• Distinguish between two of the four components of the OEFV service.

In 2000, the landmark Surgeon General’s Report called attention to the importance of children's oral health and the high incidence of dental caries (tooth decay or a cavity). Despite major efforts in recent years, oral disease still poses a significant health threat to many children. Early Childhood Caries (ECC) or dental caries is the number one infectious childhood disease.

In 2008, the American Academy of Pediatrics convened the National Summit on Children's Oral Health to Assess the Progress Since the Surgeon General’s Report. Click the following link to see the findings of this summit. The findings indicate that much more must be done beyond ensuring access to dental care. Unchecked caries rates in young children, the increases in childhood populations at risk for caries, and evidence of morbidity from the spread of caries creates a clear mandate for prevention.

The 2009 US Government Accountability (GAO) Report, “Medicaid: State and Federal Actions Have Been Taken to Improve Children’s Access to Dental Services but Gaps Remain” (GAO-09-723) states, “Although dental services are a mandatory benefit for the 30 million children served by Medicaid, these children often experience elevated levels of dental problems and have difficulty finding dentists to treat them. Attention to this subject became more acute after the widely publicized case of a 12-year-old boy (Diamante Driver) who died in 2007 as a result of an untreated infected tooth, even though he was entitled to dental coverage under Medicaid. Children in Medicaid were almost twice as likely to have untreated cavities as children with private insurance.”

Click the following link to see the 2009 GAO report. Parents are more likely to take their children to a medical provider before they take them to visit the dentist. OEFV is an initiative aimed at improving the oral health of children 6 through 35 months of age. The purpose of this program is to educate parents about the importance of their child's oral health and to help prevent ECC. Medical providers play an essential role in getting the child from the medical home into the dental home at a very early age. Through this program, medical and dental providers work together to improve the oral health of children.

Texas Medicaid medical providers must be enrolled in Texas Health Steps to provide the OEFV service. Medical providers who can be certified to provide and be reimbursed for this service include:

The OEFV service includes these four components:

  1. Intermediate oral evaluation.
  2. Fluoride varnish application.
  3. Dental anticipatory guidance.
  4. Referral to a dental home.

Oral evaluation examination

Click to enlarge oral evaluation examination
Photograph used by permission of the American Academy of Pediatrics.

During a Texas Health Steps medical checkup, the certified physician, advanced-practice registered nurse, or physician assistant must perform an intermediate oral evaluation. Click here to see the Texas Health Steps Periodicity Schedule. This evaluation involves lifting the child's lips, examining the soft tissues, and looking for the presence of white spots, brown spots, and plaque.

The intermediate oral evaluation does not need to be charted per tooth, is not diagnostic, and does not replace a dental checkup. It is a thorough look at the child's mouth during the Texas Health Steps checkup with the goal of reinforcing the importance of oral health and the need to establish a dental home. Only medical providers who are certified can perform and bill this service to Texas Medicaid.

  1. Check for Normal Healthy Teeth
    Primary teeth should be white, opaque, and have smooth surfaces.
  2. Check for Early Signs of Decay
    White decalcification along the gum line.
  3. Check for Later Signs of Decay
    Broken enamel and white decalcification. If left untreated, white spots will lead to cavitation.
  4. Check for Advanced/Severe Decay
    Moderate to severe enamel, dentin destruction and discoloration. A soft brown or black collar of decay surrounds the tooth.

Photographs used by permission of the American Academy of Pediatrics.

After the intermediate oral evaluation, the health-care provider should apply fluoride varnish to the child's teeth. If a child is 6 months old and has no erupted teeth, fluoride varnish cannot be applied. Fluoride varnish is a topical fluoride treatment (5% sodium fluoride) that should be professionally applied on the surfaces of teeth to prevent new cavities from forming and to help arrest any early demineralization. Though some fluoride varnish may come into contact with the gum tissue adjacent to the erupted teeth during application, it should not be intentionally applied to the gum tissue, as there is no benefit derived. However, it is not harmful.

  1. Fluoride Varnish Tools
    Cotton swabs, dental mirror, and brush for application of fluoride varnish.
  2. Fluoride Varnish Application
    Proper fluoride application

Photographs used by permission of the American Academy of Pediatrics

To apply fluoride varnish:

  1. Paint fluoride varnish on all tooth surfaces even if the teeth are healthy. Fluoride varnish sets when it comes into contact with saliva. You do not need to dry the teeth, but if the child is drooling, you may use gauze around the teeth to remove excess saliva.
  2. Instruct the parents not to brush the child's teeth until the next day. This period of time allows the fluoride varnish to be in contact with the teeth for as long as possible. Parents can feed their child after fluoride varnish application, but crunchy foods should be avoided.
  3. Fluoride varnish is available in yellow, white, and clear. If you use yellow fluoride varnish, remind the parent that this does not stain the teeth and will be removed with brushing the next day.

If there is an active dental infection, refer the child to a dentist for appropriate treatment. If an antibiotic is prescribed for infection, inform the parent that the medication is not a cure and that the tooth needs to be treated by a dentist to resolve the infection.

Referral to a dental home is an integral part of OEFV program. The program recommends children begin at 6 months of age, regardless of whether there are erupted teeth. Children who are 6 months through 35 months old and who are assessed as being at moderate to high risk for Severe Early Childhood Caries (SECC) may be eligible to see a dentist as often as four times per year for examination and preventive dental care if their dentist participates in the Texas Health Steps First Dental Home Initiative (FDH). First Dental Home is a companion initiative aimed at improving the oral health of children from 6 months through 35 months of age. Its purpose is to provide simple, consistent messages that promote the importance of oral health to parents and caregivers of very young children and to keep children free from oral disease. It is recommended that health-care providers establish dental homes as early as 6 months of age for all children. The health-care provider should encourage parents to make an appointment with a dentist even if their child's teeth look healthy or if they do not yet have any erupted teeth.

Click the play arrow to start this brief video about the First Dental Home.

The Department of State Health Services Oral Health Program has developed Dental Anticipatory Guidance forms that contain age-appropriate information and education for parents, including a multi-topic overview of environmental influences on oral health. These forms are laminated so they can be kept in the treatment rooms and easily disinfected. This information is not meant for the parent to read and understand but rather is referred to so providers can increase parents' understanding of the importance of good oral health. This information should be tailored to the parents' level of understanding about oral health. Medical teams can use the Dental Anticipatory Guidance forms as a reference and can order the forms in quantity, free of charge from here.

Click the play arrow to start this brief video about Oral Evaluation and Fluoride Varnish.

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