After decades of research and thousands of scientific papers, the relationships between oral health, especially periodontal health, and systemic health are well known.  Moreover, during the past ten years, data analysis by health economists, and public statements and actions by several large, private dental insurers have identified additional benefits of oral health by revealing that insured individuals who receive treatment for periodontal disease show fewer hospitalizations and reduced cost of care for a number of systemic diseases including diabetes, cardiovascular disease, and stroke.  This extensive economic data base from the private insurance sector, including a discussion of activities to add a dental benefit to Medicare, is summarized in a recent publication.  Importantly, the economic benefits are huge, with conservative estimates that a net savings of $63.5 billion over 10 years can be achieved with a minimal dental health benefit in Medicare. If prorated for the current population of Florida, this could save an estimated $4.35 billion dollars over ten years. Not a bad return on investment!

Private insurers have acted on this information  by actively recruiting insured individuals  to obtain dental care, waiving dental copays,  providing coverage for additional dental preventive visits during the year, and by waiving minimums.  The fact that these practices have gone on for more than a dozen years ensures that the positive savings of dental care are real, otherwise the companies would have lost money and canceled the enhanced dental care services. Individuals who are insured on public programs like Medicare, and many state Medicaid programs, however, not only are denied the benefits of enhanced dental care, but for the most part, get no dental care at all. 

In fact, the effect of dental care on the total health care costs of publicly insured populations had not been studied until two studies on the New York State Medicaid Dental program were completed this year.  These studies confirmed the positive effects of dental care to improve oral and systemic health outcomes and to reduce total health care costs in the New York State Medicaid population and have been submitted for publication.

Compelling evidence of the link between periodontal disease and diabetes is seen in the recent Cochrane review entitled “Treatment of periodontitis for glycemic control in people with diabetes mellitus”. The major conclusion was that at 3 months after treatment the reduction in HbA1c was 0.43%, 0.30% at 6 months and 0.50% at 12 months. Critically, the results necessitated “a change in our [Cochrane’s] conclusions about the primary outcome of glycaemic control in our level of certainty in this conclusion. We now have evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care”. Notably this changed from the previous Cochrane review, which concluded that there was not sufficient evidence to state that periodontal therapy had this beneficial effect. Further, the review stated that additional studies are “not likely to change the outcome.”

A recent report from the American Dental Association Health Policy Institute done for our partner organization, Florida Voices for Health, estimates that providing an adult dental benefit in Medicaid in Florida would cost approximately $3 million dollars a year and save approximately $30 million dollars annually.

In summary, there is now compelling evidence that periodontal disease has a significant impact on systemic diseases such as diabetes. As a result of this overwhelming evidence, the highly regarded Santa Fe Group has concluded that sufficient evidence now exists that periodontal disease is a contributory cause to certain systemic diseases, and the public should benefit from this knowledge. Specifically, Medicare, Medicaid, and other public and private health insurance programs should incorporate oral health benefits as a component of comprehensive health insurance.  These health benefits will not only improve oral health for its own sake, including speech, mastication and social acceptance, but will also produce substantial economic benefits and total health improvement for the public. Better access to affordable dental care will improve patients’ lives and save money. 

Acknowledgements– Thanks to our colleagues at CareQuest Institute For Oral Health and Well Florida Health Planning Council for providing  the Florida data for this report.