Reprinted from the Fall 2021 Issue of The Ohio Family Physician
By: Theodore E. Wymyslo, MD, FAAFP, Senior Medical Advisor, Ohio Association of Community Health Centers; Vinod Miriyala, DDS, MPH, CAGS, BDS, Centerville Pediatric Dentistry; and Susan Lawson, MHR, Oral Health Ohio
Call to Action
Family physicians have a wonderful opportunity to be a part of the solution to what is the most common chronic childhood disease – dental caries. Although we physicians traditionally expect that dentists will be the main source of preventive dental care, many children see their family physician more often, more affordably, and with easier access than they are able to see a dental provider. We don’t want to miss the opportunity to use our medical visits to partner with our dental colleagues in our shared desire to decrease the incidence and prevalence of dental caries, especially when our involvement can be so readily built into our practice workflow!
The Problem
The Ohio Department of Health reports that nearly one of every four preschool-age children in Ohio has experienced early tooth decay by age five.1 Prevalence is higher in children living in poverty, lacking insurance coverage, living in underserved areas, or on Medicaid. Pain from tooth decay (cavities) can impair sleep, growth, and the ability to learn, and can have a negative impact on the growth and development of permanent teeth. Poor oral health can adversely effect kindergarten readiness in the short term because children cannot learn when they are in pain, and in the longer term due to the detrimental medical, social, and occupational impact of poor oral health.
The Solution
Integrating oral health risk screenings, including intraoral exam, health education, fluoride varnish application, and dental referral can be done in different ways and in different medical settings during well-child visits.
Fluoride varnish application is of proven benefit in reducing the incidence of dental caries in children and adults. Fluoride helps protect against dental caries in three ways: reduces enamel demineralization, promotes enamel remineralization, and inhibits bacterial metabolism, as well as acid production. The well-child visit is an ideal time to address the fluoride needs of your pediatric patients.
As of May 4, 2021, the United States Preventive Services Task Force (USPSTF) recommends that primary care physicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption and continuing through age five (Grade B Recommendation).2 The USPSTF also recommends that primary care physicians prescribe fluoride supplementation starting at 6 months for children whose water supply is deficient in fluoride (Grade B Recommendation).2 The American Academy of Pediatric Dentists recommends applying fluoride varnish every 3-6 months before age six.3
The Process
The various components of an effective oral assessment can be integrated at various times during the visit by the clinical staff involved with the medical visit on that day. For example, oral health risk assessment and questions about establishing a dental home–the relationship between medical professional and patient– can be done by a medical assistant at the intake time. Oral exams should be done by a qualified medical professional whose scope of practice allows it (MD, DO, NP, PA, etc.). Health education and fluoride varnish application can be done by a medical assistant or nurse at the end of the visit along with appropriate risk-based referral to a dental specialist.
Oral health screening and assessment should be done for every child of any age. In Ohio, fluoride varnish application is reimbursed by Ohio Medicaid and many other private insurances. Fluoride varnish application can be done every 180 days until the child turns 6 years old, billed under CPT code 99188 (current Medicaid payment is $15).4
Resources for office protocol development and staff training are readily available on Oral Health Ohio website.
The Outcomes
The Journal of Dental Research reported in 2006 that children with no fluoride varnish treatments were more than twice as likely to have decay as those who had a yearly treatment, and almost four times as likely to have decay as those who had varnish applied at six-month intervals (over a two year study period).5 Your intervention can make a dramatic difference in a child’s health for a lifetime!
The Bottom Line
The medical community has supported the use of the medical home model of care to improve the health of patients and their families. Early preventive oral health assessments and establishment with a dental home can similarly introduce children and their families to prevention and early intervention for good oral health.
Universal oral health screenings, which include fluoride varnish application, should be the standard of care in family physician offices.
References available on the Ohio Academy of Family Physicians website.