ARCHIVED

Medical Policy

Policy Num:      08.001.041
Policy Name:    Applicatiion Of Fluoride (Varnish)
Policy ID:          [08.001.041]   [Ac / L / M+ / P ]   [0.00.00]

Last Review:    November 14, 2019
Next Review:    Policy Archived
Issue:               11:2019

ARCHIVED

Related Policies: None

Application Of Fluoride (Varnish)

SUMMARY

Many oral health problems, including dental caries, malocclusion, and fluorosis, begin in childhood and can be prevented through regular preventive dental care and counseling [1]. Despite the decrease in prevalence of dental caries among school-aged children from approximately 75 percent in the 1970s to 37 percent in 2011 to 2012 [2], caries continues to be one of the most common chronic diseases [3-8]. Data from the Centers for Disease Control and Prevention suggest that tooth decay in primary teeth of children aged two to five years has fluctuated since the 1980s but has not declined overall, increasing from 24 percent in 1988 to 1994 to 28 percent in 1999 to 2004 [9] and then decreasing to 23 percent in 2011 to 2012 [2]. The oral health goals for Healthy People 2020 include [6]:

• Decrease the proportion of three- to five-year-olds with caries in the primary dentition from 33 percent (1999 to 2004) to 30 percent
• Decrease the proportion of six- to nine-year-old children with caries in the mixed dentition from 54 percent (1999 to 2004) to 49 percent
• Decrease the proportion of adolescents with caries in the permanent dentition from 54 percent (1999-2004) to 48 percent

  The fluoride varnish is a protective medication that is painted over the teeth to help prevent new cavities and helps to stop cavities that have already begun.

The application of topical fluoride varnish can be performed by a physician or another qualified health care professional when the insured does not have dental coverage with SSS Salud.

OBJECTIVE

The objective of this review is to outline a dental program directed to the prevention of dental carries in children before 5 years of age.

POLICY STATEMENTS

Fluoride varnish is considered medically necessary to help reduce the risk of decayed, missing, or filled primary teeth in preschool children and early adulthood.

POLICY GUIDELINES

1.     It will be covered from 6 months to the day that the insured reaches 5 years of age.

2.     Limited to payment to 2 per policy year at intervals of not less than 6 months.

3.     Any other product is not considered for payment or adequate to meet the preventive requirement covered for our insured.

BENEFIT APPLICATION

BlueCard/National Account Issues

N/A

BACKGROUND

Dental disease is the most common chronic illness for children in the United States. According to the Centers for the Prevention and Diseases Control (CDC) more than one quarter of the children, have cavities in the baby (primary) teeth before they enter to the kindergarten. By 19 years of age, 68 percent of young people have suffered cavities in permanent teeth.

The dentist is considered as the "specialist" in this procedure and as such, a differential rate is applied.

Dental provider preparation for the patient to receive the fluoride with effectiveness, is to perform a dental prophylaxis (cleaning) before its application, for the fluoride to have direct contact on a surface without bacterial plaque or calculi and its absorption is the most appropriate.

REGULATORY STATUS

N/A

RATIONALE

Dental risk assessment before one year of age can help to identify children who are at risk for development of dental disease [10,11]. Risk factors for the development of dental disease have been identified in several prospective studies and include findings from both the history and examination [12-17].

Population Reference No. 1 

Children at risk for development of dental carries.

Individuals children at risk for development of dental carries

SUPPLEMENTAL INFORMATION

N/A

PRACTICE GUIDELINES AND POSITION STATEMENTS

N/A

U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS

The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride (May 2014).

MEDICARE NATIONAL COVERAGE

N/A

REFERENCES

1.     Section On Oral Health. Maintaining and improving the oral health of young children. Pediatrics 2014; 134:1224.

2.     Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS Data Brief 2015; :1.

3.     Kelly JE, Harvey CR. Basic data on dental examination findings of persons 1-74 years. United States, 1971-1974. Vital Health Stat 11 1979; :1.

4.     Kaste LM, Selwitz RH, Oldakowski RJ, et al. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res 1996; 75 Spec No:631.

5.     Edelstein BL, Douglass CW. Dispelling the myth that 50 percent of U.S. schoolchildren have never had a cavity. Public Health Rep 1995; 110:522.

6.     Healthy People 2020. Oral health. www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=32 (Accessed on January 05, 2011).

7.     Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11 2007; :1.

8.     Dye BA, Li X, Beltran-Aguilar ED. Selected oral health indicators in the United States, 2005-2008. NCHS Data Brief 2012; :1.

9.     CDC National Center for Health Statistics. Trends in Oral Health Status: United States, 1988-1994 and 1999-2004. April 2007, Series 11, Number 248. p.104.

10.  Hale KJ, American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003; 111:1113.

11.  Clark MB, Slayton RL, Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics 2014; 134:626.

12.  Günay H, Dmoch-Bockhorn K, Günay Y, Geurtsen W. Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clin Oral Investig 1998; 2:137.

13.  Warren JJ, Weber-Gasparoni K, Marshall TA, et al. A longitudinal study of dental caries risk among very young low SES children. Community Dent Oral Epidemiol 2009; 37:116.

14.  Alaluusua S, Malmivirta R. Early plaque accumulation--a sign for caries risk in young children. Community Dent Oral Epidemiol 1994; 22:273.

15.  Hallonsten AL, Wendt LK, Mejàre I, et al. Dental caries and prolonged breast-feeding in 18-month-old Swedish children. Int J Paediatr Dent 1995; 5:149.

16.  Maguire A, Rugg-Gunn AJ, Butler TJ. Dental health of children taking antimicrobial and non-antimicrobial liquid oral medication long-term. Caries Res 1996; 30:16.

17.  Aligne CA, Moss ME, Auinger P, Weitzman M. Association of pediatric dental caries with passive smoking. JAMA 2003; 289:1258.

18.  Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care - Periodicity Schedule.

19.  US Preventive Service Task Force. Accessed 1/29/2015

CODES

APPPLICABLE MODIFIERS

N/A

POLICY HISTORY