The Relationship between Periodontal Interventions and Healthcare Costs and Utilization. Evidence from an Integrated Dental, Medical, and Pharmacy Commercial Claims Database

Nasseh, Kamyar; Vujicic, Marko; Glick, Michael

doi:10.1002/hec.3316

Cited by 100 publications

(102 citation statements)

References 15 publications

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“…The gap between American adults with health insurance and those with dental benefits is concerning. It reinforces the separation of oral health from general health and continues to adversely affect the health outcomes, medical costs, and society .…”

Section: Introductionmentioning

confidence: 96%

Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment

Halasa‐Rappel

Tschampl

Foley³

et al. 2019

J Public Health Dent

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Objectives We aimed to quantify the impact of dental caries and missing anterior teeth on employment, estimate the impact of a routine dental visit on the health of anterior teeth, and the benefits of expanding dental coverage for nonelderly adults. Methods We used the 2013–2014 Continuous National Health and Nutritional Examination Survey to develop a dental problem index (DPI) using tooth counts and tooth surface conditions. We estimated the impact of DPI on employment with logistic regression, controlling for seven demographic and socioeconomic covariates. We used a routine dental visit within 6 months as a proxy for access to dental services, and a linear regression to predict the DPI score for an average individual with and without a recent routine dental visit. We then computed the incremental probability of employment associated with a recent routine dental visit. Finally, we estimated the additional number of working age adults who might become employed due to improved access to dental services. Results The probability of being employed was negatively associated with poor oral health: a one‐point increase in DPI decreased the odds of being employed by 7.70 percent (CI: 5.15–10.19%). Having a routine dental visit had a negative and statistically significant impact on DPI [−0.41 (CI: −0.68 to −0.14)]. The incremental probability of employment associated with a routine dental visit was 0.62 percent (CI: 0.21–1.03%). Conclusions Oral health in the United States is worse among minorities and poor than among other residents. The benefits associated with access to dental care should justify expanding dental services.

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Section: Introductionmentioning

confidence: 96%

Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment

Halasa‐Rappel

Tschampl

Foley³

et al. 2019

J Public Health Dent

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“…In contrast, our study identifies diabetes complications associated with oral health status at the population level. Secondly, a validated measure of diabetes diagnosis from the Ontario Diabetes Database (ODD) is used, whereas much of the current literature does not specify the validity of a diabetes diagnosis from insurance claims (17,18). Our study also utilizes self-reported oral health status as the exposure variable and proxy for periodontal condition.…”

Section: Discussionmentioning

confidence: 99%

“…An earlier cohort study reported that study participants who received periodontal therapy experienced a reduction in the risk of diabetes complications and medical costs (16). Similar studies conducted from 2008-2016 reported reduced pharmaceutical costs, increased immediate and long-term medical cost savings, as well as reduced hospital admissions and physician visits among individuals receiving periodontal treatment (17)(18)(19). As both the prevalence of diabetes and its associated indirect and direct costs continue to grow worldwide (20,21), periodontal therapy may be a solution to a lack of metabolic control among diabetics with the severest of conditions; population level interventions addressing oral health and diabetes could also improve health outcomes for Canadians.…”

Section: Introductionmentioning

confidence: 94%

Risk of complications among diabetics self-reporting oral health status in Canada: A population-based cohort study

Kaura

Rosella

Singhal

et al. 2019

Preprint

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BackgroundPeriodontitis has persistently been associated with diabetes and poor health outcomes. While clear associations have been identified for the diabetes-oral health link, less is known about the implications of poor oral health on incident complications of diabetes. This study sought to investigate the risk of diabetes complications associated with self-reported "poor to fair" and "good to excellent" oral health status among diabetics living in Ontario, Canada. MethodsThis cohort study was undertaken of diabetics from the Canadian Community Health Survey (2003 and 2007-8). Self-reported oral health was linked to electronic health records at the Institute for Clinical Evaluative Sciences. Participants under the age of 40, missing self-reported oral health and those who could not be identified in linked databases were excluded (N=5,183).A series of Cox Proportional hazard models were constructed to determine the risk of diabetes complications. Participants who did not experience any diabetes complication were censored at time of death or at the study termination date (March 31, 2016). Models were adjusted for age and sex, followed by social characteristics and behavioural factors. ResultsDiabetes complications differed by self-reported oral health. For those reporting "poor to fair" oral health, the hazard of a diabetes complication was 30% greater (HR 1.29 95%CI 1.03, 1.61) than those reporting "good to excellent" oral health. ConclusionsOur findings indicate that oral health status is associated with increased risk for complications among diabetics, after adjusting for a wide range of confounders. Examining oral health and the risk for diabetes complications from a broader perspective including socio-behavioural and biological pathways is principal for informing policies and interventions that aim to mitigate the burdens of poor systemic health.

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“…Comparing those with periodontal treatment to those without, the authors found lower total health care costs and lower T2D-related medical costs for the treatment group. 11 Other authors studied the association between dental care, glycemic control, and ED and hospital admissions with a retrospective cohort design for a sample of about 1,000 patients enrolled in Kaiser Permanente Northwest medical and dental plans between the ages of 18 and 80. About half the sample of persons with diabetes had at least two visits each year between 2005 and 2007 for hygiene or periodontal treatment while the other half had none.…”

Section: Previous Studiesmentioning

confidence: 99%

“…One such study investigated whether periodontal intervention within 2 years after diagnosis reduces the medical costs of treating 15,002 Type 2 diabetes (T2D) patients. Comparing those with periodontal treatment to those without, the authors found lower total health care costs and lower T2D‐related medical costs for the treatment group . Other authors studied the association between dental care, glycemic control, and ED and hospital admissions with a retrospective cohort design for a sample of about 1,000 patients enrolled in Kaiser Permanente Northwest medical and dental plans between the ages of 18 and 80.…”

Section: Introductionmentioning

confidence: 99%

Does covering routine dental care for the Medicare population produce cost savings in Medicare? A preliminary 2‐year analysis

Moeller

Manski

Chen

et al. 2019

J Public Health Dent

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Objectives We estimated the association between the use of preventive dental care and medical use and expense for older persons over a 2‐year period to determine if a Medicare dental benefit for routine care could result in potential cost savings in Medicare. Methods We relied on 2008‐2014 Medical Expenditure Panel Survey data to estimate separate logistic and lognormal ordinary least squares regressions to analyze the influence of year 1 preventive dental care on either year 1 or year 2 use and expenses for total health care, office‐based care, outpatient care, inpatient stays, emergency department visits, and prescription drugs. Results Our findings provide evidence over a 2‐year period that a Medicare dental benefit for routine care could produce an increase in office‐based visits and expense. We also found that older persons currently using routine dental care have healthier lifestyles and greater access to care and use of preventive medical care than current nonusers. Conclusion Our results affirm the need for a longer‐term study to provide any conclusive evidence as to the ultimate impact of a Medicare dental benefit on other health care use and expenses.

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The Relationship between Periodontal Interventions and Healthcare Costs and Utilization. Evidence from an Integrated Dental, Medical, and Pharmacy Commercial Claims Database

Cited by 100 publications

References 15 publications

Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment

Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment

Risk of complications among diabetics self-reporting oral health status in Canada: A population-based cohort study

Does covering routine dental care for the Medicare population produce cost savings in Medicare? A preliminary 2‐year analysis

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