June 18, 2018
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MaineCare backs fluoride for children's teeth

By Meg Haskell, BDN Staff

BANGOR, Maine — It’s just some gauze pads, a cheap plastic paintbrush and a thimble-sized dish of sticky goo. But for children covered by MaineCare, dentists say an application of fluoride varnish can spell the difference between a mouthful of healthy teeth and a lifetime of dental woes.

Now, thanks to a recent MaineCare rule change, fluoride varnish will be applied during routine checkups at the pediatrician’s office and other primary health care settings, in addition to its traditional availability from a child’s dentist. The rule took effect Sept. 1. Doctors are paid about $12 each time they apply fluoride varnish to the teeth of a MaineCare recipient under age 21.

MaineCare is the state’s Medicaid program for low-income residents. Several other states already have added fluoride varnish to the services they reimburse through their Medicaid programs.

“We have a really good rate of children who see their doctor on a regular basis,” said Brenda McCormick of the MaineCare office on Tuesday. “But many fewer see a dentist.” The goal of the new rule, she said, is to ensure that children at high risk of tooth decay get two fluoride varnish treatments a year — three treatments if their teeth already show signs of decay.

Fluoride strengthens teeth against decay and even helps rebuild damaged teeth by enhancing absorption of calcium.

On Tuesday, pediatric dentist Jonathan Shenkin of Bangor was host to a small gathering of area pediatricians and their staff at his Stillwater Avenue office to explain tooth decay, extol the benefits of fluoride varnish and demonstrate how it should be applied.

“You just dry the teeth with a gauze and paint each tooth with the varnish,” Shenkin said, flashing a PowerPoint slide of a toddler being held securely by her mother while a clinician applied the varnish. The simple holding technique means “they can scream, they can yell, they can try to bite, and we don’t care,” he said.

But there was no struggling involved a few minutes later, when Shenkin applied a demonstration coat of varnish to the pearly tooth buds emerging from the gums of 13-month-old Sophie Clough, the self-confident daughter of Bangor pediatrician Scott Clough. Sophie seemed only slightly puzzled at being the center of attention and maintained steady eye contact with her smiling dad throughout the painless procedure, which took less than minute. The bubble gum-flavored varnish left Sophie puckering and quizzical but not unhappy.

Shenkin explained that even though youngsters may be exposed to fluoride from public drinking water supplies and other sources, the dental varnish is so targeted and absorbs so slowly and directly into the teeth that it is virtually impossible for its use to overload even very young children.

The American Dental Association recommends that all children see a dentist sometime in the first year of life, when newly emerged teeth are most vulnerable to decay. But according to Shenkin, most parents wait until a child is at least 3 or 4 years old before scheduling the first dental visit, and many family dentists won’t see children younger than 4. That’s because dentists, as well as parents, think younger children will be less cooperative and more fearful in the dentist chair, he said.

“But that’s caused a big problem in this country,” Shenkin said, especially for children in the low-income bracket covered by MaineCare.

A recent national study shows that approximately 40 percent of 2-, 3-, and 4-year-old children from families with incomes below the federal poverty level have at least one untreated cavity, Shenkin said, largely due to poor dental hygiene and routine exposure to sugar and bacteria.

In 2002, only about 3 percent of Maine children under 3 years old who were enrolled in MaineCare saw a dentist, he said, and most MaineCare kids haven’t seen a dentist even once by the time they are 5 years old and enter school.

Shenkin said it’s not unusual for him to see a 4-year-old with every tooth needing restorative care.

The phenomenon he calls “the dental domino effect” starts early in life and sets kids up for a lifetime of dental problems and expense, he said. Educating parents and other caregivers about the causes of tooth decay, along with basic preventive care such as fluoride varnish for high-risk children, can fend off the domino cascade and save individuals and the health care system a lot of pain, trouble and money, he said.

Ellsworth pediatrician Dr. Jonathan Fanburg, president of the Maine chapter of the American Academy of Pediatrics, said his member physicians are eager to add fluoride varnishes to the services they provide to Maine children. “If we can curb [dental decay] in the beginning, it would be much better and save on the cost of emergency room visits, antibiotics and other costs further down the road,” he said.

The state does not have funds for training pediatricians and other doctors to use fluoride varnish, and will rely on small, informal sessions like the one at Shenkin’s office on Tuesday to spread the word and the technique.

More information for professionals is available by calling Luc Nye, coordinator of children’s services at the MaineCare office, at 866-796-2463.




Pediatrician Dr. Scott Clough (right) holds his daughter Sophie and listens as dentist Dr. Jonathan Shenkin explains the procedure and benefits of applying fluoride varnish to children’s teeth during medical checkups Tuesday.

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