Oral Health Resources

dad and son brushing teeth and looking in the mirror

Good oral health has a positive impact on overall health. We encourage participating PCPs to discuss the importance of oral health and regular dental visits with their patients. Learn more below about important oral health resources for providers.

How PCPs Can Help

To maintain and achieve good oral health, people of all ages should have a dental exam at least once a year, as they allow the oral health care team to provide necessary preventive services, monitor oral growth or development, provide guidance to caregivers and parents and diagnose and treat for decay disease.

As dental needs change throughout different stages of life, medical providers must stay informed about oral health challenges at each stage. This knowledge empowers them to tailor their conversations with patients for optimal care.

Primary care providers are encouraged to refer their patients to the dentist if they have not seen the dentist in over a year or if they do not have a dental home.

See below for additional provider resources to learn more about oral health:

Oral Manifestations of Medical Conditions

Consideration of oral manifestations of medical conditions is important when treating the whole person. Examining the oral cavity can be a source for early detection of other medical concerns, as many systemic conditions impact oral health and present through varying oral symptoms.

Oral bacteria has been linked to endocarditis, cardiovascular disease, pregnancy and birth complications. For additional information, read more about oral-systemic health from the American Dental Association.

Dental Services and Prevention

Preventive dental services include regular oral exams, cleanings, and x-rays for people of all ages. For children, these services include fluoride application and dental sealants. Dental sealants can be placed on permanent molars and premolars to prevent pit and fissure caries.

Adult and pediatric dental benefits for our members cover exams, radiographs, cleanings, basic restorative and oral surgery services. Other services may require prior authorization.

Topical Fluoride Varnish

Topical Fluoride Varnish (TFV) is a proven preventive measure that helps reduce the risk of tooth decay in children and adolescents. The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) recommend TFV treatments through age 21 as part of routine pediatric care. Regular application of TFV is especially critical for young children, as early intervention can significantly improve long-term oral health outcomes and reduce the need for more invasive dental procedures.

Medical Assistance enrolled physicians, physician assistants, and CRNPs can render TFV services to Medical Assistance beneficiaries. The Pennsylvania Department of Human Services has removed the requirement for mandatory TFV training. These changes are designed to reduce administrative barriers, expand provider participation, and improve oral health outcomes for children across Pennsylvania.

Additional Resources:

Dental Benefits for Members

Avesis is our dental benefits manager for all lines of business. All claims, prior authorizations, contracting and credentialing are completed through Avesis.

Have questions regarding dental benefits for your patients? Call the Avesis provider relations team at 855-536-7764 or log in to the Avesis portal.

If members are looking for a dentist, they can visit the provider directory or call the Member Relations number on the back of their ID card for assistance.