VNS Health MLTC: Dental Services

Proper dental care is about much more than teeth, though clean and healthy teeth are an essential start. Many people don't realize that issues with the teeth and gums lead to far greater problems than what is seen or felt on the surface. Many older adults ignore the signs and symptoms of poor dental health.

Cavities are sometimes seen and felt, though oftentimes not, and they are best addressed early, just as with any other condition. Once tooth pain is felt, drilling and filling are a certainty, and maybe more. Avoiding dry mouth (which occurs frequently in older adults) and brushing regularly are essential in preventing cavities.

Broken or missing teeth are a gateway to the tissues, vessels, nerves, and bones beneath. Those vessels and nerves, especially, are direct pathways to the heart and brain. Therefore, if an infection occurs beneath the teeth, it could travel to the heart or brain. Dental problems can actually cause heart disease and irreversible angina (chest pain caused by reduced blood flow to the heart).

Likewise with gum disease, which is why gingivitis should not go untreated. Gingivitis can lead to periodontal disease. Periodontal disease affects the tissues around the teeth, including the bone to which they are anchored. It is a risk factor for both heart and lung disease.

Dental problems can also affect speech, and cause difficulties with chewing or swallowing, leading to poor nutrition and aspiration risk (liquids or foods pass into the lungs).

Probably most importantly, to our loved ones at least, poor dental care can prevent them from enjoying the foods they prefer. It takes healthy teeth and gums to process meats, fibrous foods (most fruits and vegetables), and crunchy snacks.

Dentures and implants are excellent alternatives when required, though they are expensive and not as reliable as natural teeth. They are also avoidable with proper dental care.

After enrollment in the health plan, a dental card from the dental network is issued. The dental card is accepted by hundreds of fully qualified network dentists. Any network dentist can be selected for all dental care and services.

Dental benefits include:

• Twice yearly check-ups, including cleanings and X-rays

• Basic restorative services, such as fillings and extractions

• Crowns and root canals in certain circumstances to preserve more natural teeth

  • Does not include crown lengthening (except when associated with medically necessary crown or endodontic treatment)

• Dentures

  • Replacement dentures and implants will only need a dentist's recommendation to determine if they are necessary, making it easier for members to access these dental services.

• Dental Implants

  • When the medical provider says dental implants are needed to ease a medical problem, or

  • The dentist says that dental implants are the only thing that will fix the dental problem

Services not within the scope of the Medicaid program include but are not limited to:

• Fixed bridgework, except for cleft palate stabilization, or when a removable prosthesis would be contraindicated;

• Immediate full or partial dentures;

• Crown lengthening, except when associated with medically necessary crown or endodontic treatment;

• Dental work for cosmetic reasons or because of the personal preference of the member of the provider;

• Periodontal surgery, except when associated with implants or implant-related services;

• Gingivectomy or gingivoplasty, except for the sole correction of severe hyperplasia or hypertrophy associated with drug therapy, hormonal disturbances, or congenital defects;

• Adult orthodontics, except in conjunction with, or as a result of, approved orthognathic surgery necessary in conjunction with an approved course of orthodontic treatment or the ongoing treatment of clefts;

• Placement of sealants for members under 5 or over 15 years of age; and

• Improper use of panoramic images along with intraoral complete series of images.