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Linking Dental with Medical:The Role of the Dental Professional

Carl L. Stoel, DDS, MSBASenior Dental Consultant BCBSM

American Association of

Dental Office ManagersOctober 27, 2007

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AgendaMaking the Link to Overall Health

Roles and Responsibilities:

Health Plans

BCBSM

Physician

Dental Professional

Linking Dental with Medical:The Role of the Dental ProfessionalLinking Dental with Medical:The Role of the Dental Professional

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Connecting Oral Health to Overall Health

Medical

BCBSM

Dental

Health plans make the link

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Connecting Oral Health to Overall Health

“You’re not healthy without good oral health.”

Dr. C. Everett KoopFormer U.S. Surgeon General Chairman, Oral Health 2000

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Terminology and Definitions

You may understand but your customers may not:12 percent of the adult population can’t understand health information that doctors, hospitals and insurers use

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Terminology and Definitions

Medical• Diabetes• Hypertension• Ischemic Heart Disease• Low Birth Weight• Osteoporosis

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Terminology and Definitions

Gingivitis• Inflammation of gingival

tissue without loss of connective tissue

Periodontal disease • Bacteria and toxins that

invade tissues around the tooth

• Causes gum inflammation• Brings about tooth loss• Bacteria and toxins enter

blood stream and invade other areas of the body

• 34% of people over 30 years old have periodontal disease

Frequent teeth cleanings and

complex periodontal services reduce the

incidence of periodontal disease

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Other Medical-Dental Disease Links

• Oral cancer• Radiation and chemotherapy - osteoradionecrosis• Pulmonary disease (aspiration pneumonia)• Stroke• Heart valve replacement• Joint replacement• Post cancer surgery complications• Pancreatic cancer in men• Medications and xerostomia• Auto-immune diseases

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Other Medical-Dental Disease Links

• HIV• Lichen planus• Gingival infiltration in acute myelogenous

leukemia• Bulimia• Bisphosphonate-related osteonecrosis• Chronic kidney failure/renal insufficiency• Sjogren’s syndrome

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Dental Care History and Trivia

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History of Dental Care

• 2600 BC - Death of Hesy-Re, an Egyptian scribe, often called the first “dentist”

– An inscription on his tomb includes the title, “the greatest of those who deal with teeth, and of physicians.”  This is the earliest known reference to a person identified as a dental practitioner.

• 500 to 1000 AD - During the early Middle Ages in Europe, medicine, surgery, and dentistry are generally practiced by monks, the most educated people of the period

Source: ada.org

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Making the Link to Overall Health

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Dental Care – For a Lifetime

Dental care starts early• 1st exam 1-3 years old• Counseling with caregiver • Cavity prevention – fluoride

rinse and/or fluoride varnish• Preventive twice-yearly

cleanings

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Dental Care – For a Lifetime

Adding Value• Middle and later years

– Effects of systemic disease treatment on oral health

– Effects of medications on oral health

– Identifying risks associated with oral health as one ages

• Some Medicare HMO plans are recognizing the link and adding basic dental benefits to their plans

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Making the LinkDentistry – The Forefront of Overall Health

Patients visit the dentist more frequently than their regular physician.

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Making the LinkDentistry – The Forefront of Overall Health

• Dental exams and health questionnaire can help– Assess overall health– Uncover hypertension– Uncover cardiovascular disease– Detect oral cancer - accounts for 2% to 4% of cancers in the

U.S.– Diagnose and treat periodontal (gum) disease - 80 percent of

adults will have some form of periodontal disease

• This leads to overall better health

Source: cdc.gov

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Making the Link to Overall Health: Diabetes

What is the annual direct cost of diabetes in the U.S.?

A) $500 million

B) $1.8 billion

C) $27 billion

D) $92 billion

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Making the Link to Overall Health:Diabetes

• Centers for Disease Control data for the year 2002 shows direct costs of $92 billion, and total costs of $132 billion

• BCBSM (a large health plan) data indicates average annual costs of $8,600 per member

• Affects 7 percent of the U.S. population

Source: cdc.gov

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Making the Link to Overall Health:Diabetes

• Periodontal disease worsens diabetes – bacteria released into the blood stream contributes to the inflammatory process

• Diabetes worsens periodontal disease – weakening of connective tissue structure affects gums

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Making the Link to Overall Health:Heart Disease

What is the percentage of deaths in the U.S. due to heart disease?

A) 15 percent

B) 19 percent

C) 26 percent

D) 29 percent

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Making the Link to Overall Health:Heart Disease

• Heart disease accounts for 29 percent of deaths in the United States

• BCBSM data shows average annual cost of ischemic heart disease of $10,500 per member

• CDC projects cost of heart disease in the U.S. at $393 billion

Source: cdc.gov

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Making the Link to Overall Health:Heart Disease

• Bacteria found in the plaque of the arterial walls include many of the same types found in the periodontal pockets

• Bacteria creates an inflammation that causes plaque build-up in the small arteries of the heart, restricting blood flow to the heart muscle, which can lead to a heart attack

Source: cdc.gov

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Making the Link to Overall Health:Low Birth Weight Babies

What is the average cost of a preterm birth?

A) $5,000

B) $7,500

C) $9,000

D) $10,500

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Making the Link to Overall Health:Low Birth-Weight Babies

• CDC calculates the average cost of a preterm birth at $10,500

• Overall medical costs exceed $5 billion

• In 2000, 11.6 percent of infants were born preterm in the U.S.

Source: cdc.gov

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• Hormonal fluctuations can lead to gingivitis and periodontal disease

• Bacteria of periodontal disease is also found in amniotic fluid and placenta

• Mothers with periodontal disease tend to deliver premature babiesSource: cdc.gov

Making the Link to Overall Health:Low Birth-Weight Babies

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Making the Link to Overall Health:Oral Cancer

How many people are diagnosed with oral cancer in the U.S. each year?

A) 15,000

B) 20,000

C) 25,000

D) 30,000

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Making the Link to Overall Health:Oral Cancer

• According to the CDC, 30,000 people in the U.S. are diagnosed with oral cancer every year

• Oral and pharyngeal cancer account for 2% to 4% of cancers diagnosed in the U.S.

• Oral cancer occurs twice as often in males as females

• Tobacco users have a high incidence of oral cancer

Source: cdc.gov

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Making the Link to Overall Health:Oral Cancer

Early detection of oral cancer enables less invasive treatment, higher survival rate

– Early stage survival rate is 80%– Late stage five-year survival rate is 20%

Source: cdc.gov

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Making the Link to Overall Health:Oral Cancer

• Some health plans cover dental oral brush biopsy, an early detection tool

• Some plans like BCBSM offer smoking cessation programs to members and have developed specific tools to help medical providers discuss tobacco with at-risk patients

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Making the Link to Overall Health:Oral Piercing

• Oral piercing involving the tongue, lips, cheeks, uvula or a combination of sites implicated in adverse oral systemic conditions

• Following piercing certain symptoms are common– Pain and swelling– Infection – Increased salivary flow– Injuries to the gum tissue

• Additional risks – Obstructed airway due to pronounced edema– Aspiration of jewelry

Source: ada.org

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Roles and Responsibilities:Health Plans

• Innovative plan designs• Use of evidence-based dentistry guidelines• Additional benefits for at-risk patients• Work with societies to encourage dentists to

donate their time to free clinics

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Roles and Responsibilities:Health Plans

• Education to promote awareness among:– Dentists

– Physicians

– Professional societies

– Plan members

– General public

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Roles and Responsibilities:BCBSM

• Collaborating with University of Michigan School of Dentistry on research project to demonstrate and quantify medical savings of good oral care in diabetic patients

• Donating $1 million in grants in 2007 to 32 free health care clinics that provide low-or-no-cost health or dental care to more than 78,000 uninsured people

• Incorporating preventive dental services into some medical plans

• Offering individual products so members who lose group coverage can continue dental care

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Roles and Responsibilities:BCBSM

• Coupons for– Extra free cleaning to medical and dental members who suffer

from diabetes or ischemic heart disease– Extra free cleaning for medical and dental members who are

pregnant—doctors and nurse-midwives give coupon to patient at time of diagnosis

– “Quit the Nic” smoking cessation program participants

• “Happy Birthday” mailer to parents of 3-year-olds to encourage regular dental care

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Roles and Responsibilities:Physician

• Be aware of link between oral disease and systemic diseases including diabetes, heart disease, and pregnancy complications

• Ask patients if they are seeing a dentist regularly• Observe oral soft and hard tissues• Work with dentist to manage co-morbidity associated

with systemic inflammation and oral periodontal disease

• Make appropriate referrals

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Roles and Responsibilities:Dental Professional

Dentist can detect 120 disease symptoms in the mouth• Early detection of systemic diseases and

recognition of oral manifestations • Often first to identify a systemic health problem

based on what they see in the patient’s mouth• Oral evaluation and diagnosis

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Roles and Responsibilities:Dental Professional

Periodontal risk assessment• Educate patients about link between periodontal

disease and systemic diseases• Periodontal scaling and root planing• Periodontal maintenance• Antimicrobial therapy• More frequent prophylaxis

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Roles and Responsibilities:Dental Professional

Influence your patients’ oral health to improve their overall health• Get patients into the chair for preventive and

periodontal services• Identify patients that have medical conditions which

may require more frequent preventive visits • Get patients back for treatment• Reactivate patients

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Roles and Responsibilities:Dental Professional

• At-risk patients need to be motivated– BCBSM group project– Patient awards and incentives

• Recognize the risk status of the patient• Educate the patient• Provide counseling• Distribute brochures and information

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Roles and Responsibilities:Dental Professional

Intervention is key• Referrals to periodontal specialists• Referrals to physicians• Develop relationships with physician colleagues

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Roles and Responsibilities:Dental Professional

Insurance carriers have stepped up to the plate. Now it’s the dental professional’s turn. – Embrace the new information– Stay on top of patient recalls– Fill your appointment books– Use your people skills to influence patients

• Improved oral and overall health = better quality of life• Better oral health could reduce overall health care cost

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Connecting Oral Health to Overall Health

Medical

BCBSM

Dental

Dental professionals can make the link!

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For Additional Information

cdc.govcontent.nejmoralhealthamerica.orgdeltadental.comada.orgjada.ada.orgallaboutvision.comoral-cancer.orgkff.org healthdecisions.orgebri.org vsp.comnei.nih.gov/healthdeltadental.comaaopt.orgaoa.orgpreventblindness.orgbenefitselling.comsocsci.uci.edudiabetes.orgBlueHealthConnection.com

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Questions?