Defining “evidence-based dentistry”
There are multiple definitions for “evidence-based dentistry,” and Delta Dental’s definition recognizes both policy development and clinical uses of the available evidence:

Evidence-based dentistry is a set of principles and methods intended to ensure that to the greatest extent possible, clinical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit.

“Policy development” includes areas such as benefit coverage. While our definition is similar to that of the American Dental Association in terms of its clinical approach, Delta Dental, as a leader in the dental benefits industry, has the responsibility of balancing evidence-based dental practices with sound benefit policy guidelines.

Applying “evidence-based dentistry” to dental benefits plan design
Applying evidence-based dentistry to plan designs should result in dental benefits that are aligned with evidence-based criteria consistent with clinical efficacy, cost-effective treatment, and measurable cost benefit, all of which balance the needs and preferences of the individual, group and purchaser.

Evidence-based dentistry, when applied thoughtfully to dental benefit plan designs, provides the potential for improving oral and overall health for the group as a whole. At the same time, several factors should be considered to ensure that changes in plan designs deliver the maximum cost and care benefit to the purchaser and enrollee.

Clinical efficacy, scientific evidence and cost effectiveness
When developing or amending dental benefit plan designs, three considerations go hand in hand: the proven efficacy of the procedures that will be covered, empirical evidence that supports changes to the plan design and the cost effectiveness to the purchaser, group and patient.

Efficacy. Any dental procedure included as a benefit in a dental plan design should have the best scientific evidence demonstrating clinical efficacy for the condition being treated. In some cases, the recommended procedure may simply be one of many equally viable alternative treatments, giving the patient the freedom to choose their own course.

Supporting evidence. Undoubtedly, there is a connection between oral health and overall health. And evidence-based dentistry must be based on exactly that – the evidence – before dental benefit program plan designs are drastically, and globally, overhauled.

What evidence do we look at? In addition to looking at the reviewed literature (outcomes of randomized trials, cohort data, case control studies and expert opinion) Delta Dental also draws on its own data warehousing and claims analysis systems to provide “cohort data” – data drawn from the “real world” rather than from limited-population studies. Delta Dental believes that both clinical trials and data analyses are important tools in assessing outcomes, and we also recognize the potential limitations inherent in each approach.

Cost benefit. If more than one treatment option (including the option not to get treatment) demonstrates comparable clinical efficacy, it is appropriate that a determination be made as to which treatment is the most cost-effective. Dental procedures that are included as benefits should have the best scientific evidence demonstrating that the sum total of benefit to the individual or group being treated exceeds the sum total of the costs/risks of that treatment. In addition, we suggest that group purchasers use caution when considering radical benefit plan changes, as misinterpreting science may have the potential to mean over-promising results and overspending customers’ benefit dollars.

What our member companies are doing
Each Delta Dental member company necessarily has a certain amount of autonomy when determining which benefits it will offer purchasers, given local considerations and the needs of its particular client base. Several member companies have already added benefits to standard plan designs in response to evidence-based studies. Some examples of types of coverage offered by various Delta Dental member companies include enhanced periodontal and prophylaxis benefits for pregnant women and diabetics, additional cleanings for periodontal patients and medically compromised patients, topical fluoride varnish coverage for high risk, adult patients and antimicrobial rinses for pregnant women. (Like many other benefits, these enhancements are group-specific, so dentists need to verify coverage.)

Summary
Evidence-based dentistry offers a promising new direction for the future of dentistry and dental benefits. As science confirms that the use of innovative or more or less aggressive dental interventions does help improve health 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 its member companies and health plans to integrate and make optimal use of patient data.