linking dental with medical presentation by dr. carl stoel dds

8/3/2019 Linking Dental With Medical Presentation by Dr. Carl Stoel DDS

http://slidepdf.com/reader/full/linking-dental-with-medical-presentation-by-dr-carl-stoel-dds 1/44

1

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



2

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



3

Connecting Oral Health to Overall Health

Medical

BCBSM

Dental

Health plans make the link



4


³You¶re not healthy without good oral health.´

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



5

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



6


Medical

Diabetes Hypertension

Ischemic Heart Disease

Low Birth Weight

Osteoporosis



7


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



8

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



9

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



10

Dental Care History and Trivia



11

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



12

Making the Link to Overall Health



13

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



14

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



15

Making the LinkDentistry ± The Forefront of Overall Health

Patients visit the dentist more frequently than

their regular physician.



16

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



17

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



18


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



19


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



20

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



21


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



22


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



23

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



24

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



25

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



26

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



27


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



28


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



29


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



30

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



31

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



32

Roles and Responsibilities:Health Plans

Education to promote awareness among: ± Dentists

± Physicians

± Professional societies

± Plan members

± General public



33

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



34

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



35

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



36

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



37


Periodontal risk assessment

Educate patients about link between periodontaldisease and systemic diseases

Periodontal scaling and root planing

Periodontal maintenance

Antimicrobial therapy More frequent prophylaxis



38


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



39


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



40


Intervention is key

Referrals to periodontal specialists Referrals to physicians

Develop relationships with physician colleagues



41


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



42


Medical

BCBSM

Dental

Dental professionals can make the link!



43

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



44

Questions?

linking dental with medical presentation by dr. carl stoel dds

Documents