Clinical Review

Preventive Dental Services in Primary Care

Clinician Reviews. 2013 March;23(3):42-50

References

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Benefits of Fluoride Use During Middle Age

Dental care needs peak between ages 55 and 64, with the majority of care prompted by dental decay⁴⁶ (see Figure 4). A discussion about dental health should be raised when the PCP completes the review of systems or while discussing other preventive services. The option of fluoride varnish should not be overlooked in a patient of any age, particularly one with a recognizable deficiency of preventive dental services. Explaining the benefits of topical fluoride varnish (see “Fluoride Use”) and offering an opportunity to receive it in the office may persuade a patient like Saul to take advantage of this proven anticarious procedure.

Of note, topical fluoride varnish is not harmful to existing dental fillings; rather, some restorative dental material is produced and continuously released with fluoride to protect the surrounding enamel surfaces.⁴⁷ Fluoride varnish also reduces the progression of decay that is already present.¹¹ Extending exposure to fluoride with varnish allows more effective penetration of the enamel; fluoride that remains in the saliva increases the protection further.^48,49

Patients who undergo this safe procedure should be reminded to continue brushing daily with fluoridated toothpaste and drinking fluoridated water (if it is available).⁵⁰

GILL, AGE 77

Gill grew up in Grant County, New Mexico, in an area not far from Silver City; there, fluoride supplementation in the local water did not begin until Gill was about 40. His family never stressed oral hygiene, and his remaining teeth show gross plaque and decay.

He sees you routinely for his chronic illnesses, and today he has presented for his annual physical. Gill has Medicare without supplemental insurance.

Dental Care in the Medicare Years

Medicare does not cover preventive dental services unless hospitalization is required; in that case, it is covered under Medicare Part A.⁵¹ Publicly supported dental services are primarily offered for children, leaving Medicare recipients responsible for the costs of dental care. As a last resort, some patients will seek dental care at a hospital emergency department (ED). Most often prompted to visit the ED for relief of pain triggered by dental fractures or abscesses, patients usually leave with pain medications and antibiotics only; their general dental health needs remain unmet.⁵²

Preventive Dental Services in Primary Care

References

Benefits of Fluoride Use During Middle Age

GILL, AGE 77

Dental Care in the Medicare Years

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