One out of every two American adults aged 30 and over has periodontal disease, according to the CDC. This may range from simple gum inflammation to serious infections that result in major damage to the soft tissue and bone that support the teeth.
As we learn more about the association between periodontal disease and chronic systemic disease, it is becoming clear that dentists have an important role in helping control chronic disease through periodontal intervention and maintenance.
Dental diseases originate with bacteria living in the layer of dental plaque that attaches to the tooth’s smooth surface. If the biofilm layer is not removed through daily home hygiene, the bacteria eventually migrate below the gum line. Anaerobic bacteria thrive in this environment. The immune system responds by sending inflammatory cells to the tooth and gum area to fight that infection. In the case of periodontal disease, the infection is often uncontrolled. The immune system of a patient with untreated periodontal disease does not receive a ‘signal’ to stop the inflammatory response to the mouth. The result is an overabundance of cells which then migrate to other parts of the body.
There are numerous potential areas of impact. It might be a respiratory infection, where dental plaque buildup becomes a dangerous source of bacteria that can be inhaled into the lungs. Reduced bone mass (ostopenia) is related to gum disease and related tooth loss. Oral microbes have been found in the placenta of pre-term or low birth weight babies. Individuals with adult periodontitis may have a greater risk of stroke and cardiovascular disease. Chronic periodontal disease can disrupt diabetic control. Smokers with diabetes frequently have an increased risk of tooth loss.
Physicians counsel patients to make lifestyle changes as a step in controlling chronic disease—changes to diet, exercise and medications. It is also important to consider the presence of periodontal disease. Even if a patient is successful at adopting the recommended changes, the non-stop inflammation resulting from untreated periodontal disease will continue to affect the body’s ability to manage the chronic disease.
Analysis of claims data for patients managing chronic diseases is showing that when patients get treatment for periodontal disease there are notable decreases in the treatment costs for chronic diseases. Below, are highlights of recent research:
• An Aetna and Columbia University College of Dental Medicine retrospective study1 of claims data found a relationship between periodontal treatment and the overall cost of care for several chronic diseases. The study, which included approximately 145,000 Aetna members with continuous dental and medical coverage, indicated a possible association between periodontal treatment and reduced PMPM medical costs for Diabetes Mellitus, Coronary Artery Disease and Cardio Vascular Disease, with earlier treatment resulting in lower medical costs.
• Researchers at the University of Pennsylvania analyzed claims data from United Concordia and Highmark2 for 338,891 individuals with medical and dental insurance coverage who had at least one of five systemic conditions and evidence of periodontal disease (2011–2013). Comparing patients who received periodontal treatments with those who did not receive periodontal treatments, overall medical costs decreased $1,800 per year and hospital admissions decreased by 33 percent.
• Blue Cross Blue Shield of Massachusetts reported the medical costs for members with Coronary Artery Disease and Diabetes who received preventive dental and/or periodontal services are lower than members who did not receive these services3. Members with Diabetes receiving dental prophylaxis and/or periodontal treatment had $67 PMPM lower medical costs than members that did not seek these treatments. This represented a 6.6 percent difference in the members’ overall medical cost. Members with Coronary Artery Disease who received dental prophylaxis and/or periodontal treatment had $487 PMPM lower medical costs than members that did not seek these treatments. This was a 24.1 percent difference in the members’ overall medical cost.
For patients with severe periodontal disease, the dentist can supplement periodontal treatment with at-home measures such as prescription antimicrobial mouth rinses and antibiotic gels that help control bacteria and reduce the size of periodontal pockets. Oral antibiotics are also an option for the short term treatment of an acute or locally persistent periodontal infection.
As the healthcare industry seeks to slow the rate of chronic diseases, it will be important to ensure that patients receive preventive dental care. Periodontal disease is not curable, but with regular dental treatment and patient self-management, it can be controlled. And that will help patients ensure that the lifestyle changes they are making to manage their chronic disease actually make an impact.
1 From BMC Health Services Resarch. “An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population:” http://www.biomedcentral.com/1472-6963/6/103
2 From American Journal of Preventable Medicine. “Impact of Periodontal Therapy on General Health:” http://www.ajpmonline.org/article/S0749-3797(14)00153-6/fulltext
3 From Blue Cross Blue Shield of Massachusetts. “Total Health Solution:” http://www.nationaloralhealthconference.com/docs/presentations/2010/Robert%20Lewando%20-%20Periodontal%20Disease.pdf