Linking Dental with Medical: The Role of the Dental Professional

Carl L. Stoel, DDS, MSBA

Senior Dental Consultant BCBSM

American Association of Dental Office Managers

October 27, 2007

Linking Dental with Medical: The Role of the Dental Professional

Agenda
Making the Link to Overall Health Roles and Responsibilities: Health Plans BCBSM Physician Dental Professional

Connecting Oral Health to Overall Health

BCBSM

Dental

Medical

Health plans make the link

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Connecting Oral Health to Overall Health

Youre not healthy without good oral health.

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

Terminology and Definitions

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

Terminology and Definitions

Medical
Diabetes Hypertension Ischemic Heart Disease Low Birth Weight Osteoporosis

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
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Frequent teeth cleanings and complex periodontal services reduce the incidence of periodontal disease

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

Other Medical-Dental Disease Links

HIV Lichen planus Gingival infiltration in acute myelogenous leukemia Bulimia Bisphosphonate-related osteonecrosis Chronic kidney failure/renal insufficiency Sjogrens syndrome

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 Link Dentistry The Forefront of Overall Health

Patients visit the dentist more frequently than their regular physician.

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

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 babies
Source: cdc.gov

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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 atrisk 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 pregnantdoctors 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 patients 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 its the dental professionals 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

BCBSM

Dental

Medical

Dental professionals can make the link!

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For Additional Information

cdc.gov content.nejm oralhealthamerica.org deltadental.com ada.org jada.ada.org allaboutvision.com oral-cancer.org kff.org healthdecisions.org ebri.org vsp.com nei.nih.gov/health deltadental.com aaopt.org aoa.org preventblindness.org benefitselling.com socsci.uci.edu diabetes.org BlueHealthConnection.com 43

Questions?

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