Policy on Third-Party Reimbursement of Fees Related to Dental Sealants

Policy statement

The AAPD encourages all policy makers and third-party payors to consult the AAPD in the development of benefit plans that best serve the oral health interests of infants, children, adolescents, and individuals with special health care needs.

The AAPD advocates that the dentition periodically be evaluated for developmental defects and deep pits and fissures that may contribute to caries risk and that sealants be placed on primary and permanent teeth judged to be at risk for dental caries. The AAPD encourages placement of dental sealants on early (noncavitated/incipient) caries lesions to inhibit lesion progression. Once sealants have been placed, they should be evaluated for repair or replacement as part of a periodic dental examination.

The AAPD encourages third-party payors to

• recognize that dental sealants are scientifically-sound and cost-effective techniques for caries prevention in primary or permanent teeth at increased risk for caries and for early (noncavitated/ incipient) caries lesions.
• provide reimbursement for both the initial placement and the repair/replacement of dental sealants when clinically indicated.
• base third-party coverage for sealants on a patient’s caries risk rather than age. Timing of the eruption of teeth can vary widely. Furthermore, caries risk may increase at any time during a patient’s life.

The AAPD shall continue to work with other dental organizations, the insurance industry, and consumer groups to make the advantages of dental sealants understood and to seek reimbursement for fees associated with their placement, maintenance, and repair.