Fluoride isn’t just for kids! As our population ages, the need for fluoride treatments becomes more critical. The Oral Health in America A National Institutes of Health report recently reported that by 2035, there will be more adults over 65 than young people in the US.
Adults keep their teeth longer and as they age, the financial burden of regular dental visits can be prohibitive. In addition, many have systemic health conditions that require a polypharmacy of medications to treat, many of which carry the side effects of dry mouth or hyposalivation.
Determining the need for any fluoride product requires a risk assessment. There are many examples of these assessments: Caries Management through Risk Assessment (CAMBRA); American Dental Association; California Dental Association and others. These checklists provide an easy way to determine whether a patient is low risk, moderate risk, or high risk and provide the perfect opportunity to show patients their risk of caries infection.
Once the risk is determined, the CDT modifier code and any insurance claim forms should be added to the patient record. These serve as documentation for fluoride treatments or products that may be recommended.
- D0601 caries risk assessment and documentation, with low risk finding
- D0602 assessment and documentation of caries risk, with a finding of moderate risk
- D0603 caries risk assessment and documentation, with high risk finding
For many decades, dental insurance carriers denied fluoride benefits to anyone over the age of 18. With this in mind, many dental professionals still do not offer fluoride treatments to adult patients because they assume they will not be covered. Whether or not a carrier provides benefits it should not specify if offered. Dentists are guilty of making assumptions about what patients will and won’t accept. If adult patients are educated about the benefits of fluoride treatment in relation to their oral health, they will accept the treatment.
Fortunately, attitudes are changing, albeit slowly. Many of the major carriers now provide fluoride coverage for adults, although it is almost always limited to one coverage per year.
How to choose a fluoride
What is the Why behind choosing a particular fluoride agent? V. Kim Kutsch, DMD, states in his book, Balance, “The primary goal in choosing the appropriate treatment strategy is to provide enough protective factors to offset any risk factors or biofilm induction and tip the balance back toward health.” This is why there are now many “fluoride” or “preventive agent” procedure codes included in the CDT manual.
The key to reimbursement is proper documentation of the risk assessment as well as the reason for providing the treatment. The purpose may include preventing the development of disease, promoting remineralization, or reducing the risk of relapse. This determination will help guide product selection as well as the appropriate CDT procedure code. It is important to understand that these procedure codes should be selected based on their descriptor and not just their title. Dental software management systems usually do not include the description.
D1206 topical application of fluoride varnish—Example: Voco’s Profluorid Varnish
D1208 topical application of fluoride, except varnish—Example: 1.23% acidified fluorine phosphate
D1354 caries-inhibiting drug application, per tooth—Descriptor: Conservative treatment of an active, asymptomatic carious lesion by topical application of a caries-inhibiting or caries-inhibiting drug and without mechanical removal of healthy tooth structure. An example: diamine silver fluoride (SDF)
D1355 application of drug to prevent caries, per tooth—Descriptor: For primary prevention or remineralization. The medications applied do not include topical fluoride. Examples include SDF, silver mitral (SN), thymol-chlorhexidine varnish, and topical povidone iodine (PVP-1)
D9630 drugs or drugs dispensed in the office for home use—Descriptor: Includes, but is not limited to, oral antibiotics, oral analgesics, and topical fluoride, and does not include writing recipes. Example: Remin from Voco
Remember, fluoride isn’t just for kids! Clinicians need to be more diligent in recommending fluoride and preventive products that will benefit adult patients throughout their lives.
