Dental caries is the most common chronic infectious disease of childhood – with prevalence roughly six times that of asthma – yet is nearly 100% preventable. Tooth decay has substantial consequences and barriers to accessing dental care persist.

Dental caries can cause pain, sleeplessness, poor growth and development, speech problems, shyness about appearance, poor school attendance, focus, and achievement. To address concerns of access to dental care and high rates of tooth decay in young children, Medicaid and Medicaid-Managed care began reimbursing for primary care oral health preventive services in New York State in October of 2009. This required primary care providers to perform oral health risk assessments, provide anticipatory guidance, apply fluoride varnish prophylaxis, and refer to establish a dental home. Regular fluoride varnish application results in 37% prevention of dental decay in primary teeth and over 40% in permanent teeth. In studies where fluoride varnish prophylaxis was accompanied by changes in home oral hygiene and dietary behaviors, the cavity prevention effect is much stronger, up to 50-60% incremental caries reduction. 

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In 2014, the United States Preventive Services Task Force (USPSTF) issued a recommendation statement on Prevention of Dental Caries in Children From Birth Through Age Five Years (USPSTF recommendations fluoride 2014 clinical summary and USPSTF fluoride recommendations 2014 full report). This statement recommends that primary care clinicians apply fluoride varnish to the teeth of all infants and children at least every 6 months, starting with the appearance of the first primary tooth through age 5. This recommendation applies to ALL children, and is no longer a risk-based recommendation.

The implications of the USPSTF recommendations include that:

• All pediatric primary care practices must provide this service for all children at least bi-annually. This recommendation was assigned a “B” grade, meaning that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial and that practices must offer or recommend this service.

• Private insurers will be required to reimburse for these services in the primary care setting as of 2015. Preventive services given A or B recommendations by the USPSTF must be covered by new and individual insurance plans of all types and by Medicaid and Medicaid-Managed care with no cost sharing.

• The USPSTF recommendation was not prescriptive about training requirements.

• Click for recommendations. 

 

Where can I find training regarding oral health prevention and application of fluoride varnish?

• Smiles for Life  is a comprehensive training program for primary providers. Courses 2 and 6 address children’s oral health and fluoride varnish with 1 hour free CME per course.

• AAP Children’s Oral Health webpage  has educational information and an in-depth training program, Protecting All Children’s Teeth (PACT), available for 11 hours of free CME.
   

How do I advocate for reimbursement for fluoride varnish in our office?

• Letter to insurers from AAP National regarding the USPSTF recommendations can be viewed here

• AAP Children’s Oral Health webpage contains information about advocacy for reimbursement and children’s oral health issues

 

Where do I order supplies and how do I get started?

• New CPT code for fluoride varnish application is 99188; effective January 1, 2015. Suggest to append a V -33 modifier for preventive services.

• Information on office integration, reimbursement, and practice tools can be found here on the AAP Children’s Oral Health website.

• Fluoride varnish and supply ordering information can be accessed here

• Educational materials for patients and families can be found on both the Smiles for Life and AAP Children’s Oral Health websites.

 

Where can I find information about fluoride recommendations and community water fluoridation?

• AAP clinical report addressing Fluoride Use in Caries Prevention in the Primary Care Setting was published in Sept 2014. View here.

• The AAP is a partner in the Campaign For Dental Health, a network of national, state and local children’s and oral health advocates, health professionals, and scientists. The Campaign supports water fluoridation as a safe, cost-effective method of preventing tooth decay and provides reliable information for use by consumers and advocates.

• The Schuyler Center for Analysis and Advocacy is a nonprofit, policy analysis and advocacy organization working to improve health, welfare and human services for all New Yorkers. They are actively advocating for improved oral health of New Yorkers and community water fluoridation. For information visit: http://www.scaany.org/policy-areas/health

 

What if I have questions?

• Many frequently addressed questions are addressed on the Smiles for Life and AAP Children’s Oral Health webpages as above. For additional questions, please contact your New York Chapter 1 Oral Health Advocate, Melinda Clark, MD, FAAP.