% of general dentists and
38% pediatric dentists responded that they do not conduct a caries susceptibility test (D0425). Of the pediatric dentists
surveyed who responded that they do perform D0415 and D0425, the majority of these dentists do not submit a claim
to an insurance company (86% of those performing D0415 and 78% of those performing D0425 do not submit
claims). The survey responses are in conformity with the data obtained from Delta Dental, which reveals that more
than 99% of general and pediatric dentists do not submit insurance claims for D0415 and D0425. However, when
pediatric dentists were surveyed, 67% said they would be more likely to perform D0425 and 59% would be more
likely to perform D0415 if they received insurance reimbursement for those services. The majority of respondents
agreed that a reasonable fee for D0415 for culture and sensitivity is ≥$40 and a reasonable fee for D0425 is $30.
Discussion: Survey of general and pediatric dentists suggests that there is under-utilization of caries risk assessment
services. This, to a degree, reflects a lack of monetary incentive as there is both time and cost associated with utilizing
these unreimbursed risk assessment tools. However, this does not diminish the evidence showing that S. mutans
cultures and caries susceptibility testing are promising approaches for identifying children who need early and
intensive intervention to prevent or minimize caries experience.
Research supported by the Health Resources and Services Administration Maternal and Child Health Bureau:
Leadership Training in Pediatric Dentistry Grant T17MC06359
Post-doctoral Training in Pediatric Dentistry Grant D88HP20109
59