Oral Health Studies

Role of Dental Coverage in Oral Health

Oral Health and Overall Health

Individuals with dental coverage visit the dentist more often and receive the care they need when compared to individuals without coverage. The NADP 2019 Consumer Survey reported 75% of persons with dental benefits have seen a dentist in the past year compared to only 47% of those without dental benefits. Primary procedures performed for persons with dental benefits include fillings for cavities; crowns, extractions, fluoride treatments and root canals.

The following studies demonstrate how maintaining oral health lowers health care cost. In addition, recent news articles provide insight into the role oral health plays in maintaining overall health.


 Studies Demonstrating Medical Cost Savings from Maintaining Oral Health

Author

Findings/Results 

Aetna

Through ongoing research from Aetna and Columbia University, medical researchers are finding dental health is tied closely to overall health. Key findings regarding members in the Aetna Dental/Medical Integration program:

  • Members who received dental treatment over a 2-year period had 27% lower risk score.
  • Members who received a longer course of periodontal treatment had 12% lower medical costs
  • Program members had a 22% reduction in hospital admissions when they sought dental care.
  • Members enrolled in the program use 42% fewer major and basic dental services.
  • On average, a program member has 5% lower medical claims costs.
  • Targeted dental care outreach results in a 10% increase in preventive dental care.

In the relatively short time since Aetna began integrating its dental and medical claims data, it has examined thousands of claims and medical conditions. A database sampling from the Aetna Dental/Medical Integration program shows:

  • Up to 20 percent of employees enjoy better health when the medical and dental data is integrated and outreach is provided.
  • By year-end 2017, Aetna identified more than 2.7 million members at risk and provided more than $70 million in enhanced dental benefits — inducements to help prevent more serious and costly conditions.
  • Data integration helps produce better outcomes for diabetic members, improving control of the chronic disease by 45 percent.
  • In general, a member with well-controlled diabetes can cost about 10 percent less than someone whose diabetes is poorly controlled.

Source: “It’s All Connected,” Aetna White Paper (2018)

Cigna

Average annual medical cost savings for individuals in study who had the following medical conditions and appropriate periodontal treatment. Diabetes: $1,292 or 27.6%; Heart disease: $2,183 or 25.4%; Stroke: $2,831 or 34.7%.

Source: “Appropriate Periodontal Therapy Associated with Lower Medical Utilization and Costs” national Cigna study presented at the International Association for Dental Research Meeting, March 2013, Seattle

Dominion National

Study indicating people with chronic health conditions such as asthma, diabetes or heart disease who received preventive dental care covered by Capital BlueCross' BlueCross DentalSM benefits are found to have fewer costly emergency room visits and hospital stays. The study was conducted over a two-year period in partnership with Capital BlueCross and Geneia.®

The research compared medical costs and utilization between Capital BlueCross members with chronic conditions and BlueCross DentalSM coverage who have received preventive dental services versus those who have not received preventive dental services. It found:

•People with chronic conditions, but no BlueCross DentalSM coverage, had a 7 percent higher incidence rate of inpatient hospital stays than those with BlueCross DentalSM coverage who received a preventive dental service.

•Those who had BlueCross DentalSM coverage, but did not receive preventive dental services, had a 19 percent higher incidence rate of emergency department visits than those with BlueCross DentalSM coverage who received preventive dental services.

Source: Capital Blue Cross Press Release

Kaiser Permanente

Diabetic population receiving dental care have lower costs per member per month (PMPM) than those not receiving dental care; after adjusting for patient characteristics. In terms of overall costs, the diabetic population receiving dental care had $129 PMPM lower costs overall than those not receiving dental care.

Source: Kaiser Permanente Northwest actuarial data (claims analyzed over a two-year period from 2011–2013. Savings based on 6,872 commercial and 2,767 Medicare members).

United Concordia

Statistically significant reductions in two outcomes (i.e. total allowed medical costs and number of hospitalizations) were found for type 2 diabetes, cerebral vascular disease, coronary artery disease, and pregnancy, for which costs were lower by 40.2%, 40.9%, 10.7%, and 73.7%, respectively; results for hospital admissions were comparable.

Source: Jeffcoat, M.K. et al. (2014). Impact of Periodontal Therapy on General Health. American Journal of Preventive Medicine, 47(2), 166 – 174.

UnitedHealthcare

Overall, net medical costs for members who received dental care (i.e., periodontal treatment or cleanings) was on average $1,037 lower than medical costs (or $701 when including drugs) for members who received other or no dental care (i.e., extractions, root canals, restorative treatment, other dental claims or no dental claims) after adjusting for the extra expense of the dental care. The largest medical savings ($1,849 for just medical or $1,706 including Rx) were for members who were not medically compliant with their disease management program and received dental care after adjusting for the extra expense of the dental care.

Source: Optum for UnitedHealthcare (2013). Medical Dental Integration Study. Available from: http://bit.ly/2FFOhny

NADP/MEPS

To determine if similar impacts occur in public programs, in 2017 NADP commissioned a review of the Medical Expenditure Panel Survey (MEPS) data for consumers with Medicaid coverage. The analysis revealed that when a preventive dental benefit was provided for adult Medicaid recipients in 2014, medical costs for patients with seven chronic conditions were lowered. NADP is expanding the examination of MEPS information this year under a contract with Columbia University Medical Center to create longitudinal data of the differences in medical costs when adult preventive dental treatment is funded by state Medicaid programs.

Source: National Association of Dental Plans. (2017, November 23). NADP Analysis Shows Adults with Medicaid

American Public Health Association

Dental visits accounted for 2.5% of emergency department (ED) visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years. The majority of ED dental visits were by uninsured (49.3%) and Medicaid (32.8%) patients. Dental visits to the ED resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 in hospital costs per visit.

Conclusions: Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.

Source: Sun, Benjamin C, Donald L Chi, Eli Schwarz, Peter Milgrom, Annick Yagapen, Susan Malveau, Zunqui Chen, et al. “Emergency Department Visits for Nontraumatic Dental Problems: a Mixed-Methods Study.” American Journal of Public Health. American Public Health Association, May 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386544/ 

 

News Articles Highlighting Role of Oral Health in Overall Health

NOTE: Inclusion in the following list does not constitute an NADP endorsement of studies mentioned.

Publication

Headline and Summary 

Mayo Clinic

Healthy LifeStyle

June 4, 2019

Oral Health: A Window to Your Overall Health

Explores connection between oral and overall health. Lists following conditions that can be linked to oral health:

  • Endocarditis
  • Cardiovascular disease
  • Pregnancy and birth complications
  • Pneumonia

Lists conditions that might also affect oral health:

  • Diabetes
  • HIV/AIDS
  • Osteoporosis
  • Alzheimer's disease

Source: Mayo Clinic Staff. “Oral Health: A Window to Your Overall Health.” Mayo Clinic. Mayo Foundation for Medical Education and Research, June 4, 2019.

NADP SmartBrief

March 5, 2020

Vaping may raise risk of oral infections, inflammation

Smoke from electronic cigarettes changes the balance of beneficial oral bacteria and potentially increases susceptibility to oral infections and inflammation, a study published in iScience found. "We found there is a shift in the microbiome of e-cigarette users, making it much closer to that of regular cigarette smokers," said senior author Deepak Saxena, a professor of craniofacial biology at NYU College of Dentistry. 

Full Story: HealthDay News (2/26) 

Source:  iScience 

NADP SmartBrief

March 5, 2020

Frequent tooth brushing may reduce diabetes risk

A study published in Diabetologia found that brushing teeth at least three times a day decreases the risk of developing type 2 diabetes. The findings, based on a cohort of 188,013 diabetes patients from South Korea, also revealed that the presence of periodontal disease and missing teeth were tied to the occurrence of new-onset diabetes after adjustments for demographics, smoking status, regular exercise, alcohol consumption, vascular risk factors, history of malignancy and laboratory findings.

Full Story: Physician's Briefing/HealthDay News (3/3) 

Source: Diabetologia

NADP SmartBrief

May 1, 2019

Pediatric dental infections linked with adult cardiovascular disease

Adults are 87% more likely than average to develop subclinical atherosclerosis if they had one of four signs of oral infection as children, and the risk rises to 95% in adults who had all four signs -- bleeding during dental exams, cavities, fillings and pocketing around teeth -- in childhood, according to research published in JAMA Network Open. Hypertension and high body mass index are also associated with poor pediatric oral health, which may be a cause of these health conditions or an indicator of poor nutrition or other causal factors, says Dr. Salim Virani, who wrote an accompanying editorial.

Full Story: Reuters (4/30)

Source: JAMA Network Open, online April 26, 2019, bit.ly/2IQMLk8

NADP SmartBrief

Oct. 1, 2019

Study: People with psoriasis might need extra dental care

People with psoriasis might have an elevated risk for periodontitis, according to a study published in the Journal of Investigative Dermatology. Researchers found genetic, pathophysiologic and risk factors common to both conditions and recommended including regular periodontal exams in psoriasis-management protocols.

Full Story: DrBicuspid (free registration) (1/9) 

Source: Journal of Investigative Dermatology, Jan. 2, 2019

NADP SmartBrief

Nov. 1, 2018

Study links oral health to blood glucose levels in diabetes

Patients with type 2 diabetes reduced their HbA1C levels by 7 mmol/mol on average one year after receiving intensive treatment for gum disease, compared with those who received standard care consisting of teeth cleaning and polishing, according to a study in The Lancet Diabetes & Endocrinology. Researchers analyzed 264 diabetes patients with moderate to severe gum disease and noted that intensive periodontal treatment "is similar to the effect that's seen when people with type 2 diabetes are prescribed a second blood glucose lowering drug," said lead researcher Francesco D'Aiuto.

Full Story: Diabetes (UK) (10/26) 

Source: The Lancet Diabetes & Endocrinology.

NADP SmartBrief

Oct. 25, 2019

Study links poor oral health to higher risk of hypertension

People with periodontal disease are more likely than those with good oral health to have hypertension, and their blood pressure might not respond well to medication, according to a study published in Hypertension. Physicians and dentists should be aware of the association and monitor patients' blood pressure and oral health accordingly, lead author Davide Pietropaoli said.

Full Story: The Atlanta Journal-Constitution (free content) (10/23) 

Source: Hypertension, American Heart Association, volume 72, No. 6

NADP SmartBrief

Oct. 11, 2019

Mouse study links chronic periodontitis to Alzheimer's risk

Researchers at the University of Illinois at Chicago found that mice chronically exposed to bacteria that cause chronic periodontitis for 22 weeks had greater levels of accumulated amyloid beta, increased brain inflammation and fewer intact neurons due to degeneration, which are common in patients with Alzheimer's disease, compared with mice not exposed to the pathogen. The research, published in PLOS ONE, "is the first study to show that exposure to the periodontal bacteria results in the formation of senile plaques that accelerate the development of neuropathology found in Alzheimer's patients," said Dr. Keiko Watanabe, a periodontics professor at the school's College of Dentistry and a co-author of the study.

Full Story: United Press International (10/4) 

Source: PLOS ONE

 
If you have a study you'd like to share about how maintaining oral health lowers health care cost or even recent news articles provide insight into the role oral health plays in maintaining overall health, please contact us.