Topical fluoride for children

HEDIS^® is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

Dental cavities are the most common chronic disease in children in the United States. Topical fluoride plays an important role in preventing tooth decay. This measure helps encourage at least two fluoride varnish applications for pediatric (age 1 to 4) Medicaid members and will help promote fluoride varnish treatments for younger members.

Measure description: The percentage of members 1 to 20 years of age who received at least two fluoride varnish applications on different dates of service during the measurement year

Services for topical fluoride varnish can be provided by the following providers:

• Primary physician’s (PCP’s) office
• Dental provider’s office

Note: No more than one fluoride application can be counted for the same member on the same date of service.

Codes that apply to the measure:

Helpful coding tips

Administrative enrollment and claims data is required within the reporting year for measurement.

Medical Record Documentation:

• Documentation is required of at least two instances on different dates of service.
• If the parent reports their child already received topical fluoride at a dental visit, this can be documented in the patient’s medical history.

How to improve HEDIS scores

American Academy of Pediatrics (AAP) Bright Futures recommends:

• Fluoride varnish application at least once every six months for all children and every three months for children at high risk for dental caries.
• Performing oral health risk assessments on all children at every routine well-visit beginning at six months of age.
• Recommend use of fluoridated toothpaste starting at eruption of the first tooth: rice-grain sized amount for children younger than three years, and a pea-sized amount for most children starting at three years of age.

United States Preventative Services Task Force (USPSTF) recommends:

• Primary Care Physicians (PCPs) prescribe oral fluoride supplementation starting at six months for children whose water supply is deficient in fluoride.
• PCPs apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.

Other recommendations:

• Remind parents that bottled water is generally not fluoridated.
• Check with parents if member has received a topical fluoride treatment within the last six months prior to current visit.
• Recommended use of fluoridated toothpaste: a grain of rice sized amount is recommended for children younger than three years, and a pea-sized amount is appropriate for most children starting at three years of age.

Supplemental resources:

• Smiles for Life: Child Oral Health | Smiles for Life Oral Health
• Open Wide: Open Wide (mchoralhealth.org)

Resources:

• Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions. Recommendation: Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)
• HEDIS measures. www.ncqa.org.
• American Academy of Pediatrics (AAP) Bright Futures. Home | AAP
• Water Fluoridation Guidelines & Recommendations. Guidelines & Recommendations | Community Water Fluoridation | Division of Oral Health | CDC