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EPSDT and Oral Health: How Medicaid Increases Children’s Access to Dental Care

Updated: Feb 27

Dental Care Matters for Children 

Quality dental care is essential to ensure a child’s overall well-being. Traumatic dental injuries (TDIs) can happen to children while playing or during sports, while cavities and other chronic dental diseases impact a child’s nutrition, speaking, sleep habits, educational performance, and self-esteem.  

However, access to quality dental care is unequal. Poor oral health is more common among members of low-income, uninsured, racial/ethnic minority, immigrant, and rural communities. Untreated cavities and other dental diseases can continue into adulthood and lead to permanent cavities, complete tooth loss, and gum disease. 

Unequal access to oral healthcare starts in childhood. According to the Centers for Disease Control and Prevention, this is due to limited access to affordable, quality dental care. For example, children aged 5 to 19 years from low-income families are twice as likely to have cavities than children from higher-income families. 

The American Dental Association reports that Hispanic and Black households are most likely to face cost barriers to dental care. Mexican-American and non-Hispanic Black children between ages 2 and 5 have more cavities and are three times as likely to have untreated cavities than non-Hispanic White children. By ages 12 to 19, Mexican-American children are more likely to have had cavities in their permanent teeth than non-Hispanic White children.  

Improving access to quality dental care is essential to reducing these disparities in oral health. TennCare (Medicaid) coverage and EPSDT help parents, providers, and advocates ensure children in Tennessee are getting the dental care they need.  

What is EPSDT? 

Early Periodic Screening, Diagnostic, and Treatment (EPSDT) covers age-appropriate and medically necessary care for kids with Medicaid. Tennessee’s Medicaid program is called TennCare. Children enrolled in TennCare are eligible for EPSDT services from birth.  

Dental services are an integral part of the benefits EPSDT offers. Tennessee’s recommended schedule for pediatric dental checkups begins at birth and continues through age 20. Dental care should be provided at intervals according to Tennessee’s pediatric dental schedule. If medically necessary dental care is needed outside of this schedule, that service should be covered. 

EPSDT covers a range of dental service providers such as dentists, dental hygienists, dental therapists, dental assistants, and community dental health coordinators. This variety in coverage is essential in areas where there are few dentists. Oral health screenings by physicians do not meet the requirements for a covered ESPSDT dental screening. 

Dental services covered under EPSDT can be grouped into two categories: general dental care and urgent services for dental diseases. General dental care includes care needed for relief of pain, infection, restoration of teeth, and maintenance of dental health. Urgent services include emergency, preventative, and therapeutic services for dental diseases that can cause serious or irreversible damage to the teeth, mouth, or jaw. 

In addition, any medically necessary oral health and dental services are covered for ESPDT-eligible children on TennCare. “Medically necessary” services must be ordered by the child’s provider and approved by the child’s TennCare insurance. Examples of medically necessary services are those that prevent disease, promote oral health, and restore oral health and function. This can include some orthodontia treatment like braces. Cosmetic dental procedures on the other hand are not covered. 

Improving Children’s Oral Health  

Over the last two decades, children’s oral health access has improved due to increased use of Medicaid’s dental services. Children covered by Medicaid visit the dentist more than uninsured children because Medicaid makes dental care more accessible for children. In Tennessee, EPSDT helps children on TennCare receive quality dental care early. This increased access to quality dental care is key to reducing prevalent oral health disparities. 

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