Poor dental health can not only damage physical health and emotional well-being, but also take a huge bite out of our wallets. The old saying, “Pay now or pay more later” holds true for preventive dental care.
Unfortunately, far too many Floridians must delay dental care due to high out-of-pocket costs – even when they have insurance – or because they can’t find a dentist in their community. Nearly every county in Florida (66 out of 67) has Dental Health Professional Shortage Areas. Delaying care often results in dental problems becoming even more costly to treat.
Here’s the sad truth: Florida spends more on treating the consequences of poor oral health than any other state in the nation and has the least to show for it.
Nearly $550 Million Spent on Hospital ER/Admissions for Preventable Dental Issues – The best illustration of the economic inefficiency of Florida’s oral health system is the enormous cost for hospital emergency room (ER) visits and actual hospitalizations for non-traumatic preventable dental conditions.
When people are in dental pain and cannot afford to see a dentist in their local community, or there are few dentists nearby, they often turn to hospital ERs which by law must see them.
The problem is that hospital ERs are poorly equipped to properly treat these dental problems, primarily providing diagnosis and prescriptions for antibiotics and pain medication and advice to see a dentist as soon as possible. If these patients could not afford a dentist on the day of the ER visit, they are unlikely to find an affordable dentist the next day. Many of these patients become repeat visitors to the hospital ER. In fact, Florida leads the country in the number of repeat visitors to the hospital ER for non-traumatic, preventable dental conditions.
Not only are hospitals not able to treat the root cause of non-traumatic dental issues, but also they are typically 6-7 times more costly than an average visit to a dental office.
As shown below, there were a total of 116,980 hospital visits for non-traumatic dental conditions in Florida in 2021. Total charges were $380,558,743 with Medicaid being the primary payer at $135,635,241 or about 36% of billings. Self-Pay, or uninsured or actually no pay patients accounted for over $85,910,764. The reality is that taxpayers are on the line for all of these charges which translate into higher insurance premiums, higher hospital billing fees, and higher taxes.
|Payor Source||Total ER Visits||Total Charges|
When the dental infection is potentially life threatening, patients are usually admitted to the hospital for treatment including intravenous antibiotics and surgical treatment of the infection. In some of these cases, if the hospital has a dental service, the offending tooth can be treated or removed.
The table below displays hospitalization charges for non-traumatic dental conditions in 2021 for Florida. There were a total of 3,165 hospitalizations with hospitals charging $167,327,810. The primary payer was Medicare representing the large number of older, probably medically compromised older patients admitted to the hospital. Again, these charges fall upon the shoulders of all Floridians for reasons cited above.
|Payor Source||Total Hospitalizations||Total Charges|
|Commercial Insurance||757||$37,985, 968|
|All Others**||280||$14,351, 029|
The American Dental Association Health Policy Institute, working with Florida Voices for Health estimated that a dental benefit in Florida’s adult Medicaid would cost approximately $30 million dollars a year by the third year of implementation (see citation below). Considering the total expenditures for hospital ER visits and hospitalizations of nearly $550 million in 2021, hundreds of millions of dollars could be saved annually by significantly reducing expenditures for Hospital ER visits and hospitalizations – not to mention preventing much pain, infection and suffering in Florida residents.
On average, over $45 billion of work productivity is lost each year in the United States due to untreated oral disease. Another study found 92.4 million work or school hours were lost annually for emergency (unplanned) dental care. Black, Indigenous, and People of Color (BIPOC) and those with less than a high school diploma are disproportionately impacted. With Florida being the third most populated state, a tremendous chunk of lost productivity in adults and children can be attributed to the Sunshine State.
In addition, nearly 18% of working adults report the appearance of their teeth affects their ability to interview for a job. This percentage increases to 29% for people with low incomes.
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 in this report.