Integrated care: healthy mouth, healthy body

Research continues to associate oral health with overall health. Periodontal disease may have a potentially significant impact on systemic health, and the implications for cost of care and quality of life can be staggering. Dr. Miles Hall studies the impact that appropriate periodontal care has had in particular on diabetes, heart disease, and stroke in recent years.

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Since my first day of dental school some 37 years ago, the significance of good oral health has always been a topic of great importance. Research continues to associate oral health with overall health. Periodontal disease may have a potentially significant impact on systemic health, and the implications for cost of care and quality of life can be staggering.

In 2013, Cigna published a national study, (1) analyzing its own medical and dental claims among other factors, that highlights an adverse association between untreated periodontal disease and higher medical costs for individuals with diabetes, heart disease, and stroke.

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For example, the average annual medical savings for those individuals in the study who had one of these medical conditions but also received appropriate periodontal care was as follows:

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Findings also indicated a $1,020 average medical savings per person per year for individuals with periodontal disease who received appropriate care, regardless of whether or not they had an underlying medical condition. Why? The study found that individuals who received appropriate preventive dental treatment have, on average, 12.5% fewer extractions and 5.4% fewer root canals. Furthermore, individuals with periodontal disease who are receiving appropriate periodontal care have a 67% lower hospital admission rate and 54% lower ER rate.

Some insights by condition include:

  • Diabetes. Individuals with diabetes are more likely to have periodontal disease than people without diabetes, because they are more at risk of getting infections. Inflammation that starts in the mouth may weaken the body’s ability to control blood sugar. The estimated economic cost of diabetes in 2012 was estimated at $245 billion, a 41% increase over a five-year period. More than one in five health-care dollars in the United States is spent caring for someone diagnosed with diabetes. (2)
  • Cardiovascular disease or stroke. Periodontal disease and heart disease are often present together. Up to 91% of patients with heart disease have periodontitis, compared to 66% of people with no heart disease. The two conditions have several risk factors in common, such as smoking, unhealthy diet, and excess weight. And some suspect that periodontitis has a direct role in raising the risk for heart disease as well. (3)
  • Pregnancy and prematurity. Pregnancy can increase the risk for periodontal disease because of hormonal changes and can worsen existing dental problems. Several studies have shown that periodontal disease may increase the risk for low birth weight and preterm labor. The medical costs that businesses pay to care for one premature baby for a year could cover the costs of 10 healthy, full-term infants ($49,000 vs. $4,550). When combined, maternity and first-year costs for a premature baby were four times as high as those for a baby born without any complications ($64,713 and $15,047, respectively). (4)

As health-care professionals, we can continue to educate patients as to the importance of good oral health and its impact on overall health and even medical costs. Keeping current and thorough medical histories is a key for informing patients of this association.

Armed with research and findings showing the impact of medical/dental integration will help the public understand why going to the dentist is so important.

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Mileshalldds124x124Miles Hall, DDS, is Cigna Dental’s chief clinical director. In this role, he helps develop strategic clinical policy and is involved with medical/dental integration efforts, including the creation of studies demonstrating the value of integration in improving overall health outcomes. He has been with Cigna since 1996, and has worked in the dental industry for more than 30 years, including private practice. He is currently a member of the American Dental Association, American Association of Dental Consultants, and a member of the National Association of Dental Plans’ PRC Clinical Workgroup. The Cigna Dental Oral Health Integration Program® is offered to all of Cigna's dental customers. This program provides enhanced dental coverage — such as 100% reimbursement of copayments and coinsurance on certain dental procedures — for customers with specific medical conditions.

References
1. Improved Health And Lower Medical Costs: Why Good Dental Care Is Important. Cigna Corporation. 2013.
2. American Diabetes Association by Wenya Yang (The Lewin Group, Inc., Falls Church, Virginia); Timothy M. Dall (IHS Global Inc., Washington, DC); Pragna Halder (The Lewin Group, Inc.); Paul Gallo (IHS Global Inc.); Stacey L. Kowal (IHS Global Inc.); and Paul F. Hogan (The Lewin Group, Inc.). Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care, April 2013;(36).
3. Barker, Joanne. Oral Health: The Mouth-Body Connection. WebMD. Jan. 4, 2012.
4. Thomson Reuters. The Cost of Prematurity and Complicated Deliveries to U.S. Employers. Report prepared for the March of Dimes, Oct. 29, 2008.

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