ADA leaders urge insurance groups to cover preventive services
Association group pens open letter to third-party payers, Medicaid agencies, employer groups
Editor’s note: This is a reprint of an open letter the ADA president, president-elect and several council chairs wrote urging dental benefit third-party payers, Medicaid agencies and employer groups to cover preventive services, including fluoride treatment, across the patients’ life span.
The American Dental Association strongly urges your organization to take decisive action in supporting and expanding coverage for evidence-based preventive dental services within dental benefit plans. This includes essential interventions such as fluoride treatments, dental sealants and regular periodontal care which are crucial for the health of patients at every stage of life. It is imperative that we prioritize these preventive measures for the well-being of our community.
Oral health is critical for overall health and wellbeing. Not only does oral health promote people’s ability to chew, speak and smile, it is also linked with systemic conditions that extend well beyond the mouth. For example, oral diseases have been associated with diabetes, stroke, dementia, heart disease and negative pregnancy outcomes. Poor oral health leads to lost school days for children, missed workdays and diminished job prospects for working-age adults and reduced labor productivity. Studies consistently demonstrate that every dollar invested in preventive dental care can save multiple dollars in restorative and emergency treatment. In essence, neglecting oral health exacts an economic penalty.1
Dental disease does not discriminate by age. Older adults face increased risks due to medication-induced xerostomia, receding gums, and interactions with chronic diseases. Providing preventive care throughout life reduces the burden of untreated disease, enhances quality of life, and supports medical-dental integration goals. Aside from long term health benefits, multiple published studies have demonstrated that preventive dental care lowers future dental 2, 3 and medical expenses 4, 5.
Extensive research, systematic reviews, and clinical guidelines support the effectiveness of fluoride treatments and sealants in preventing dental caries, reducing the need for costly restorative care, and improving overall health outcomes. Fluoride varnish applications significantly reduce the risk of caries in children and adults. Fluoride varnish application twice a year reduces the incidence of caries by 37% in primary teeth and 43% in permanent teeth.6, 7 Furthermore, individuals at higher risk—including seniors, patients with dry mouth, and those with chronic conditions—benefit significantly from ongoing fluoride exposure. Topical fluoride products (e.g., varnish, gel and high-fluoride toothpaste) are effective in reducing root caries and coronal caries in older populations.8 Silver diamine fluoride is effective in limiting progression of carious lesions in primary teeth as well as root caries.9 All dental benefit plans should cover fluoride varnish or gel applications twice an year along with silver diamine fluoride applications as deemed necessary by the treating dentist without any limits on age.
Dental sealants are a proven intervention recommended for children and adolescents. They prevent 80% of cavities in the posterior teeth, where 9 out of 10 cavities occur.10 There is also emerging support for sealant and resin infiltration use in adults with deep fissures or early non-cavitated lesions, suggesting a broader preventive role beyond adolescence.11 Although most research focuses on children, sealants may also be appropriate for adults at high caries risk, particularly when access to care is limited or oral hygiene is suboptimal. Importantly, current age limitations for sealant coverage can result in some individuals missing out on this preventive care—particularly those with delayed eruption of their 12-year molars. Removing arbitrary age restrictions would allow providers to apply sealants based on clinical need rather than age, ensuring high-risk patients receive timely, effective prevention regardless of developmental variation.
Routine prophylaxis, oral health education, and risk-based assessments—including caries risk and periodontal evaluations—are vital in maintaining oral health and preventing disease progression. These services align with a preventive health model that reduces long-term healthcare costs and supports whole-person care.
The ADA urges you to uphold science and support coverage for at least the following preventive dental services across the lifespan at least twice each year:
•Prophylaxis.
• Oral health risk assessment.
• Screening and education for oral and oropharyngeal cancer and other dental/medical related conditions.
• Topical fluoride applications.
•Interim caries arresting medicament application (e.g. silver diamine fluoride).
• Prescription or use of supplemental dietary or topical fluoride for home use.
• Application of pit and fissure sealants and reapplication as necessary.
• Resin infiltrations.
• In-office patient education, (i.e. oral hygiene instruction, dietary counseling, dental- and medical related conditions, and tobacco cessation counseling with regard to the promotion of good oral and overall health).
In closing, we strongly encourage you to ensure comprehensive coverage of preventive dental services across the lifespan and as frequently as appropriate to reduce the risk of disease. We also request you to conduct proactive outreach to covered individuals encouraging good oral hygiene, reduced sugar consumption and regular dental preventive visits.
Aligning benefit design with scientific guidelines improves health outcomes and reflects a commitment to population health. Thank you for your leadership in advancing patient-centered, evidence-based oral healthcare.
Sincerely,
Brett H. Kessler, D.D.S.
President, American Dental Association
Richard J. Rosato, D.M.D.
President-Elect, American Dental Association
Ashraf F. Fouad, B.D.S., D.D.S.
Chair, ADA Council on Scientific Affairs
Mark Moats, D.M.D.
Chair, ADA Council on Dental Benefit Programs, ADA
Jessica Robertson, D.M.D.
Chair, ADA Council on Advocacy for Access and Prevention
REFERENCES
1. The Economic Rationale for a Global Commitment to Invest in Oral Health, Accessed at https://www.weforum.org/publications/the-economic-rationale-for-a-global-commitment-to-invest-in-oral-health/
2. Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid‐Enrolled Children in Six Southeastern States. Health Serv Res. 2017 Nov 30;53(5):3592–3616.
3. The impact of underutilization of preventive dental care by adult Medicaid participants. J Public Health Dent. 2022 Jan 11;82(1):88–98.
4. Unexpected ways to reduce medical costs, Cigna. Accessed at https://dental-dna.cigna.com/unexpected-ways-to-save
5. Making the most of integrated benefits. Accessed at https://www.aetnadental.com/professionals/pdf/DMI%20Whitepaper.pdf
6. Fluoride varnishes for preventing dental caries in children and adolescents, Cochrane Database Syst Rev. 2013 Jul 11;2013(7):CD002279
7. Topical fluoride for caries prevention, Weyant et al. Journal of the American Dental Association, Volume 144, Issue 11: p1279-1291, November 2013
8. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review J Dent 2022 Oct:125:104273
9. Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults. Cochrane Database Syst Rev. 2024 Nov 7;11(11):CD012718.
10. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. Volume 147, Issue 8p672-682.e12August 2016
11. Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic review and meta-analysis. BMC Oral Health. 2025 Jan 8;25:48.
