Docstoc

Linking Dental with Medical

Document Sample
Linking Dental with Medical Powered By Docstoc
					   Linking Dental with Medical:
The Role of the Dental Professional

       Carl L. Stoel, DDS, MSBA
        Senior Dental Consultant BCBSM


        American Association of
        Dental Office Managers
               October 27, 2007




                                         1
Linking Dental with Medical:
The Role of the Dental Professional


                       Agenda
       Making the Link to Overall Health
       Roles and Responsibilities:
          Health Plans
          BCBSM
          Physician
          Dental Professional



                                            2
Connecting Oral Health to Overall Health




                         BCBSM




                Dental           Medical




         Health plans make the link

                                           3
Connecting Oral Health to Overall Health




 ―You’re not healthy without good oral health.‖

                                       Dr. C. Everett Koop
            Former U.S. Surgeon General Chairman, Oral Health 2000




                                                                     4
Terminology and Definitions



 You may understand but your customers may not:
   12 percent of the adult population can’t understand
   health information that doctors, hospitals and
   insurers use




                                                         5
Terminology and Definitions



    Medical
    •   Diabetes
    •   Hypertension
    •   Ischemic Heart Disease
    •   Low Birth Weight
    •   Osteoporosis




                                 6
Terminology and Definitions


  Gingivitis                   Periodontal disease
  • Inflammation of gingival   • Bacteria and toxins that
    tissue without loss of       invade tissues around the
    connective tissue            tooth
                               • Causes gum
                                 inflammation
                               • Brings about tooth loss
                               • Bacteria and toxins enter
          Frequent teeth
           cleanings and
                                 blood stream and invade
        complex periodontal      other areas of the body
        services reduce the    • 34% of people over 30
            incidence of
        periodontal disease      years old have
                                 periodontal disease

                                                             7
Other Medical-Dental Disease Links


    •   Oral cancer
    •   Radiation and chemotherapy - osteoradionecrosis
    •   Pulmonary disease (aspiration pneumonia)
    •   Stroke
    •   Heart valve replacement
    •   Joint replacement
    •   Post cancer surgery complications
    •   Pancreatic cancer in men
    •   Medications and xerostomia
    •   Auto-immune diseases


                                                          8
Other Medical-Dental Disease Links



     • HIV
     • Lichen planus
     • Gingival infiltration in acute myelogenous
       leukemia
     • Bulimia
     • Bisphosphonate-related osteonecrosis
     • Chronic kidney failure/renal insufficiency
     • Sjogren’s syndrome




                                                    9
Dental Care History and Trivia



                                 10
History of Dental Care



• 2600 BC - Death of Hesy-Re, an Egyptian scribe, often called the
first ―dentist‖
    – An inscription on his tomb includes the title, ―the greatest of those who
      deal with teeth, and of physicians.‖ This is the earliest known
      reference to a person identified as a dental practitioner.

• 500 to 1000 AD - During the early Middle Ages in Europe, medicine,
  surgery, and dentistry are generally practiced by monks, the most
  educated people of the period

Source: ada.org




                                                                              11
Making the Link to Overall Health




                                    12
Dental Care – For a Lifetime



  Dental care starts early
  • 1st exam 1-3 years old
  • Counseling with caregiver
  • Cavity prevention – fluoride
    rinse and/or fluoride varnish
  • Preventive twice-yearly
    cleanings




                                    13
Dental Care – For a Lifetime


   Adding Value
   • Middle and later years
      – Effects of systemic disease treatment on oral health
      – Effects of medications on oral health
      – Identifying risks associated with oral health as one ages
   • Some Medicare HMO plans are recognizing the link
     and adding basic dental benefits to their plans




                                                                    14
Making the Link
Dentistry – The Forefront of Overall Health



  Patients visit the dentist more frequently than
  their regular physician.




                                                    15
Making the Link
Dentistry – The Forefront of Overall Health


 • Dental exams and health questionnaire can help
     – Assess overall health
     – Uncover hypertension
     – Uncover cardiovascular disease
     – Detect oral cancer - accounts for 2% to 4% of cancers in the
       U.S.
     – Diagnose and treat periodontal (gum) disease - 80 percent of
       adults will have some form of periodontal disease
 • This leads to overall better health
 Source: cdc.gov




                                                                  16
Making the Link to Overall Health:
Diabetes



 What is the annual direct cost of diabetes in the U.S.?
 A) $500 million
 B) $1.8 billion
 C) $27 billion
 D) $92 billion




                                                           17
Making the Link to Overall Health:
Diabetes



• Centers for Disease Control data for the year 2002
  shows direct costs of $92 billion, and total costs of
  $132 billion
• BCBSM (a large health plan) data indicates average
  annual costs of $8,600 per member
• Affects 7 percent of the U.S. population

Source: cdc.gov




                                                          18
Making the Link to Overall Health:
Diabetes



• Periodontal disease worsens diabetes – bacteria
  released into the blood stream contributes to the
  inflammatory process
• Diabetes worsens periodontal disease – weakening of
  connective tissue structure affects gums




                                                        19
Making the Link to Overall Health:
Heart Disease



 What is the percentage of deaths in the U.S. due to
 heart disease?
 A) 15 percent
 B) 19 percent
 C) 26 percent
 D) 29 percent


                                                       20
Making the Link to Overall Health:
Heart Disease


• Heart disease accounts for 29 percent of deaths in the
  United States
• BCBSM data shows average annual cost of ischemic
  heart disease of $10,500 per member
• CDC projects cost of heart disease in the U.S. at
  $393 billion
Source: cdc.gov




                                                           21
Making the Link to Overall Health:
Heart Disease


• Bacteria found in the plaque of the arterial walls include
  many of the same types found in the periodontal
  pockets
• Bacteria creates an inflammation that causes plaque
  build-up in the small arteries of the heart, restricting
  blood flow to the heart muscle, which can lead to a
  heart attack

Source: cdc.gov



                                                             22
Making the Link to Overall Health:
Low Birth Weight Babies


 What is the average cost of a preterm birth?
    A) $5,000
    B) $7,500
    C) $9,000
    D) $10,500




                                                23
Making the Link to Overall Health:
Low Birth-Weight Babies


• CDC calculates the average cost of a preterm birth at
  $10,500
• Overall medical costs exceed $5 billion
• In 2000, 11.6 percent of infants were born preterm in
  the U.S.
Source: cdc.gov




                                                          24
Making the Link to Overall Health:
Low Birth-Weight Babies


• Hormonal fluctuations can lead to gingivitis and
  periodontal disease
• Bacteria of periodontal disease is also found in
  amniotic fluid and placenta
• Mothers with periodontal disease tend to deliver
  premature babies
  Source: cdc.gov




                                                     25
Making the Link to Overall Health:
Oral Cancer



  How many people are diagnosed with oral cancer in the
  U.S. each year?
     A) 15,000
     B) 20,000
     C) 25,000
     D) 30,000



                                                      26
Making the Link to Overall Health:
Oral Cancer


  • According to the CDC, 30,000 people in the U.S. are
    diagnosed with oral cancer every year
  • Oral and pharyngeal cancer account for 2% to 4% of
    cancers diagnosed in the U.S.
  • Oral cancer occurs twice as often in males as females
  • Tobacco users have a high incidence of oral cancer

  Source: cdc.gov




                                                          27
Making the Link to Overall Health:
Oral Cancer


  Early detection of oral cancer enables less invasive
  treatment, higher survival rate
  – Early stage survival rate is 80%
  – Late stage five-year survival rate is 20%

  Source: cdc.gov




                                                         28
Making the Link to Overall Health:
Oral Cancer


• Some health plans cover dental oral brush biopsy, an
  early detection tool
• Some plans like BCBSM offer smoking cessation
  programs to members and have developed specific
  tools to help medical providers discuss tobacco with at-
  risk patients




                                                         29
Making the Link to Overall Health:
Oral Piercing


 • Oral piercing involving the tongue, lips, cheeks, uvula or
   a combination of sites implicated in adverse oral systemic
   conditions
 • Following piercing certain symptoms are common
     –   Pain and swelling
     –   Infection
     –   Increased salivary flow
     –   Injuries to the gum tissue
 • Additional risks
     – Obstructed airway due to pronounced edema
     – Aspiration of jewelry

     Source: ada.org


                                                                30
Roles and Responsibilities:
Health Plans



    •   Innovative plan designs
    •   Use of evidence-based dentistry guidelines
    •   Additional benefits for at-risk patients
    •   Work with societies to encourage dentists to
        donate their time to free clinics




                                                       31
Roles and Responsibilities:
Health Plans


    • Education to promote awareness among:
       – Dentists
       – Physicians
       – Professional societies
       – Plan members
       – General public




                                              32
Roles and Responsibilities:
BCBSM


• Collaborating with University of Michigan School of
  Dentistry on research project to demonstrate and
  quantify medical savings of good oral care in diabetic
  patients
• Donating $1 million in grants in 2007 to 32 free health
  care clinics that provide low-or-no-cost health or dental
  care to more than 78,000 uninsured people
• Incorporating preventive dental services into some
  medical plans
• Offering individual products so members who lose group
  coverage can continue dental care
                                                         33
Roles and Responsibilities:
BCBSM


• Coupons for
   – Extra free cleaning to medical and dental members who suffer
     from diabetes or ischemic heart disease
   – Extra free cleaning for medical and dental members who are
     pregnant—doctors and nurse-midwives give coupon to patient at
     time of diagnosis
   – ―Quit the Nic‖ smoking cessation program participants
• ―Happy Birthday‖ mailer to parents of 3-year-olds to
  encourage regular dental care



                                                                34
Roles and Responsibilities:
Physician



  • Be aware of link between oral disease and systemic
    diseases including diabetes, heart disease, and
    pregnancy complications
  • Ask patients if they are seeing a dentist regularly
  • Observe oral soft and hard tissues
  • Work with dentist to manage co-morbidity associated
    with systemic inflammation and oral periodontal
    disease
  • Make appropriate referrals

                                                      35
Roles and Responsibilities:
Dental Professional



    Dentist can detect 120 disease symptoms
    in the mouth
    • Early detection of systemic diseases and
      recognition of oral manifestations
    • Often first to identify a systemic health problem
      based on what they see in the patient’s mouth
    • Oral evaluation and diagnosis



                                                          36
Roles and Responsibilities:
Dental Professional



   Periodontal risk assessment
   • Educate patients about link between periodontal
     disease and systemic diseases
   • Periodontal scaling and root planing
   • Periodontal maintenance
   • Antimicrobial therapy
   • More frequent prophylaxis



                                                       37
Roles and Responsibilities:
Dental Professional


   Influence your patients’ oral health to improve
   their overall health
   • Get patients into the chair for preventive and
     periodontal services
   • Identify patients that have medical conditions which
     may require more frequent preventive visits
   • Get patients back for treatment
   • Reactivate patients


                                                        38
Roles and Responsibilities:
Dental Professional



   • At-risk patients need to be motivated
       – BCBSM group project
       – Patient awards and incentives
   •   Recognize the risk status of the patient
   •   Educate the patient
   •   Provide counseling
   •   Distribute brochures and information



                                                  39
Roles and Responsibilities:
Dental Professional



  Intervention is key
  • Referrals to periodontal specialists
  • Referrals to physicians
  • Develop relationships with physician colleagues




                                                      40
Roles and Responsibilities:
Dental Professional


  Insurance carriers have stepped up to the
  plate. Now it’s the dental professional’s turn.
   –   Embrace the new information
   –   Stay on top of patient recalls
   –   Fill your appointment books
   –   Use your people skills to influence patients
       • Improved oral and overall health = better quality of life
       • Better oral health could reduce overall health care cost



                                                                     41
Connecting Oral Health to Overall Health




                         BCBSM




                Dental           Medical




   Dental professionals can make the link!

                                             42
For Additional Information

               cdc.gov
               content.nejm
               oralhealthamerica.org
               deltadental.com
               ada.org
               jada.ada.org
               allaboutvision.com
               oral-cancer.org
               kff.org
               healthdecisions.org
               ebri.org
               vsp.com
               nei.nih.gov/health
               deltadental.com
               aaopt.org
               aoa.org
               preventblindness.org
               benefitselling.com
               socsci.uci.edu
               diabetes.org
               BlueHealthConnection.com

                                          43
Questions?




             44

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:94
posted:4/11/2008
language:English
pages:44