Managing Oral Health

Managing Oral HealthPeggy Sue: Grandpa, if you had a chance to go back and do it all differently, what would you have changed?

Grandpa: Well, I would have taken better care of my teeth.

– Peggy Sue Got Married (1986)

Words to live by.

The Massachusetts Health Policy Commission (HPC) had a board meeting this past week and oral health was on the agenda.1 Why address this issue? Because the Commission’s objective is to develop policies that reduce growth in health care expenses and improve quality of patient services.2 Thus, topics such as access to dental care must be addressed.

I know a number of financially secure friends who have comprehensive dental insurance, but do not take advantage of routine cleanings or check-ups. Perhaps after this week’s Update, a few might consider making a dental pit stop to brighten their summer smiles.

Here is a list of issues that may lead to preventable health conditions:

• Tooth decay
• Inflammation of the dental pulp and guns
• Poor fillings
• Loss of teeth due to trauma
• Inflammation of the ling of the cheeks, lips, and tongue

And the serious problems they can lead to:

• Heart and lung disease
• Osteoporosis
• Diabetes
• Low-birthweight

On the positive side, regular dental care can actually reduce overall health care expenses and potentially lower the number of hospitalizations for certain conditions, such as rheumatoid arthritis.

Want another good reason to go to the dentist? An important cost driver is emergency room (ER) visits related to conditions that could have been treated in a regular dental office visit. In 2014, there were 349 (dental-related) ER visits per 1,000 patients in Massachusetts – and these were a lot more expensive than simple preventative care. (This ratio is higher than the national average, but I’d be willing to wager that the rising cost of dental care is an issue across the country.) Emergency room services can range from $400 to $1,500, compared to $90 to $200 at a dental office. Moreover, since ER’s are not designed to handle comprehensive dental care, 80% of those patients will require a dental visit anyway, which will obviously compound costs.

Why so many emergency visits? There are a host of reasons, including a limited availability of practicing dentists in certain geographic areas, lack of affordable insurance coverage, and low household incomes. And, ninety percent are adults under the age of 65, and the largest cohort is between 19 and 34.

Additionally, less than 1.5 persons per thousand in every cohort over the age of 65 utilized the ER for dental issues. Another significant statistic is that almost 49% of preventable oral health related ER visits were made by MassHealth (Medicaid) patients but, MassHealth insurance only covered one third of those visits. It is also important to note that MassHealth (the second largest insurer in the State) insures approximately 25% of residents.

Areas that experienced the most ER visits were communities that had a small population/dentist ratio combined with a lower median income – compared to the Commonwealth as a whole. (I would imagine that this trend is probably consistent throughout the nation.)

Massachusetts is considering several options to improve oral health, since it impacts both quality of life and health care costs at the individual, state, and federal levels. Some ideas include licensing mid-level dental providers and telemedicine initiatives, which in theory will ostensibly increase access to dental care through expanded capacity and technology.

Not everyone is on board when it comes to licensing mid-level practitioners, as is evidenced below in a full-page Boston Sunday Globe ad sponsored by the Massachusetts Dental Society (MDS).

Globe Screenshot 2

Do I support the MDS position? I agree that we should not rush to make a decision, but I do not believe all of the responsibility should be placed on the shoulders of the MassHealth insurance program and taxpayers.

Nurse practitioners and physician assistants play an important role in the delivery of quality health care today, and they are not eliminating jobs for doctors. Will creating a mid-level practitioner deliver more access to quality dental care while actually lowering costs? Possibly. It depends on the level of training and qualifications associated with the position. Some questions must still be answered. Will dental practitioners be required to work directly for a dentist? Will practicing dentists be involved in developing job specifications? What have been the results of licensing mid-level practitioners in other states across the country?

Ultimately, states need to study the potential benefits of employing mid-level practitioners in an industry that has fewer dentists than doctors.

Is it important to take care of your oral health? Absolutely, both for your well-being and your budget.