Dental InsuranceDental insurance is easier for people with autism to get in the private market than health insurance because being autistic is not a disqualifier.
Some health insurance plans include dental. Dental insurance can be bought separately.
Medicare covers dental.
Anesthesia/ SedationMany autistic people require sedation even for a checkup. Many insurance plans (both dental and health insurance) do not cover sedation for dental procedures. If you have a “stand alone” dental insurance, check to make sure as to whether or not your health insurance will cover sedation during a dental procedure. This has become less likely as time has passed and insurance companies have limited coverage. It is unlikely that your dentist will be a service provider of your health insurance company so if you get approved by your health insurance company, you will have to pay out of pocket and then file a claim with your health insurance company.
Medicaid covers iv sedation for dental patients three years or under, or severely disabled patients. The medical necessity, coverage, documentation and payment rules applicable to dental sedation vary from one state to another. Your dentist has to be a Medicaid provider for your health management organization.
This coverage is a good reason to apply for Medicare if you qualify, even if your autistic child is covered by private health insurance. If you have both private health insurance and Medicare, Medicare is the secondary insurance payer.
This coverage of Sedation for dental procedures has been widely abused with fraudulent claims. It usually will require preauthorization.
Dental SealantsDental sealants are well worth getting for anyone that cannot brush properly. They last about 10 years. Dental sealants are a plastic material that fills in and smooths out the grooves and fissures in your teeth that tend to trap food particles and cavity-causing bacteria. According to the American Dental Association, sealants work by “’sealing out’ food and plaque… [because] toothbrush bristles cannot reach all the way into the depressions and grooves.” The American Dental Association recommends that kids receive dental sealants as soon as their adult teeth erupt.
Silver Nitrate and Fluoride Varnish for Tooth DecayA fairly new procedure is the use of brushed on silver nitrate, a widely used liquid antimicrobial medical treatment, with fluoride varnish, a widely used dental product, to stop tooth decay. The silver nitrate stops most bacterial decay, not all. The fluoride varnish re-mineralizes the soft tooth decay. Because it is brushed on there is no need for the dentist’s drill. A drawback is that the silver leaves black spot stains where it contacts the bacteria. The dark spots can eventually be covered with tooth-colored material. Depending on your child’s behavior and tolerance of dental work this is a possible way of treating a cavity without sedation.