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Preventive Dental Care Associated with Fewer ED, Hospital Visits

Treating dental care like a population health management issue may help reduce avoidable ED visits and hospitalizations.

Population health and preventive dental care

Source: Thinkstock

By Jennifer Bresnick

- Providing dental coverage as a preventive care benefit may help providers and payers reduce the number of emergency department visits and hospitalizations, according to a new two-year study from Capital BlueCross, Dominion National, and Geneia LLC.

Integrating dental services more tightly into the medical care continuum helped to cut utilization by individuals with chronic conditions, researchers said. 

Individuals with chronic diseases but without dental coverage through Capital BlueCross had a seven percent higher rate of hospital stays than those with dental benefits. 

Members who had dental coverage but did not use the benefit for preventive services had a 19 percent higher incidence rate of ED visits than those who took advantage of routine dental care.

“We know that having quality dental coverage, and using it for preventive care, can contribute to overall good health,” said Capital BlueCross President and CEO Gary St. Hilaire.

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“The findings of this study reinforce how integrating medical and dental coverage and care can be associated with improved health and lower costs for those dealing with chronic medical issues.”

Poor dental health has been associated with an increase in heart disease for some time, although studies have not conclusively proven that gum disease and other dental issues contribute directly to cardiovascular events. 

Nevertheless, recent research has highlighted strong correlations between oral health and the successful management of chronic conditions.

In a recent report from the Blue Cross Blue Shield Association, researchers found that individuals with serious oral health conditions spent twice as much as other members on healthcare expenses.

Individuals with dental health issues are also 25 percent more likely to suffer from heart disease, two times as likely to experience an ED visit or hospitalization, and are also more likely to be diagnosed with autoimmune conditions, kidney disease, and anemia.

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“People need to pay attention to their dental and vision care, as they can indicate other serious health issues that should be addressed,” said Trent Haywood, Senior Vice President and Chief Medical Officer for the Blue Cross Blue Shield Association.  The study also looked at vision issues such as cataracts, injuries, and glaucoma.

“Seeking oral and vision care throughout your life can help detect more serious problems down the road.”

Unfortunately, dental and vision benefits are often financially separated from traditional medical insurance coverage, leading to a lack of access for individuals on the lower end of the socioeconomic spectrum.

Access to dental care follows similar socioeconomic patterns as other chronic illnesses, according to the national Healthy People project, with individuals in the lowest income brackets being about half as likely as wealthier patients to visit a dentist.

Similarly, non-white patients are much less likely to have visited a dentist within 12 months. 

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Among the uninsured, just 17 percent have established relationships with a dentist, and only a third of publicly insured individuals have visited an oral health professional recently.

As a result, they tend to end up in the emergency department when dental pain becomes overwhelming. 

A 2017 study from the International Journal for Quality in Health Care found that “toothache” and other dental disorders were among the top five reasons why individuals came to emergency departments between 2005 and 2011.

The vast majority of dental issues – around 95 percent – required enough intervention from emergency physicians that the visits could not be classified as unavoidable, said Renee Y. Hsia and Matthew Niedzwiecki from the UCSF Emergency Department and Philip R. Lee Institute for Health Policy Studies.

Emergency department providers are not optimally equipped to handle oral health issues, the researchers pointed out, leaving patients without proper care and the healthcare system with a high bill to pay.

Increasing coverage for preventive dental care, and treating oral health as a population health management issue, could significantly reduce the incidence of ED visits, thereby cutting costs and relieving pressure on the healthcare system.

Public and private payers have not yet embraced this idea on a broad scale, said Hsia and Niedzwiecki.

“For example, of the 46 states in the US that offer dental coverage for non-pregnant adult Medicaid enrollees, 28 provide coverage for preventive services and 18 provide emergency services only,” the study says.

“Although providing dental coverage is a step towards increasing access to dental care, less than half of dentists treat any Medicaid-insured patients.”

Some payers, including Capital BlueCross, are attempting to close the gap between dental and medical care by offering more comprehensive dental benefits.

The American Dental Association is also pushing for a population health approach to oral care, and offers Dental Public Health as a well-established sub-specialty.

“The challenge for dental public health, and dentistry in general, is to create a shared vision of optimal oral health for widely diverse groups; inform and educate these groups as to their potential role in improving oral health and to be better stewards of their own oral health; assessing the oral health status of differing communities of interest; designing, implementing and coordinating activities and programs; and evaluating outcomes,” the ADA says.

“Successfully meeting the oral health demands of all Americans depends on the inclusion of a strong private sector, adequately reimbursed, with an appreciation of cultural competency and adequate geographic distribution to treat those people for whom a viable business model capable of supporting that practice exists.” 

Reducing preventable emergency department visits and avoidable hospitalizations due to dental issues or the exacerbation of chronic disease from poor oral health will require public and private payers, not to mention clinical care providers, to reexamine the relationship between the mouth and the rest of the body.

Developing closer alignment between the two disciplines may have significant long-term impacts on overall health, the costs of care, and the outcomes for individuals with multiple chronic diseases.

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