Objectives

  • Select the recall frequency for children with moderate-to-high risk for the development of severe early childhood caries.
  • Indicate how much time dentists should consider setting aside each a week to provide preventive dental checkups for Medicaid-enrolled children 6 through 35 months of age.

Determining When Children Should be Scheduled for Oral Health Visits

Children enrolled in Texas Medicaid are eligible to begin receiving preventive dental services, including First Dental Home visits, at 6 months of age. A Medicaid-enrolled child 6 though 35 months of age can begin First Dental Home visits in your dental practice at any time during this time span. The child can be a new patient to your practice or an existing patient who is under 3 years of age. Children who are at a moderate-to-high risk for developing SECC should be placed on a 3-month-recall schedule. As your office staff schedules First Dental Home visits, note the following limitations:

Treatment Planning and Coordination

As with any patient, you may find a child has restorative needs that you are unable to treat. There will be times when, in the best interests of the child, you choose to refer the child to a pediatric dental specialist. When making a referral to a pediatric dental specialist, it is important to communicate with the pediatric dental office. The pediatric office needs to know:

This decision requires communication, coordination, and correspondence between the referring general dentist and the pediatric dental specialist to whom you are referring the child. It is also important that you or someone on your staff inform the dental team of this decision. This coordination helps to ensure that the child continues to have regularly scheduled First Dental Home visits between the time of referral and completion of restorative needs.

Documentation for the First Dental Home Visit

First Dental visit documentation form Documentation of all First Dental Home visits is important. To assist you, DSHS developed a First Dental Home documentation form, also available under Materials at the DSHS website. Keep the documentation form (or an equivalent) in the patient record for each First Dental Home visit. If you have electronic records, scan the documentation form or add the components of this form into your records.

It is important to record who accompanied the child to the First Dental Home appointment. For example, if the child’s mother comes for the first visit and another caregiver comes for the second visit, this may change the result of the caries risk assessment as well as the anticipatory guidance. The difference depends on each person’s level of understanding about the oral health needs of the child.

You must document what takes place at each First Dental Home visit, and also document whether a component is completed during the visit.

If the child does not yet have erupted teeth, toothbrush prophylaxis or fluoride varnish application are not feasible. You must record this information in the patient record. In these cases, it is expected that you will spend more time with the parent to educate them about what to expect in relation tooth eruption, how to care for the mouth and gums, and additional anticipatory guidance including coping with teething.

If for some reason the parent refuses fluoride varnish, you must make a note of that on the documentation form and/or in the patient record.

The following information is needed for the First Dental Home visit documentation form:

Billing the First Dental Home Visits

In response to dental stakeholder input, Texas Medicaid has simplified the billing process for First Dental Home visits. For each and every First Dental Home visit, Current Dental Terminology (CDT) code D0145 is utilized.: For First Dental Home purposes, the code D0145 is:

Remember these important points about billing First Dental Home visits:

Incorporating First Dental Home Visits into Your Practice

As a dental provider in Texas and Texas Medicaid, you are in a position to help reduce the incidence of severe early childhood caries for low-income children enrolled in Texas Medicaid. Other state health-care programs have also implemented First Dental Home. These programs are the Children with Special Health Care Needs Services Program and Title V/Maternal and Child Health contractors who offer dental services.

Because dental decay is the most common infectious disease in childhood, the incidence of early childhood caries can be reduced significantly with early intervention. Consider setting aside one morning a week to provide preventive dental checkups for Medicaid-enrolled children 6 through 35 months of age. Talk with pediatricians and family medicine physicians within your community about your willingness and availability to provide dental checkups for this age group. You should find that seeing very young children can be a rewarding experience as you help to develop good dental patients who do not relate going to the dentist with a painful experience.

Product Resources

Forms

Forms for the First Dental Home visits can be downloaded from the DSHS website. Dental Risk Assessment Questionnaire

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