Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) The Impact of a Policy change in Wisconsin Authorizing Non-Dental Providers to Bill Medicaid for the Application of Fluoride Varnish to Children's Teeth

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Project Number: R40 MC 08955-01
Grantee: Marquette University
Department/Center: Clinical Service/Public Health/School of Dentistry
Project Date: 2/1/2008

Final Report

(SDAS) The Impact of a Policy change in Wisconsin Authorizing Non-Dental Providers to Bill Medicaid for the Application of Fluoride Varnish to Children's Teeth Final Report (PDF) Exit Disclaimer

Principal Investigator

Christopher Okunseri, DDPH
Assistant Professor
Post Office Box 1881
Milwaukee, WI  53201-1881
Phone: (414) 288-6524


  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)


Approximately 2.5 million children between the ages of two and five years in the United States suffer from dental caries, a chronic and infectious disease that is preventable with early preventive measures, sustainable home care, and appropriate periodic dental visits. Medicaid, a jointly funded federal and state program, requires that eligible children who are enrolled receive preventive dental services through the Early and Periodic Screening, Diagnostic and Treatment program. However, only one child in every five enrolled in Medicaid receives dental services. In 2004, policymakers amended the Wisconsin Medicaid program's preventive dental procedure guidelines to address a gap in service provision. Wisconsin, along with eight other States, now allows non-dental providers to apply, and bill Medicaid for, fluoride varnish applications to children's teeth aged one to five years, who live in poverty, are minorities and/or who have special health care needs. It remains unclear, however, whether this change in policy has resulted in an appreciable increase in fluoride varnish applications for children enrolled in Medicaid. This study will examine whether there is an increase in the application of fluoride varnish to the teeth of children who are enrolled in Medicaid following the change in policy. Also, the study will examine how three main domains (patient, provider and county level characteristics) have impacted the rate of fluoride varnish application and utilization among Medicaid enrollees. The study will use data from the Electronic Data Systems of Medicaid Evaluation and Decision Support (MEDS) for Wisconsin for 2002-2006. This database is managed by the Division of Health Care Financing in the Wisconsin Department of Health and Family Services and contains all Medicaid claims for the state of Wisconsin. Descriptive statistics and multivariate regression models will be used to estimate the effect of the policy change on the rate at which Medicaid eligible children receive fluoride varnish and the rate at which they seek this application from non-dental providers. We will control for other covariates including child's county of residence, age and year effects. This project addresses all four of the Strategic Research Issues established by the Maternal and Child Health Bureau (MCHB). First, it will determine whether there is an increase in the rate of fluoride varnish application and utilization by children. Second, if there has been an increase, to explore whether it can be attributed to the involvement of non-dental providers by examining the settings and types of non-dental providers most likely to provide fluoride varnish to children. Third, it will explore patients' socio-demographics, and provider and county level characteristics that might account for the observed differences. Fourth, it will estimate the effect of race/ethnicity on the receipt of fluoride varnish from a non-dental provider. This secondary data analysis project will improve our knowledge on the benefits of allowing non-dental providers to provide fluoride varnish. This research is important for future potential expansion of the policy into other states to enhance the overall improvement of oral health in children.


Listed is descending order by year published.

Gonzalez CD, Okunseri C. Senior dental students' experience with Cariogram in a pediatric dentistry clinic. J Dent Educ. 2010 Feb;74(2):123-9.

Okunseri C, Girgis D, Self K, Jackson S, McGinley EL, Tarima SS. Factors associated with reported need for dental care among people who are homeless using assistance programs. Spec Care Dentist. 2010 Jul-Aug;30(4):146-50.

Okunseri C, Szabo A, Garcia RI, Jackson S, Pajewski NM. Provision of fluoride varnish treatment by medical and dental care providers: variation by race/ethnicity and levels of urban influence. J Public Health Dent. 2010 Summer;70(3):211-9.

McGuire J, Szabo A, Jackson S, Bradley TG, Okunseri C. Erosive tooth wear among children in the United States: relationship to race/ethnicity and obesity. Int J Paediatr Dent. 2009 Mar;19(2):91-8.

Noyce M, Szabo A, Pajewski NM, Jackson S, Bradley TG, Okunseri C. Primary language spoken at home and children's dental service utilization in the United States. J Public Health Dent. 2009 Fall;69(4):276-83.

Okunseri C, Szabo A, Jackson S, Pajewski NM, Garcia RI. Increased children's access to fluoride varnish treatment by involving medical care providers: effect of a Medicaid policy change. Health Serv Res. 2009 Aug;44(4):1144-56.


Oral Health, Insurance Coverage, Health Disparities

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