The health care industry has long suspected important connections between oral and systemic health. Recent studies lean toward confirming these suspicions, and the potential for improving oral and overall health is exciting. Not to discount these hopes and aspirations, but another reality should also be weighed when considering these exciting developments: The science is not all in, and what science is available is occasionally in conflict. Evidence does not yet definitively support some of the conclusions that various carriers in our industry may seem to be jumping toward in leaps and bounds.

What we know and still need to learn
When it comes to developing benefits and policies that incorporate the new findings about “the medical-dental connection,” our affiliated companies are prepared and actively engaged in adopting changes that make good medical and economic sense for our customers. At times, however, this may mean resisting the temptation to misinterpret some of the more recently announced “associations” between dental and medical pathology. Remember, misinterpreting science has the potential to mean overpromising results to your customer and overspending your customers’ benefit dollars.

In January 2007, Scientific American dedicated a special edition to summarizing the most recent findings surrounding the connection between oral health and overall health. A close reading of this publication and other well-respected medical journals suggests that group purchasers would do well to be cautious when considering drastic changes in their current medical and dental program designs. Undoubtedly, there is a connection between oral health and overall health, but more research is needed before we are ready to predict with any certainty what the impact of specific dental treatments will be on many of the associated medical conditions.

Why then, all the media attention and interest?
The idea of a link between oral and systemic health leads to some intriguing new possibilities for ways dentists and physicians can work together to help improve the health of their patients. For instance, periodontal disease has been associated in some studies with pre-term, low birth weight babies. These infants require costly medical interventions that far exceed the cost to treat periodontal disease of their mothers more aggressively.

Will offering more cleanings or root planing and scaling procedures to pregnant women reduce the risk of those medical costs? Based on the research, we can only offer a qualified “maybe,” as the jury is still out with conflicting studies on the matter. However, we do know that at the very least, these additional treatments are effective at addressing the underlying dental disease of the mother. In addition, extra cleanings and checkups are safe for the patient and they might lead to healthier babies. Because the cost to extend additional coverage to pregnant women is reasonable and relatively limited to a small group of eligible enrollees, we can say that building pregnancy dental benefits into a group’s standard scope of benefits makes business and health care sense.

Others in the health benefits industry are talking about treating periodontal disease more aggressively in patients with diabetes, coronary and cerebrovascular disease, and respiratory ailments. Again, the research is suggestive of an association between these conditions and periodontal disease. However, there is no convincing answer as to what type or amount of additional treatment will be effective at this point in the research. Science has not answered whether periodontal disease is a risk factor for these conditions or whether periodontal treatment truly results in a positive outcome in disease control, as in many cases other risk factors may prove more important.

In addition, consider the fact that as the population of patients who are eligible for more aggressive dental treatment increases, so too will the premium cost that all groups and all individuals within those groups (in premium-sharing plans) must pay. Dental plans should always encourage enrollees to obtain whatever necessary care their dentist and/or physician recommends. Plus, there is no prohibition to a patient receiving recommended treatment even if it is not a covered benefit.

Should a group want to pay for these benefits and study the results on their employees, which some groups are doing, we support the effort and are happy to help administer this type of program. But to impose these costs on all groups and simply hope the research bears it out is a risk we believe may be premature. Rather, we feel that it is best to base a change in benefits, especially one that would increase the cost of everyone’s benefits plan, on more conclusive science.

What does the emergence of medical-dental science mean for the future?
As science confirms that the use of more aggressive dental interventions does help improve medical outcomes, Delta Dental will be at the forefront of innovative ways to promote those interventions through changes in benefit design, enrollee education and communication, and by working closely with health plans to integrate and make optimal use of patient data. We are already actively involved in collaborations with the health plans of some of our group customers to integrate patient claims data with medical data so that patients with identified patterns of care or defined diagnoses will be referred to the proper health professional.

For now, group purchasers who are tracking the medical- dental connection trend should be cautious regarding suggestions to overhaul their current group dental programs. Bear in mind that no matter how interconnected science may eventually determine oral and systemic health to be, a visit to the dentist is not a substitute for medical care. By working together, your customers’ physicians and dentists can be encouraged to collaborate to provide the most complete health care to their mutual patients.