Dental Services and Health Outcomes in the New York State Medicaid Program

Abstract

Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012–June 2014) was compared to health care outcomes in the final year (July 2014–June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (−$262.91 [95% confidence interval (CI), −325.40 to −200.42] to −$379.82 [95% CI, −451.27 to −308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99–904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (−$235.64 [95% CI, −299.95 to −171.33]) and IP (−$181.39 [95% CI, −208.73 to −154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.

The use of the phrase “data not shown” in dental research

“…However, in some articles, notable conclusions were made based on data not shown. For instance, in a study investigating the association of preventive dental care to healthcare outcomes, tooth extractions and endodontic treatments were given considerable attention in terms of methodological decisions, results and their interpretation, but for restorative treatments, it was just stated in the discussion that, “Furthermore, we examined the effect of receiving restorative dental care on health outcomes, but no associations were seen (data not shown)” [ 22 ]. Other examples of how the phrases were used in the studies are provided in Table 1 .…”

Science-Informed Health Policies for Oral and Systemic Health

“…86 Studies continue to reveal associations between poor oral health and chronic conditions and access to preventive and conservative care is associated with better health outcomes. 1,2,[87][88][89][90] It is estimated that healthcare costs, not including the costs of the current pandemic, will continue to grow at 5.5% per year, reaching $6 trillion by 2027. 86 One-third of the total population are not living longer, are not healthier, and are not receiving the best care for dollars spent.…”

The dilemma of different dental degrees: DDS and DMD

“…While the dental profession debates the impact of closer alignment with the larger healthcare environment, and whether the DMD better reflects that intent, there is ever‐increasing evidence‐based research on the oral‐systemic connection and its significance for physical and mental health. For example, ongoing research in “periodontal medicine” indicates that oral infection and inflammation have been identified as risk factors for cardiovascular disease, 46 diabetes mellitus, 47 and other chronic diseases, much of which is being reported by esteemed journals of medicine, dentistry, and public health; for example, that conservative treatment of oral disease significantly reduces the cost of overall healthcare, particularly for inpatient/hospital utilization 48 …”

“…For example, ongoing research in "periodontal medicine" indicates that oral infection and inflammation have been identified as risk factors for cardiovascular disease, 46 diabetes mellitus, 47 and other chronic diseases, much of which is being reported by esteemed journals of medicine, dentistry, and public health; for example, that conservative treatment of oral disease significantly reduces the cost of overall healthcare, particularly for inpatient/hospital utilization. 48 In general, the addition of selected primary healthcare activities in the dental office including possible monitoring and managing some chronic diseases such as diabetes will require greater use of mid-level providers. 49,50 "By having simple, uncomplicated dental procedures performed by these mid-level providers, dentists will be able to use their more extensive training to perform more complex dental treatments, as well as being available to provide limited preventive and primary care services as part of the overall healthcare of their patients.…”