Oral Health – Its Impact on Medicaid Populations

We sometimes view oral health as simply that of good dental care.  Yet it goes beyond maintaining the hard enamel structure of teeth, a structure so impervious that remaining dentition can often times be used as a tool for identification when all other human structures have decomposed.

Abundant bacterial colonies found in the oral environment have the power to not only destroy the strong enamel matrix of teeth, but create a host of other oral diseases, many of which have now been associated with medical conditions that effect overall health.

Medicaid populations are especially vulnerable to poor oral health due to social-economic, racial, age, physical/behavioral disabilities, and cultural disparities that significantly impact availability and quality of care.  Many States offer no or limited dental benefits for adult populations.  And no dental benefit is available under Medicare.  While addressing many of the social determinants of health care, through value added health equities programs, Medicaid plans struggle to identify resources and funding for oral health interventions.

The oral environment can be an adjunctive portal through which host bacteria can disseminate systemically.  Studies, some of which conducted by Aetna in collaboration with Columbia University, have shown several diseases including heart conditions, stroke, and diabetes can be affected.  Providing periodontal therapy can significantly lower medical costs (up to 74%) and reduce hospital admissions (up to 39%).¹  Research is just beginning to find additional links, including a potential oral marker for colon cancer.

Most importantly, poor oral health can have an impact on preterm birth/low birth weight infants. In 2001, 8% of all 4.6 million infant stays nationwide included a diagnosis of preterm birth/low birth weight. Preterm/low birth weight infant stays averaged between $15,100 and $65,600, (for infants with specific respiratory-related complications).  Of all preterm/low birth weight infant stays, 42% designated Medicaid as the expected payer.  This same study additionally states, “Preterm/low birth weight infants in the United States account for half of infant hospitalization costs and one quarter of pediatric costs, suggesting that major infant and pediatric cost savings could be realized by preventing preterm birth.”²   Additionally, this does not address the additional lifelong costs due to debilitating handicaps in many of these infants.  

In general, periodontal disease, in various stages, impacts 50-70% of the population.  Studies have focused on improving periodontal health during pregnancy and the resultant effect on preterm birth/low birth weight infants.  Jeffcoat et al. reported a reduced, though not statistically significant, risk of premature birth in women with periodontal disease who received scaling and root planning or dental prophylaxis treatment.³

Additional Aetna/Columbia University studies (2011) have shown an association between improved dental care while pregnant and pre-term labor (25%)  or low birth weight (34%). While these studies  demonstrate a potential for improving medical costs with better health outcomes, additional studies may be needed to understand the impact on Medicaid populations.                   

For children, Streptococci Mutans are the most common bacteria implicated in the initiation of dental caries.  As children are not born with S. Mutans, it is predominately acquired from mother’s saliva. Improving the oral health of the mother through restorative treatment of caries, consistent use of anti-microbial oral rinses, and use of Xylitol products has a significant impact on mother-child transmission of S. Mutans thereby preventing or delaying colonization.⁴

Once colonization has occurred it is important that the child receive dental visits at the earliest possible age with application of preventive fluoride varnishes by the physician and/or dental provider.

It is imperative that dental providers and physicians/medical specialists perform oral risk assessment screenings of  all patients, children as early as the eruption of the first primary tooth, adults who exhibit multiple medical co-morbidities, and pregnant women.  With limited Medicaid resources, it is essential to identify high risk members for initiation of early interventions.  Dental providers and physicians need to cross-communicate and refer as necessary. Ongoing technology developments with shared data record platforms will enhance this process.  The role of Medicaid Plans is to drive innovation for better quality outcomes, educate decision makers of the costly implications  of poor oral health and the need for appropriate resource allocation, and work with health providers at all levels to integrate and coordinate oral health into overall health through collaboration with case managers and/or oral health liaisons.

For more on oral health benefits in Medicaid, check out our issue brief here.

References

1. Jeffcoat, M. K., Jeffcoat, R. L., Gladowski, P. A., Bramson, J. B., & Blum, J. J. (2014). Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. American Journal of Preventive Medicine, 47(2), 166-174.
2. Russell, R. B., Green, N. S., Steiner, C. A., Meikle, S., Howse, J. L., Poschman, K., … & Petrini, J. R. (2007). Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics, 120(1), e1-e9.
3. Jeffcoat, M. K., Hauth, J. C., Geurs, N. C., Reddy, M. S., Cliver, S. P., Hodgkins, P. M., & Goldenberg, R. L. (2003). Periodontal disease and preterm birth: results of a pilot intervention study. Journal of Periodontology, 74(8), 1214-1218.
4. Council, O. (2007). Guideline on Oral Health Care for the Pregnant Adolescent. American Academy of Pediatric Dentistry, 33, 137-41.