Family Physicians are in Perfect Position to Address Oral Health

The mouth affects the entire body across the life cycle. Examples include untreated caries leading to pain, unnecessary emergency department visits and missed school, as well as the systemic inflammation of periodontitis, which can be associated with worse control of diabetes, increasing obesity rates and heart disease.

Family physicians are the first line of defense against illness and disease. In this era of the patient-centered medical home (PCMH), family physicians act as leaders of the team, coordinating all aspects of a patient’s health as their first contact and helping with referrals to relevant specialists, including dentists and periodontists.

Primary care health teams can and should play a role in preventing oral diseases and promoting oral health in individuals of all ages. This can be accomplished through counseling, oral hygiene instruction, screening, and appropriate dental referral.

According to the American College of Obstetrics and Gynecology Committee Opinion(www.acog.org), physicians should perform a risk history and oral exam for pregnant women during the intake visit and make a referral to get dental care during pregnancy, which evidence shows is safe. This will help the mother avoid dental issues during pregnancy and offer her newborn a lower risk for caries.

For infants and children, the American Academy of Pediatrics suggests (pediatrics.aappublications.org) that primary care health professionals discuss oral health with parents starting when children are 6 months of age. Family Physicians see children for well care six to 10 times before they ever see a dentist. The Family Physician office is the family’s dental home until they are referred to one.

At the 6 and 9 month visits, conduct an oral health risk assessment which includes a risk history for caries, an oral exam, dental hygiene and dietary counseling. Encourage the parent to select a dental home for the child by one year of age.  For the 12, 18, 24, and 30 month visits, risk assessments should continue if a dental home has not been established. Document a referral or inability to refer to a dental home if one has not been established. For those at high risk, consider application of fluoride varnish for caries prevention.  At 3 and 6 years: Determine if the patient has a dental home. If not, a referral must be made. If a dental home has not been established, perform a risk assessment and consider application of fluoride varnish for caries prevention.

Several studies have shown that fluoride varnish is efficacious in reducing decay in the primary teeth of high-risk children. Varnish placement is quick and easy. The CDC (2001) and ADA (2006) recommend at least biannual application at six-month intervals.

Effective January 1, 2015, the application of topical fluoride varnish by a physician or other qualified health care professional may be billed with the new CPT code 99188. This applies to providers enrolled in and filing claims under GA Medicaid programs 430, 431, and 740.

Only providers enrolled in and filing claims under GA Medicaid programs 430, 431, 450, and 740 may bill Code D1206 Fluoride Varnish (eff. 1/1/2010).

  • Dentists: under category of service 450
  • Physicians: under category of service 430
  • Physician Assistants (PA): under category of service 431
  • Nurse Practitioners: under category of service 740

AAFP Recommendations:

  • The AAFP recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (2014).
  • The AAFP recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (2014)