Medical-dental integration refers to a new trend in dental benefit program design whereby enhanced dental benefits are offered in response to the important new connections being discovered between various types of medical and dental conditions. Delta Dental reviews and monitors the science behind these connections closely and supports changes in dental benefit design where such changes are based upon well-established science, and make sense from both an oral health and economic standpoint for our customers and enrollees.

To evaluate the advisability of offering a specific enhanced dental benefit, Delta Dental focuses on whether the preponderance of scientific evidence indicates a “cause-effect” relationship – one in which dental treatment is likely to reduce or eliminate the onset of a specific medical condition. In many of the medical-dental connections suspected today, we know of an “association,” but not the full extent and nature of the linkage.

In 2007, our affiliated companies will phase in at no additional cost additional examination and root planing benefits for pregnant women as a standard benefit – a change based on a growing body of evidence that suggests improved periodontal health for expectant mothers could improve health outcomes for their unborn children.

Other companies have recently announced the addition of enhanced benefits for patients with diabetes, heart disease and respiratory disease. While we remain highly interested in what studies may eventually reveal regarding the link between these diseases and periodontal interventions, our approach will be wait for science to point with more certainty towards a cause-effect relationship before recommending changes to our plan designs. To date, the data is inconclusive and the economic value to our customers and enrollees unknown.

For those who may inquire why our enterprise has not yet incorporated some of these additional enhanced benefits, we suggest a careful reading of a recent, edition of Scientific American (Oral and Whole Body Health, January, 2007) dedicated to exploring the status of what is and is not known regarding the oral-systemic link based on the most current scientific literature. Among the relevant highlights:

• The lead story by Sharon Guynup describes the “confusion and hype” surrounding this topic, which “underscores the need for objective, credible analyses.” The author suggests that many recent articles in the press “have greatly exaggerated or oversimplified the connection” between medical and dental health.
• In a review of current research concerning the connection between periodontal inflammation and cardiovascular disease, Peter Libby, chief of Cardiovascular Medicine at Brigham and Women’s Hospital, summarizes several of the intriguing hypotheses while making clear that the “jury is still out while scientists investigate this link.”
• A similar conclusion is discussed by Kaumudi Joshipura, director of the division of Dental Public Health at University of Puerto Rico and a Harvard University instructor. He reviews the issue of how treating periodontal disease affects heart health in a piece entitled, “Evaluating the Data,” concluding that “everyone should be conscientious about treating gum disease, but it is not yet clear that doing so will protect you from heart disease.”
• In the final article, Daniel M. Meyer, associate executive director for the American Dental Association, pointedly captures the state of medical-dental integration science when he states: “The burden of proof of a causal relationship [between diabetes, cardiovascular and respiratory disease and periodontal health] is not yet met…” He goes on to say, “…it’s important that we distinguish between sound science and pseudoscience, and between causal relationships and casual relationships.”

Delta Dental urges anyone with an interest in the science behind medical-dental integration to read the complete Scientific American edition referred to above.