Fluoride use protects teeth

The Utah Department of Health and Human Services wants to remind clinicians to consider applying dental fluoride varnish for children younger than age 4 as part of a well-child exam at primary care and dental visits. Fluoride promotes healthy teeth.  However, according to the All Payer Claims Database in 2022, only 1.9% of Utah’s children 0-4 years of age are receiving fluoride treatments at well-child visits. 

Fluoride is a mineral that strengthens tooth enamel which helps prevent cavities. Fewer cavities means less mouth pain. Fluoride can also stimulate new bone growth. 

While soil, water, plants, and food contain trace amounts of fluoride, fluoridated water, toothpastes, and rinses are the most common sources where people get fluoride. Besides fluoridated toothpastes and mouth rinses that are recommended for daily home use,  fluoride can also be applied by a dental or medical professional during routine office visits. This topical application is in the form of a gel, foam, or varnish. Applying fluoride to the surface of the teeth is a safe and effective way to prevent tooth decay. 

The American Academy of Pediatrics (AAP), the United States Preventive Services Task Force (USPSTF), and the American Dental Association (ADA) recommend the application of fluoride varnish to reduce the risk of tooth decay. The AAP, ADA, and USPSTF recommend fluoride varnish be applied 2 to 4 times a year for all children beginning at 6 months of age. 

In the state of Utah, Medicaid reimburses for the application of dental fluoride varnish application for children from birth through 4 years as part of a well-child exam during primary care and dental visits. Reimbursement for the fluoride varnish application is allowed by Medicaid up to 4 times per calendar year. This limitation applies to the combined total of applications in medical and dental settings, until the child turns 5. Through the Patient Protection and Affordable Care Act (ACA) passed in 2015, most private dental insurance plans were required to cover fluoride varnish applications performed during pediatric (ages 1-4) well-child visits. Once the patient turns 5 years old, the fluoride needs to be applied in a dental office. Medical providers should file CPT code 99188 for this service. 

Medicaid and most private insurance also reimburses for the fluoride varnish application during a preventive dental visit. Both the ADA and AAP recommend that children have their teeth checked by a dentist by 1 year of age then every 6 months thereafter. Fluoride varnish should be applied on every child at 6 month intervals starting at their first visit, no matter the child’s risk for cavities. After age 5, fluoride varnish can be applied 4 times a year in a dental setting. The billing code for dental providers in a medical or dental setting is CDT code D1206. This code is reported on the ADA dental claim form.

The AAP has also recommended that a pediatrician perform a caries risk assessment on all children at well-child visits beginning at 6 months of age. A risk assessment looks at family eating habits, home care habits, access to dental care and insurance and helps a provider determine a child’s risk for dental issues. The assessment can be used to establish a fluoride application schedule for each child. It is recommended that a child discovered to have a moderate to high risk for developing cavities receive a fluoride application 4 times per year. A child discovered to be at a low risk for developing cavities is recommended to have a fluoride application at least 2 times per year. This assessment can be done in the medical or dental office. The AAP recommends a risk assessment be done at the 6- and 9-month visits. A risk assessment only needs to be done if the child doesn’t have a dental home for the remainder of the well-child visits. Even though there isn’t a validated risk assessment tool, the AAP and ADA each created one. The AAP assessment tool can be found here and the ADA assessment tool can be found here. Check back later for a separate blog to learn more about caries risk assessments.

Fluoride can benefit patients of all ages, but it is important for children as they grow and learn how to take care of their teeth. Applying a fluoride varnish is a quick and easy way to help prevent cavities in young patients. 

Resources:

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1

https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/library/oral-health-topics/topics_caries_under6.pdf?rev=adb3b45683794a2bbcb91f4c6e056b25&hash=030A0D0985056C6EF1FBCAF8BCD0200C

https://www.aapd.org/globalassets/media/policies_guidelines/bp_cariesriskassessment.pdf?v=new

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811821

https://downloads.aap.org/AAP/PDF/oralhealth_RiskAssessmentTool.pdf

https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/#:~:text=Fluoride%20is%20the%20ionic%20form,contain%20trace%20amounts%20of%20fluoride.

https://ibis.utah.gov/ibisph-view/indicator/view/AgeDistPop.html

https://www.statista.com/statistics/206370/resident-population-in-utah

The Utah Department of Health and Human Services (DHHS) may occasionally link to outside sources of information. DHHS and the state of Utah do not necessarily endorse the provider of the content and are not responsible for any content published on the external site.