ity. The primary focus is on the effectiveness of dental services not currently covered by Medicare.

What Are Medically Necessary Dental Services?

Several definitions of medically necessary dental services have been proposed. In 1995, the National Alliance for Oral Health held a consensus conference on medically necessary dental services and proposed the following definition: “that care that is a direct result of, or has a direct impact on, an underlying medical condition and/or its resulting therapy” (Consensus Conference, 1995). The consensus conference also noted that such care was integral to comprehensive treatment to ensure optimum health outcomes and could potentially reduce health care expenditures for treatment of complications.

In 1990, the American Dental Association’s House of Delegates adopted the following comprehensive definition of medically necessary dental services:

the reasonable and appropriate diagnosis, treatment, and follow-up care (including supplies, appliances, and devices) as determined and prescribed by qualified, appropriate health care providers in treating any condition, illness, disease, injury, or birth developmental malformations. Care is medically necessary for the purpose of controlling or eliminating infection, pain, and disease; and restoring facial disfiguration, or function necessary for speech, swallowing, or chewing.

Several important points are implied by these definitions, which are illustrated in Figure C-1. First, medically necessary dental services can be provided across a continuum of underlying diseases or conditions. Medically necessary dental services may be provided to prevent the onset of a disease

FIGURE C-1 A model of medically necessary dental services.



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