Preventive dental care is associated with improved health care outcomes and reduced costs for Medicaid members with diabetes

Abstract

IntroductionPreventive dental services have been associated with improved health outcomes. This study expands on previous observations by examining the relationship between oral health care and health care outcomes and costs in a publicly insured population with diabetes.MethodsUtilization of dental services, health care outcomes and costs were evaluated for New York State Medicaid members with a diagnosis of diabetes mellitus (DM), ages 42 to 64, who were continuously enrolled between July 1, 2012 and June 30, 2015. Utilization of dental services focused on preventive dental care (PDC), and extractions and endodontic treatment (both indicative of advanced dental infection). Data were analyzed using regression models with propensity score weighting to control for potential confounding.ResultsReceipt of PDC was associated with lower utilization rates and costs compared to members who did not access dental services. The most pronounced average cost difference was observed for inpatient admissions at $823 per year for members who had at least one PDC without extraction or endodontic treatment. Each additional PDC visit received was associated with an 11% lower rate of inpatient admissions and lower average inpatient costs by $407 per member. The need for a dental extraction or endodontic therapy was associated with relatively higher rates and costs.ConclusionsThese findings demonstrate an association between PDC and improved health care outcome rates and lower average costs among members with DM and suggest a general health benefit associated with provision of preventive dental care for persons with DM.

Oral Health Nursing Education and Practice Program: Ten-Year Outcomes

“…We also collaborated with dental faculty champions about integrating systemic clinical conditions like diabetes, heart disease, and cancer in the dental curriculum. For example, evidence supporting diabetes and its bidirectional relationship with oral health provided a link between effective management of diabetes and glycemic control and decreased risk for periodontal disease (Lamster, 2014;Lamster et al, 2022;Siddiqi et al, 2022).…”

“…The most commonly stated reason for not visiting the dentist is cost (CDC, 2021;Kramarow, 2019). Periodontal disease has a bi-directional relationship with diabetes and cardiovascular disease through systemic infection and inflammation that originates in the oral cavity (Borah et al, 2022;Lamster, 2014;Lamster et al, 2022;Simpson et al, 2022). Poor oral health, tooth decay, infections, and periodontitis have a negative impact on transplant patients as well as cancer patients receiving chemotherapy and/or radiation who are immunosuppressed (Acharya et al, 2019;Gudiol et al, 2021;Hemmersbach et al 2019;Keefe & Bateman, 2019;Parisi & Glick, 2003).…”

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.…”

“…11,13,14,[110][111][112] Findings from a number of studies examining patients in public and private insurance systems have demonstrated healthcare cost savings and improved health outcomes by inclusion of preventive dental care (tooth cleaning) and conservative periodontal treatment services for persons with diabetes. [87][88][89][90] The future of integrated oral and primary care healthcare will continue to evolve, increasing the focus on prevention, deploying tools to enhance precision and personalized care, incorporating new technologies such as telemedicine and smartphone communications, and facilitating easier access to care. 72,[112][113][114][115][116][117][118][119][120][121][122][123][124] Oral healthcare integrated into primary care with teams consisting of health professionals with expertise in pediatrics, geriatrics, internal medicine, oral health and disease, family medicine, primary care, nursing, behavioral sciences, and social service will increasingly provide healthy and brighter smiles.…”

“…The pioneering studies by Marjorie Jeffcoat et al and more recently Ira Lamster et al clearly established that preventive oral health care decreases the costs for patients with type 2 diabetes and several other chronic diseases. [87][88][89][90] Ideally, our healthcare systems and policy makers must embrace and support a proactive and systems-oriented approach to disease prevention and health promotion, beginning with perinatal health and continuing throughout life and healthcare transitions.…”