Don’t Let Insurance Dictate Treatment – Adults Need Sealants Too!

Dental sealants are an effective tool in the caries prevention toolbox. Pit-and-fissure sealants have been  used for many decades to prevent and control caries in both primary and permanent teeth. The ADA included this treatment in their evidence-based clinical practice guideline on nonrestorative treatments for carious lesions. “The expert panel convened by the ADA Council on Scientific Affairs prioritized the use of sealants plus 5% NaF varnish or sealants alone over the use of all other treatments for occlusal noncavitated lesions on both primary and permanent teeth.”¹

Despite the well-established benefits, dental sealants remain underutilized, especially in adult patients. The big barrier is insurance. Unfortunately, many times adults are not offered the preventive treatments they need simply because insurance doesn’t reimburse for them. Clinicians do not feel comfortable having conversations about additional cost with their patients, but the logic is flawed. Even though the patient may have to pay out-of-pocket now, in the long run, sealants will help them avoid more expensive dental work in the future. It is just like going to the gym. Medical insurance does not cover gym membership fees, but you pay anyway because you know exercise is good for your health long term.

We must create the urgency for preventive dental care. Start discussing preventive treatments, including sealants, with your adult patients today. Adults are not “immune” to caries. In fact, according to the CDC, “Adults aged 20 to 34 have more untreated cavities in their back teeth than any other age group.”² Caries has been increasing in adults, and with your help, we can reverse this concerning trend.

Always offer treatment according to the patient’s risk level. Have your patients complete Patient Self-Assessment Forms and fill out the CAMBRA Risk Assessment Forms to evaluate their risk level and determine the right therapeutic and/or preventive plan. (Hint – you can find these forms on our prevention-focused website CariesPrevention.com!) Remember to submit codes and CAMBRA forms to insurance to show why treatment was provided. Insurance companies might change their practices and begin reimbursing for preventive care, such as sealants, if they see enough claims being submitted. Lastly, remember to recall your patients based on risk. According to ADA recommendations, you should see your moderate-risk patients every 6 months and high-risk patients, every 3 to 4 months.

P.S. If you are looking for a bioactive, moisture-friendly, and easy-to-place sealant, look no further than the popular Centrix brand, Champ^®! Champ is less technique-sensitive; it readily penetrates into and adapts to the pits and fissures, tightly seals at the margins and has greater strength and durability than traditional or GI-based materials. What’s more, you can choose the delivery style that is right for you – multi-patient syringe; traditional delivery system OR single-patient application in our LolliPack^® packaging that helps eliminate the risk of cross-contamination.

Together, we in the dental profession have a responsibility to our patients, and we know that preventing a problem is much better than trying to fix or restore the problem later.

Learn more about Champ Pit and Fissure Sealant here!

1.     https://jada.ada.org/article/S0002-8177(18)30469-0/fulltext?_ga=2.37977510.483584176.1695671200-311131708.1675273097&_gl=1*1m28r7z*_ga*MzExMTMxNzA4LjE2NzUyNzMwOTc.*_ga_X8X57NRJ4D*MTY5NTY3NDgxMy4yNy4xLjE2OTU2NzYzNDUuMC4wLjA.*_ga_NJ0EYRGSL1*MTY5NTY3NDgxMy4zMi4xLjE2OTU2NzYzNDQuNjAuMC4w
2.     https://www.cdc.gov/oralhealth/fast-facts/dental-sealants/index.html