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Preventing Dental Disease in Young Children- and Getting Paid for It!

October 21, 2013

Dental caries (tooth decay) is a chronic, progressive, multi-factorial, infectious disease that can begin in early infancy and that, by the time children reach adulthood, will affect over 92% of the U.S. adult population.  The disease is 5 times more common than asthma and 7 times more common than hay fever.  Following decades of sustained community efforts, including water fluoridation, use of topical fluoride and educational initiatives, many children are free from dental caries.  Unfortunately, these improvements are not uniform as disparities in oral health status still exist.  Per national statistics, racial/ethnic minorities and children from low income families are more likely to be affected by dental disease.

Difficulties in Accessing Dental Care for Young Children

All children, especially those at high risk for dental disease, should establish a dental home by age 1.  The unfortunate reality is that most children’s preventive dental visits are delayed until school-age, despite recommendations from Bright Futures, the American Academy of Pediatrics, and the American Academy of Pediatric Dentistry.  Early childhood caries (ECC) is severe decay in the teeth of infants or young children that can require complex and expensive restorative care. Consequences of ECC include hospitalizations, emergency room visits, increased treatment costs, poor physical development, loss of school days, increased days with restricted activity, decreased ability to learn, and diminished quality of life.

Receiving preventive dental care is critical for young children at high risk for dental disease.  Unfortunately, there are significant problems with access to dental care across the country, particularly for very young children.  Reasons include a shortage of dentists willing to see very young children and/or accept Medicaid, geographic and language/cultural barriers, and a lack of knowledge about the importance of oral health and its relationship to overall health.  Because of these barriers, many children from low-income families are unable to access a dentist at all.

Providing Early Oral Health Services in FQHCs

Primary care medical providers

FQHCs are ideally positioned to address this crisis in access to preventive oral health services.  Community health center PCPs can play a huge role in promoting pediatric oral health as they have already established medical homes for this young and vulnerable population.  PCPs see their pediatric patents early and often, especially from ages 0 to 3. Quick, reimbursable preventive oral health services, anticipatory guidance, and referral to a dental home during well child visits. Forty-four state Medicaid programs in the U.S. reimburse medical providers for preventive pediatric oral health services, such as fluoride varnish (HCPCS code D1206) during well child exams.  Fluoride varnish provides a highly concentrated, temporary dose of fluoride that prevents and even reverses early tooth decay.  This evidence-based preventive measure is reimbursable by Medicaid in the vast majority of states. Information about state–by-state Fluoride Varnish Reimbursement can be found on the AAP Oral Health Initiative Web site.  In addition to a State Medicaid Payment Information Map and an Oral Health Coding Fact Sheet for PCPs, there is a resource on state Medicaid program requirements related to payment for oral health services, including codes to submit for payment, age limitations, the number of varnishes that can be applied annually, training required prior to implementation, and if delegation to ancillary staff is allowed.

Dental providers

Most community health centers provide dental services for their communities.  An integrated “health home” approach in an FQHC can provide an ongoing referral source for patients between the organization’s medical and dental clinics.  As PCPs begin to address oral health during well child visits, promote the Age 1 Dental Visit, and identify those children at high risk for oral disease, an increased number of referrals to the organization’s dental clinic will arise for young pediatric patients.  Dental providers will have a “home grown” referral source, and be provided with a large number of new patients on a regular and consistent basis. Not only will the dental clinic provide valuable preventive oral health services, such as exams (D0145), dental cleanings (D1120), and fluoride treatments (D1206), to a brand new cohort of patients but they will also establish positive habits early in infancy and create compliant, lifelong dental patients, ideally free of dental disease.  Establishing an infant and toddler program in an FQHC can produce a steady stream of new revenue, while providing a valuable service to its patients and the community.  This age group is an untapped and very important group for which early, and ongoing preventive services are desperately needed.

With dental caries being a common and significant childhood disease, it is essential that FQHCs include oral health in primary care pediatrics as well as becoming a dental home for one year olds. Encompassing preventive oral health services is a win-win: from both an overall health care perspective and expanding the capacity and service provision of the organization. It’s easy, will add revenue, and your patients will thank you for it!

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