Article contributed by CareQuest Institute for Oral Health
On September 15, 2022, the American Medical Association (AMA) approved a new CPT code for the application of silver diamine fluoride (SDF) by health-care professionals to treat cavities without a dental filling. This is a milestone in medical-dental integration and a step forward for oral health equity, providing access to this valuable treatment for millions of Americans who don’t see a dentist every year.
Tooth decay is the most common noncommunicable disease worldwide and can lead to serious health problems, including brain or heart infections, if left untreated. SDF is a minimally invasive way to prevent dental decay from progressing and spreading to other teeth. The brush-on liquid stops cavities by strengthening affected tooth structures and keeping bacteria from growing on them. Unlike traditional treatments, such as drilling and filling a cavity, SDF is quick, painless, and does not require local anesthesia or sedation.
WHO adds three dental treatments to essential medicines list
Adult fluoride billing and coding strategies
“The AMA just created a transformative mechanism for payors to support medical teams to control tooth decay with a breakthrough medicine,” said Jeremy Horst Keeper, DDS, PhD, director of clinical innovation at CareQuest Institute Partners and one of the authors of the code. “SDF is carefully brushed on to cavities and repeated periodically, stopping a great majority of them. It also prevents new cavities more efficiently than anything we’ve ever seen before. Why wouldn’t medical teams use SDF to take control of the most prevalent disease? They can, they do, and now there is a code for payors to compensate them for it.”
The stats
With this change, medical teams are further empowered to administer SDF to improve the overall health of their patients, especially those at higher risk of dental disease and with lower access to regular dental care, including those living in poverty and historically marginalized. It will also help the more than 60 million people living in dental health professional shortage areas.1
The new CPT code will positively impact children and older adults. Most young children see a medical team but not a dental team. In fact, only 2% of children under the age of 2 have seen a dental team,2 but the typical 2-year-old has seen a medical team 10 times. Additionally, only 29% of older adults have dental insurance,3 while nearly all have health insurance, and dentists generally do not provide care for older adults in long-term care facilities.
Further, one in 50 adult Medicaid beneficiaries4 visits an emergency department for tooth decay each year. With this change, medical and public health professionals can now apply SDF to children and older adults with tooth decay outside of a dental setting. This will greatly improve care for these populations by creating more points of access.
Goals for the future
CareQuest Institute for Oral Health,5 in partnership with several leading oral health and medical organizations, championed the code and submitted it for approval. “To achieve oral health equity, we need the participation of the entire health system,” said Myechia Minter-Jordan, MD, MBA, president and CEO of CareQuest Institute. “The inclusion of a new CPT code for medical professionals to offer critical non-invasive therapeutic oral health care to their patients is a key step toward a more accessible, equitable, and integrated health system that meets the needs of everyone.”
The newly approved CPT code is expected to be inputted into code sets by electronic health records vendors in July 2023. CareQuest Institute will partner with Smiles for Life Oral Health to develop training and educational materials on dental caries identification and SDF application for medical professionals.
The code proposal was supported by a diverse group of dental and medical care professionals and advocates, including the American Dental Association (ADA), American Dental Hygienists Association (ADHA), National Dental Association (NDA), Society of American Indian Dentists, Children’s Health Alliance of Wisconsin, National Coalition of Dentists for Health Equity, NorthWest Health Law Advocates, Community Catalyst, and the Center for Medicare Advocacy.
Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.
References
1. Teledentistry: providing access to care during the COVID-19 crisis. CareQuest Institute for Oral Health. https://www.carequest.org/resource-library/teledentistry-providing-access-care-during-covid-19-crisis
2. Kolstad C, Zavras A, Yoon RK. Cost-benefit analysis of the age one dental visit for the privately insured. Pediatr Dent. 2015;37(4):376-380.
3. Disparities in oral health. Centers for Disease Control and Prevention. Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion. Reviewed February 5, 2021. https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm
4. Medicaid adult beneficiaries emergency department visits for non-traumatic dental conditions. Centers for Medicare & Medicaid Services. https://www.medicaid.gov/medicaid/benefits/downloads/adult-non-trauma-dental-ed-visits.pdf
5. Improving the oral health of all. CareQuest Institute for Oral Health. https://www.carequest.org/
