Extending Medicare coverage to medically necessary dental care

Background. Periodically, Congress considers expanding Medicare coverage to include some currently excluded health care services. In 1999 and 2000, an Institute of Medicine committee studied the issues related to coverage for certain services, including "medically necessary dental services." Methods. The committee conducted a literature search for dental care studie s in five areas: head and neck cancer, leukemia, lymphoma, organ transplant ation, and heart valve repair or replacement. The committee examined eviden ce to support Medicare coverage for dental services related to these condit ions and estimated the cost to Medicare of such coverage. Results. Evidence supported Medicare coverage for preventive dental care be fore jaw radiation ther for head or neck cancer and coverage for treatment to prevent or eliminate acute oral infections for patients with leukemia be fore chemotherapy. Insufficient evidence supported dental coverage for pati ents with lymphoma or organ transplants and for patients who had undergone heart valve repair or replacement. Conclusions. The committee suggested that Congress update statutory languag e to permit Medicare coverage of effective dental services needed in conjun ction with surgery, chemotherapy, radiation therapy or pharmacological trea tment for life-threatening medical conditions. Practice Implications. Dental care is important for members of all age grou ps. More direct, research-based evidence, on the efficacy of medically nece ssary dental care is needed both to guide treatment and to support Medicare payment policy.