Most patients never receive a simple saliva test that can help prevent tooth decay.
The reason? Dentists traditionally don't offer it, because they stand to make more money filling a cavity than preventing it, says Dr. Rory Hume, dean of UCLA's School of Dentistry. While a filling costs $100 to $200, the test runs about $25 to $50.
What's more, insurance companies typically won't pay for it. So, in late 1996, Hume and other researchers set about developing financial incentives to encourage dentists to offer the test and insurers to cover it. He and other researchers received a $62,000 grant from San Francisco-based Delta Dental Plan of California, the largest dental plan in the state.
The test checks for the presence of streptococcus mutans and lactobacilli, two bacteria that live in saliva and plaque. In high levels, these bacteria indicate a high risk of future tooth decay. Patients found to be at high risk would be advised to eat less often, avoid sweets, drink tea, which kills the bacteria, and use fluoride mouthwashes.
Sold by the European company Ivoclar, the test was approved for the U.S. market five years ago. However, Ivoclar estimates that only 150 of the nation's 140,000 dentists offer the test.
What's more, Hume and his collaborators are finding it tough to buck the system. Whatever new insurance product they come up with to encourage use of the preventive test must satisfy the patient, the dentist, the insurer and the employer, who typically provides the insurance coverage.
"It's complex," said Hume, who predicts it will be at least two years before a new product can be designed.
Barbara Marsh covers health care for The Times. She can be reached at (714) 966-7762 and at firstname.lastname@example.org.