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Linking Dental with Medical: The Role of the Dental Professional

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Linking Dental with Medical: The Role of the Dental Professional

  1. 1. 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
  2. 2. Linking Dental with Medical: The Role of the Dental Professional <ul><li>Agenda </li></ul><ul><ul><li>Making the Link to Overall Health </li></ul></ul><ul><ul><li>Roles and Responsibilities: </li></ul></ul><ul><ul><ul><li>Health Plans </li></ul></ul></ul><ul><ul><ul><li>BCBSM </li></ul></ul></ul><ul><ul><ul><li>Physician </li></ul></ul></ul><ul><ul><ul><li>Dental Professional </li></ul></ul></ul>
  3. 3. Connecting Oral Health to Overall Health Medical BCBSM Dental Health plans make the link
  4. 4. Connecting Oral Health to Overall Health <ul><li>“ You’re not healthy without good oral health.” </li></ul><ul><li>Dr. C. Everett Koop </li></ul><ul><li>Former U.S. Surgeon General Chairman, Oral Health 2000 </li></ul>
  5. 5. Terminology and Definitions <ul><li>You may understand but your customers may not: </li></ul><ul><li>12 percent of the adult population can’t understand health information that doctors, hospitals and insurers use </li></ul>
  6. 6. Terminology and Definitions <ul><li>Medical </li></ul><ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Ischemic Heart Disease </li></ul><ul><li>Low Birth Weight </li></ul><ul><li>Osteoporosis </li></ul>
  7. 7. Terminology and Definitions <ul><li>Gingivitis </li></ul><ul><li>Inflammation of gingival tissue without loss of connective tissue </li></ul><ul><li>Periodontal disease </li></ul><ul><li>Bacteria and toxins that invade tissues around the tooth </li></ul><ul><li>Causes gum inflammation </li></ul><ul><li>Brings about tooth loss </li></ul><ul><li>Bacteria and toxins enter blood stream and invade other areas of the body </li></ul><ul><li>34% of people over 30 years old have periodontal disease </li></ul>Frequent teeth cleanings and complex periodontal services reduce the incidence of periodontal disease
  8. 8. Other Medical-Dental Disease Links <ul><li>Oral cancer </li></ul><ul><li>Radiation and chemotherapy - osteoradionecrosis </li></ul><ul><li>Pulmonary disease (aspiration pneumonia) </li></ul><ul><li>Stroke </li></ul><ul><li>Heart valve replacement </li></ul><ul><li>Joint replacement </li></ul><ul><li>Post cancer surgery complications </li></ul><ul><li>Pancreatic cancer in men </li></ul><ul><li>Medications and xerostomia </li></ul><ul><li>Auto-immune diseases </li></ul>
  9. 9. Other Medical-Dental Disease Links <ul><li>HIV </li></ul><ul><li>Lichen planus </li></ul><ul><li>Gingival infiltration in acute myelogenous leukemia </li></ul><ul><li>Bulimia </li></ul><ul><li>Bisphosphonate-related osteonecrosis </li></ul><ul><li>Chronic kidney failure/renal insufficiency </li></ul><ul><li>Sjogren’s syndrome </li></ul>
  10. 10. Dental Care History and Trivia
  11. 11. History of Dental Care <ul><li>2600 BC - Death of Hesy-Re, an Egyptian scribe, often called the </li></ul><ul><li>first “dentist” </li></ul><ul><ul><li>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. </li></ul></ul><ul><li>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 </li></ul><ul><li>Source: ada.org </li></ul>
  12. 12. Making the Link to Overall Health
  13. 13. Dental Care – For a Lifetime <ul><li>Dental care starts early </li></ul><ul><li>1 st exam 1-3 years old </li></ul><ul><li>Counseling with caregiver </li></ul><ul><li>Cavity prevention – fluoride rinse and/or fluoride varnish </li></ul><ul><li>Preventive twice-yearly cleanings </li></ul>
  14. 14. Dental Care – For a Lifetime <ul><li>Adding Value </li></ul><ul><li>Middle and later years </li></ul><ul><ul><li>Effects of systemic disease treatment on oral health </li></ul></ul><ul><ul><li>Effects of medications on oral health </li></ul></ul><ul><ul><li>Identifying risks associated with oral health as one ages </li></ul></ul><ul><li>Some Medicare HMO plans are recognizing the link and adding basic dental benefits to their plans </li></ul>
  15. 15. Making the Link Dentistry – The Forefront of Overall Health <ul><li>Patients visit the dentist more frequently than </li></ul><ul><li>their regular physician. </li></ul>
  16. 16. Making the Link Dentistry – The Forefront of Overall Health <ul><li>Dental exams and health questionnaire can help </li></ul><ul><ul><li>Assess overall health </li></ul></ul><ul><ul><li>Uncover hypertension </li></ul></ul><ul><ul><li>Uncover cardiovascular disease </li></ul></ul><ul><ul><li>Detect oral cancer - accounts for 2% to 4% of cancers in the U.S. </li></ul></ul><ul><ul><li>Diagnose and treat periodontal (gum) disease - 80 percent of adults will have some form of periodontal disease </li></ul></ul><ul><li>This leads to overall better health </li></ul><ul><li>Source: cdc.gov </li></ul>
  17. 17. Making the Link to Overall Health: Diabetes <ul><li>What is the annual direct cost of diabetes in the U.S.? </li></ul><ul><li>$500 million </li></ul><ul><li>$1.8 billion </li></ul><ul><li>$27 billion </li></ul><ul><li>$92 billion </li></ul>
  18. 18. Making the Link to Overall Health: Diabetes <ul><li>Centers for Disease Control data for the year 2002 shows direct costs of $92 billion , and total costs of $132 billion </li></ul><ul><li>BCBSM ( a large health plan ) data indicates average annual costs of $8,600 per member </li></ul><ul><li>Affects 7 percent of the U.S. population </li></ul><ul><li>Source: cdc.gov </li></ul>
  19. 19. Making the Link to Overall Health: Diabetes <ul><li>Periodontal disease worsens diabetes – bacteria released into the blood stream contributes to the inflammatory process </li></ul><ul><li>Diabetes worsens periodontal disease – weakening of connective tissue structure affects gums </li></ul>
  20. 20. Making the Link to Overall Health: Heart Disease <ul><li>What is the percentage of deaths in the U.S. due to heart disease? </li></ul><ul><li>15 percent </li></ul><ul><li>19 percent </li></ul><ul><li>26 percent </li></ul><ul><li>29 percent </li></ul>
  21. 21. Making the Link to Overall Health: Heart Disease <ul><li>Heart disease accounts for 29 percent of deaths in the United States </li></ul><ul><li>BCBSM data shows average annual cost of ischemic heart disease of $10,500 per member </li></ul><ul><li>CDC projects cost of heart disease in the U.S. at $393 billion </li></ul><ul><li>Source: cdc.gov </li></ul>
  22. 22. Making the Link to Overall Health: Heart Disease <ul><li>Bacteria found in the plaque of the arterial walls include many of the same types found in the periodontal pockets </li></ul><ul><li>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 </li></ul><ul><li>Source: cdc.gov </li></ul>
  23. 23. Making the Link to Overall Health: Low Birth Weight Babies <ul><li>What is the average cost of a preterm birth? </li></ul><ul><ul><li>A) $5,000 </li></ul></ul><ul><ul><li>B) $7,500 </li></ul></ul><ul><ul><li>C) $9,000 </li></ul></ul><ul><ul><li>D) $10,500 </li></ul></ul>
  24. 24. Making the Link to Overall Health: Low Birth-Weight Babies <ul><li>CDC calculates the average cost of a preterm birth at $10,500 </li></ul><ul><li>Overall medical costs exceed $5 billion </li></ul><ul><li>In 2000, 11.6 percent of infants were born preterm in the U.S. </li></ul><ul><li>Source: cdc.gov </li></ul>
  25. 25. <ul><li>Hormonal fluctuations can lead to gingivitis and periodontal disease </li></ul><ul><li>Bacteria of periodontal disease is also found in amniotic fluid and placenta </li></ul><ul><li>Mothers with periodontal disease tend to deliver premature babies </li></ul><ul><li>Source: cdc.gov </li></ul>Making the Link to Overall Health: Low Birth-Weight Babies
  26. 26. Making the Link to Overall Health: Oral Cancer <ul><li>How many people are diagnosed with oral cancer in the U.S. each year? </li></ul><ul><ul><ul><li>A) 15,000 </li></ul></ul></ul><ul><ul><ul><li>B) 20,000 </li></ul></ul></ul><ul><ul><ul><li>C) 25,000 </li></ul></ul></ul><ul><ul><ul><li>D) 30,000 </li></ul></ul></ul>
  27. 27. Making the Link to Overall Health: Oral Cancer <ul><li>According to the CDC, 30,000 people in the U.S. are diagnosed with oral cancer every year </li></ul><ul><li>Oral and pharyngeal cancer account for 2% to 4% of cancers diagnosed in the U.S. </li></ul><ul><li>Oral cancer occurs twice as often in males as females </li></ul><ul><li>Tobacco users have a high incidence of oral cancer </li></ul><ul><li>Source: cdc.gov </li></ul>
  28. 28. Making the Link to Overall Health: Oral Cancer <ul><li>Early detection of oral cancer enables less invasive treatment, higher survival rate </li></ul><ul><ul><li>Early stage survival rate is 80% </li></ul></ul><ul><ul><li>Late stage five-year survival rate is 20% </li></ul></ul><ul><ul><li>Source: cdc.gov </li></ul></ul>
  29. 29. Making the Link to Overall Health: Oral Cancer <ul><li>Some health plans cover dental oral brush biopsy, an early detection tool </li></ul><ul><li>Some plans like BCBSM offer smoking cessation programs to members and have developed specific tools to help medical providers discuss tobacco with at-risk patients </li></ul>
  30. 30. Making the Link to Overall Health: Oral Piercing <ul><li>Oral piercing involving the tongue, lips, cheeks, uvula or a combination of sites implicated in adverse oral systemic conditions </li></ul><ul><li>Following piercing certain symptoms are common </li></ul><ul><ul><li>Pain and swelling </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Increased salivary flow </li></ul></ul><ul><ul><li>Injuries to the gum tissue </li></ul></ul><ul><li>Additional risks </li></ul><ul><ul><li>Obstructed airway due to pronounced edema </li></ul></ul><ul><ul><li>Aspiration of jewelry </li></ul></ul><ul><ul><li>Source: ada.org </li></ul></ul>
  31. 31. Roles and Responsibilities: Health Plans <ul><li>Innovative plan designs </li></ul><ul><li>Use of evidence-based dentistry guidelines </li></ul><ul><li>Additional benefits for at-risk patients </li></ul><ul><li>Work with societies to encourage dentists to donate their time to free clinics </li></ul>
  32. 32. Roles and Responsibilities: Health Plans <ul><li>Education to promote awareness among: </li></ul><ul><ul><li>Dentists </li></ul></ul><ul><ul><li>Physicians </li></ul></ul><ul><ul><li>Professional societies </li></ul></ul><ul><ul><li>Plan members </li></ul></ul><ul><ul><li>General public </li></ul></ul>
  33. 33. Roles and Responsibilities: BCBSM <ul><li>Collaborating with University of Michigan School of Dentistry on research project to demonstrate and quantify medical savings of good oral care in diabetic patients </li></ul><ul><li>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 </li></ul><ul><li>Incorporating preventive dental services into some medical plans </li></ul><ul><li>Offering individual products so members who lose group coverage can continue dental care </li></ul>
  34. 34. Roles and Responsibilities: BCBSM <ul><li>Coupons for </li></ul><ul><ul><li>Extra free cleaning to medical and dental members who suffer from diabetes or ischemic heart disease </li></ul></ul><ul><ul><li>Extra free cleaning for medical and dental members who are pregnant—doctors and nurse-midwives give coupon to patient at time of diagnosis </li></ul></ul><ul><ul><li>“ Quit the Nic” smoking cessation program participants </li></ul></ul><ul><li>“ Happy Birthday” mailer to parents of 3-year-olds to encourage regular dental care </li></ul>
  35. 35. Roles and Responsibilities: Physician <ul><li>Be aware of link between oral disease and systemic diseases including diabetes, heart disease, and pregnancy complications </li></ul><ul><li>Ask patients if they are seeing a dentist regularly </li></ul><ul><li>Observe oral soft and hard tissues </li></ul><ul><li>Work with dentist to manage co-morbidity associated with systemic inflammation and oral periodontal disease </li></ul><ul><li>Make appropriate referrals </li></ul>
  36. 36. Roles and Responsibilities: Dental Professional <ul><li>Dentist can detect 120 disease symptoms in the mouth </li></ul><ul><ul><li>Early detection of systemic diseases and recognition of oral manifestations </li></ul></ul><ul><ul><li>Often first to identify a systemic health problem based on what they see in the patient’s mouth </li></ul></ul><ul><ul><li>Oral evaluation and diagnosis </li></ul></ul>
  37. 37. Roles and Responsibilities: Dental Professional <ul><li>Periodontal risk assessment </li></ul><ul><ul><li>Educate patients about link between periodontal disease and systemic diseases </li></ul></ul><ul><ul><li>Periodontal scaling and root planing </li></ul></ul><ul><ul><li>Periodontal maintenance </li></ul></ul><ul><ul><li>Antimicrobial therapy </li></ul></ul><ul><ul><li>More frequent prophylaxis </li></ul></ul>
  38. 38. Roles and Responsibilities: Dental Professional <ul><li>Influence your patients’ oral health to improve their overall health </li></ul><ul><ul><li>Get patients into the chair for preventive and periodontal services </li></ul></ul><ul><ul><li>Identify patients that have medical conditions which may require more frequent preventive visits </li></ul></ul><ul><ul><li>Get patients back for treatment </li></ul></ul><ul><ul><li>Reactivate patients </li></ul></ul>
  39. 39. Roles and Responsibilities: Dental Professional <ul><li>At-risk patients need to be motivated </li></ul><ul><ul><li>BCBSM group project </li></ul></ul><ul><ul><li>Patient awards and incentives </li></ul></ul><ul><li>Recognize the risk status of the patient </li></ul><ul><li>Educate the patient </li></ul><ul><li>Provide counseling </li></ul><ul><li>Distribute brochures and information </li></ul>
  40. 40. Roles and Responsibilities: Dental Professional <ul><li>Intervention is key </li></ul><ul><li>Referrals to periodontal specialists </li></ul><ul><li>Referrals to physicians </li></ul><ul><li>Develop relationships with physician colleagues </li></ul>
  41. 41. Roles and Responsibilities: Dental Professional <ul><li>Insurance carriers have stepped up to the plate. Now it’s the dental professional’s turn. </li></ul><ul><ul><li>Embrace the new information </li></ul></ul><ul><ul><li>Stay on top of patient recalls </li></ul></ul><ul><ul><li>Fill your appointment books </li></ul></ul><ul><ul><li>Use your people skills to influence patients </li></ul></ul><ul><ul><ul><li>Improved oral and overall health = better quality of life </li></ul></ul></ul><ul><ul><ul><li>Better oral health could reduce overall health care cost </li></ul></ul></ul>
  42. 42. Connecting Oral Health to Overall Health Medical BCBSM Dental Dental professionals can make the link!
  43. 43. 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
  44. 44. Questions?

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