Pediatricians may face challenges in implementing new U.S. Preventive Services Task Force recommendations that advocate the provision of oral fluoride supplementation to children in fluoride-deficient areas and fluoride varnish to all children by primary care clinicians.
The speed with which the recommendations are applied in primary care settings likely will depend on state support, training availability, and insurer cooperation.
“The updated recommendations are a very important step forward toward improving oral health in children through collaborative care,” Dr. Lee Savio Beers of Children’s National Medical Center, Washington, said in an interview. However, “primary care providers will face a number of barriers in implementing these recommendations, including workflow and staffing issues, access to training, and adequate payment.”
The USPSTF guidelines, published in early May 2014, recommend that primary care providers prescribe oral fluoride supplementation starting at 6 months for children whose water supply is lacking in fluoride and that they apply fluoride varnish to the primary teeth of all children starting at primary tooth eruption. The recommendations cite evidence that show fluoride varnish and oral supplements help prevent dental caries in children aged 5 years and younger, and that the treatments’ benefits outweigh the potential harms of fluorosis (Pediatrics 2014[doi:10.15425/peds.2014-0483]). The recommendations update 2004 guidelines in which only oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in their local drinking water. That recommendation remains.
Whether the treatments will be covered by insurers will depend greatly on the state and the insurer. In nearly every state, Medicaid currently reimburses providers for the provision of fluoride varnish, said Dr. Patricia Braun, a pediatrician at Denver Health’s Eastside Neighborhood Health Center, and at the University of Colorado. She is a member of the American Academy of Pediatrics Section on Oral Health.
“From the publically insured perspective, it has already been decided that (such treatments) are important,” Dr. Braun said in an interview. “The next challenge will be to get private insurers to do the same. As the task force recommendations indicate, all kids are at risk for caries, some more than others … and all benefit from these services, including those (who) are insured by private organizations.” …