Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Janice C. Probst


In South Carolina, the burden of dental decay disproportionately affects disadvantaged children enrolled in Medicaid (Dye et al., 2012; Martin et al., 2012; Ayers et al., 2013). To address this oral health disparity, South Carolina’s Medicaid Program initiated payment to physicians for the delivery of fluoride varnish (FV), an evidence-based preventive dental service at the well-child visit, to children up to thirty-six months of age. Fluoride varnish has been found to reduce dental decay by thirty-seven percent when applied two to four times a year (Weyant et al., 2013; Marinho et al., 2013).

Two retrospective cohort studies were undertaken to assess the effectiveness of FV policy, using deidentified billing records for 52,841 children insured by SC Medicaid. The first study found that during SFY2008-2013, the FV rates per child-year delivered by physicians and dentists were 1 percent and 23 percent respectively. A policy intended to increase the provision of FV through pediatric primary care was not successful, possibly due to restrictions imposed on length of time between FV administrations and decrease in the number of EPSDT visits for two and three year olds. The second study, examining the relationship between receipt MFV and well-child visits, found the strongest effect was in rural, primary care HPSAs and pediatric practices.

Results highlight the importance of examining the intended and unintended consequences of health services policy. These analyses provide a baseline of knowledge upon which SC DHHS can utilize, in collaboration with key stakeholders, to develop policy improvement strategies to increase access to fluoride varnish in the pediatric primary care system.