Last Updated: September, 2019

Author: Oral Health Program, Vermont Department of Health

Since 2008, medical health care providers have been reimbursed by Medicaid for completing oral health risk assessments and fluoride varnish applications as part of well-child visits (check-ups). Oral health risk assessments involve looking in a child’s mouth as well as asking parents/caregivers questions to assess the child’s risk for dental decay. Fluoride varnish is a clear resin that can be “painted” on teeth to decrease a child’s risk for dental decay.  In 2010 the Affordable Care Act began requiring that all medical health insurers reimburse for fluoride varnish applications for children under age 6. This change, combined with our recent collaboration with the University of Vermont’s Office of Primary Care and Area Health Education Centers (AHEC) Program to expand the “From the First Tooth” (fluoride varnish application in primary care) pilot training to medical practices in Vermont, has led to an increased interest among practices in applying fluoride varnish in the primary care medical home. We hope these changes will translate into increased engagement among medical professionals in applying fluoride in the medical home and referring children to local dental practices at age one. We continue to see the curve move in the right direction. 

• The University of Vermont's Office of Primary Care and Area Health Education Centers (AHEC) program
• The Department of VT Health Access
• The VT Chapter of the American Academy of Pediatrics
• The VT Child Health Improvement Program
• The VT Oral Health Coalition

Evidence shows that involving medical health care professionals in delivering oral health messages and services as part of well-child care increases the likelihood that children will have fewer cavities or remain cavity free (Douglass & Clark, 2015). In addition to the decay preventing benefits of fluoride varnish and oral health education provided by medical professionals, ideally, parents/caregivers are also connected with a local dental practice when their child is one year of age, positioning them for regular and preventive dental care and heathy mouths. 

• We are collaborating with the University of Vermont’s Office of Primary Care and Area Health Education Centers (AHEC) to expand the “From the First Tooth” (fluoride varnish application in primary care) training to medical practices in Vermont.

• We are working with AHEC to promote the “Smiles for Life” oral health curriculum to health care professionals, medical residents, faculty, and health professions students. “Smiles for Life” is a series of free, online educational modules designed to train medical professionals about oral health and integrate oral health into primary care.

• We have connected with the Vermont Child Health Improvement Program to promote fluoride varnish application in the medical home as a quality improvement measure in the Child Health Advances Measured in Practice (CHAMP) network of practices, a network of over 49 practices that see children in Vermont.

• Public health dental hygienists working in district offices throughout Vermont continue to provide outreach, education, and technical assistance to local medical care professionals about how to initiate fluoride varnish application in the medical practice setting; for FY17, this work is being done in collaboration with UVM AHEC.

We are confident that by working collaboratively with our partners in the medical and human services fields we will be successful in increasing the number of medical professionals that routinely provide fluoride varnish applications to children under age 6 in Vermont.

Data Source: Vermont's Medicaid Claims

Medicaid claims data were used to identify the number of medical providers submitting claims for applying fluoride varnish (CPT=99188, D1206, or D1208) to a child under age 6.