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8/3/2019 Linking Dental With Medical Presentation by Dr. Carl Stoel DDS
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Linking Dental with Medical:
The Role of the Dental ProfessionalCarl L. Stoel, DDS, MSBA
Senior Dental Consultant BCBSM
American Association of
Dental Office ManagersOctober 27, 2007
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Agenda
Making the Link to Overall Health
Roles and Responsibilities:
Health Plans
BCBSM
PhysicianDental Professional
Linking Dental with Medical:The Role of the Dental ProfessionalLinking Dental with Medical:The Role of the Dental Professional
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Connecting Oral Health to Overall Health
Medical
BCBSM
Dental
Health plans make the link
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Connecting Oral Health to Overall Health
³You¶re not healthy without good oral health.´
Dr. C. Everett KoopFormer U.S. Surgeon General Chairman, Oral Health 2000
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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 andinsurers use
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Terminology and Definitions
Medical
Diabetes Hypertension
Ischemic Heart Disease
Low Birth Weight
Osteoporosis
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Terminology and Definitions
Gingivitis Inflammation of gingival
tissue without loss of
connective tissue
Periodontal disease Bacteria and toxins that
invade tissues around thetooth
Causes guminflammation
Brings about tooth loss
Bacteria and toxins enter
blood stream and invadeother areas of the body
34% of people over 30years old haveperiodontal disease
Fr equent teeth
cleanings and
complex per iodontal
services r educe the
incidence of
per iodontal disease
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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
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Other Medical-Dental Disease Links
HIV
Lichen planus
Gingival infiltration in acute myelogenousleukemia
Bulimia
Bisphosphonate-related osteonecrosis
Chronic kidney failure/renal insufficiency Sjogren¶s syndrome
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Dental Care History and Trivia
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History of Dental Care
2600 BC - Death of Hesy-Re, an Egyptian scribe, often called thefirst ³dentist´
± An inscription on his tomb includes the title, ³the greatest of those whodeal with teeth, and of physicians.́ This is the earliest knownreference 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 mosteducated people of the period
Source: ada.org
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Making the Link to Overall Health
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Dental Care ± For a Lifetime
Dental care starts early
1st exam 1-3 years old
Counseling with caregiver
Cavity prevention ± fluoriderinse and/or fluoride varnish
Preventive twice-yearly
cleanings
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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 linkand adding basic dental benefits to their plans
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Making the LinkDentistry ± The Forefront of Overall Health
Patients visit the dentist more frequently than
their regular physician.
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Making the LinkDentistry ± 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 theU.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
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Making the Link to Overall Health:Diabetes
What is the annual direct cost of diabetes in the U.S.?
A) $5
00 millionB) $1.8 billion
C) $27 billion
D) $92 billion
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Making the Link to Overall Health:Diabetes
Centers for Disease Control data for the year 2002shows 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
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Making the Link to Overall Health:Diabetes
Periodontal disease worsens diabetes ± bacteriareleased into the blood stream contributes to the
inflammatory process
Diabetes worsens periodontal disease ± weakening of connective tissue structure affects gums
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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 percentD) 29 percent
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Making the Link to Overall Health:Heart Disease
Heart disease accounts for 29 percent of deaths in theUnited States
BCBSM data shows average annual cost of ischemicheart disease of $10,500 per member
CDC projects cost of heart disease in the U.S. at$393 billion
Source: cdc.gov
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Making the Link to Overall Health:Heart Disease
Bacteria found in the plaque of the arterial walls includemany of the same types found in the periodontal
pockets
Bacteria creates an inflammation that causes plaquebuild-up in the small arteries of the heart, restrictingblood flow to the heart muscle, which can lead to a
heart attack
Source: cdc.gov
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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
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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 inthe U.S.
Source: cdc.gov
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Hormonal fluctuations can lead to gingivitis andperiodontal disease
Bacteria of periodontal disease is also found inamniotic fluid and placenta
Mothers with periodontal disease tend to deliver premature babies
Source: cdc.gov
Making the Link to Overall Health:Low Birth-Weight Babies
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Making the Link to Overall Health:Oral Cancer
How many people are diagnosed with oral cancer in theU.S. each year?
A) 15,000
B) 20,000
C) 25,000
D) 30,000
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Making the Link to Overall Health:Oral Cancer
According to the CDC, 30,000 people in the U.S. arediagnosed 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
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Making the Link to Overall Health:Oral Cancer
Early detection of oral cancer enables less invasivetreatment, higher survival rate
± Early stage survival rate is 80%
± Late stage five-year survival rate is 20%
Source: cdc.gov
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Making the Link to Overall Health:Oral Cancer
Some health plans cover dental oral brush biopsy, anearly detection tool
Some plans like BCBSM offer smoking cessationprograms to members and have developed specifictools to help medical providers discuss tobacco with at-risk patients
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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 systemicconditions
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
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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
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Roles and Responsibilities:Health Plans
Education to promote awareness among: ± Dentists
± Physicians
± Professional societies
± Plan members
± General public
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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 diabeticpatients
Donating $1 million in grants in 2007 to 32 free healthcare clinics that provide low-or-no-cost health or dentalcare to more than 78,000 uninsured people
Incorporating preventive dental services into somemedical plans
Offering individual products so members who lose groupcoverage can continue dental care
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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 arepregnant²doctors and nurse-midwives give coupon to patient attime of diagnosis
± ³Quit the Nic´ smoking cessation program participants
³Happy Birthday´ mailer to parents of 3-year-olds toencourage regular dental care
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Roles and Responsibilities:Physician
Be aware of link between oral disease and systemicdiseases including diabetes, heart disease, andpregnancy complications
Ask patients if they are seeing a dentist regularly
Observe oral soft and hard tissues
Work with dentist to manage co-morbidity associatedwith systemic inflammation and oral periodontaldisease
Make appropriate referrals
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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
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Roles and Responsibilities:Dental Professional
Periodontal risk assessment
Educate patients about link between periodontaldisease and systemic diseases
Periodontal scaling and root planing
Periodontal maintenance
Antimicrobial therapy More frequent prophylaxis
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Roles and Responsibilities:Dental Professional
Influence your patients¶ oral health to improvetheir overall health
Get patients into the chair for preventive andperiodontal services
Identify patients that have medical conditions whichmay require more frequent preventive visits
Get patients back for treatment Reactivate patients
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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
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Roles and Responsibilities:Dental Professional
Intervention is key
Referrals to periodontal specialists Referrals to physicians
Develop relationships with physician colleagues
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Roles and Responsibilities:Dental Professional
Insurance carriers have stepped up to theplate. 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
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Connecting Oral Health to Overall Health
Medical
BCBSM
Dental
Dental professionals can make the link!
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For Additional Information
cdc.gov
content.nejm
oralhealthamerica.org
deltadental.com
ada.org
jada.ada.org
allaboutvision.comoral-cancer.org
kff.org
healthdecisions.org
ebri.org
vsp.com
nei.nih.gov/health
deltadental.com
aaopt.org aoa.org preventblindness.org
benefitselling.comsocsci.uci.edu
diabetes.org
BlueHealthConnection.com
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Questions?