There is one genuinely good piece of news in American dental coverage, and it applies to children. Unlike adult dental care, dental services for children enrolled in Medicaid are a required benefit in every state. If your child is covered, dental care is not an optional extra that a state can drop.
Why children are covered when adults are not
Adult dental coverage under Medicaid is optional for states, which is why it varies from extensive to nonexistent depending on where you live. Children's coverage works differently. Under the Early and Periodic Screening, Diagnostic and Treatment benefit, states must cover dental services for children enrolled in Medicaid, including relief of pain and infection, restoration of teeth, and maintenance of dental health. CHIP, which covers children in families earning too much for Medicaid but not enough for private insurance, also includes dental coverage. This is the single most important fact for a parent who cannot afford a dentist, and it is the first thing to check before assuming care is out of reach.
Finding a dentist who takes the coverage
The practical difficulty is rarely eligibility and usually access: not every dentist participates, and in some areas participating practices are scarce. Two routes work better than searching generally. First, community health centers with dental clinics see children as a matter of course and are used to Medicaid and CHIP billing. Second, your state Medicaid program or managed care plan maintains a provider list and a member services line whose job is to find you an in-network dentist -- if the list is out of date, call them and say you cannot find an available provider, because plans have obligations around access. Dental schools and dental hygiene programs also treat children, and pediatric dentistry residencies exist at many of them.
When to start, and what the first visits are for
The usual guidance is a first dental visit by the time the first tooth appears or by the first birthday, whichever comes first. Parents often find that surprisingly early. The point of those visits is not drilling; it is checking development, spotting decay early when it is cheap to treat, applying fluoride varnish, and giving you specific advice on brushing, bottles and diet. Early decay in baby teeth is common, moves faster than in adult teeth, and is the main route to a child needing treatment under general anesthetic, which is both expensive and something everyone would rather avoid.
Sealants, fluoride and school programs
Dental sealants are thin coatings placed in the grooves of back molars, where most childhood decay starts. They are quick, painless, and among the most cost-effective preventive treatments available. Many states and counties run school-based sealant and fluoride varnish programs, typically in schools serving lower-income areas, at no cost to families -- if a consent form comes home from school, it is worth signing. Ask your child's school or your local health department whether a program operates there.
If your child has a dental emergency
Facial swelling, fever, or a child who cannot eat or sleep because of tooth pain should be seen urgently, and spreading swelling with fever belongs in an emergency room. A knocked-out baby tooth is not put back -- attempting to can damage the adult tooth developing underneath -- so control the bleeding with gentle pressure and get the child seen. A knocked-out permanent tooth is the opposite: it is a race against the clock, keep it moist in milk, do not scrub it, and get to a dentist immediately.
