Does Treatment of Oral Disease Reduce the Costs of Medical Care?

Marjorie Jeffcoat, DMD; Nipul K. Tanna, DMD, MS; Clay Hedlund, DDS; Michael S. Hahn, DDS; Miles Hall, DDS, MBA; Robert J. Genco, DDS, PhD

|Disclosures|October 19, 2011

Editor's Note

The following analysis, although not a randomized controlled trial, tests a potential, and important, association between oral and systemic health. Data are derived from a convenience sample of insured persons with both diabetes and periodontal disease. Although the generalizability of these results to other populations (such as the uninsured) is not known, we believe that these findings could serve as a springboard for further research exploring this association. This compelling preliminary analysis may be of interest to researchers in many arenas, including dentistry, chronic disease, and healthcare costs.

Mining Insurance Data to Answer Clinical Questions

The exploratory studies needed to detect associations between clinical conditions and potential contributing factors (demographic, environmental, genetic, or medical) pose a special challenge in research. On one hand, large sample sizes are needed to detect subtle influences in the presence of strong known effects (eg, smoking) or confounders. On the other hand, the tentative nature of the hypothesis may not justify the effort and cost of large (usually multicenter) randomized controlled trials at an early stage of knowledge. When possible, researchers seek to "mine" historical records as an early step in determining the credibility of a hypothesis. We, as well as others, have found insurance records to be especially rich and reliable sources of health data (such as healthcare costs). What they lack in medical, dental, behavioral, and adherence detail is often offset by their uniformity and sheer size. The trick is to formulate the research question in a way that it can be answered from the available data.

This article discusses how data from a group of large private insurance plans were used to investigate whether periodontal health affects the cost of medical care in patients with type 2 diabetes. Although the findings are interesting, the process may also be relevant to other clinicians trying to interpret reports derived from these valuable data sources.

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Authors and Disclosures


Marjorie Jeffcoat, DMD

Professor and Dean Emeritus, University of Pennsylvania School of Dental Medicine, Philadelphia; Professor, Hospital of the University of Pennsylvania, Philadelphia

Disclosure: Marjorie Jeffcoat, DMD, has disclosed the following relevant relationships:
Served as a director, officer, partner, employee, advisor, consultant or trustee for: University of Pennsylvania (employee); Cigna (reviewer); NIH (reviewer); FDA (panel chair); United Concordia
Received research grant from: Proctor & Gamble; Warner Chilcott; United Concordia
Received income in an amount or equal to or greater than $250 from: United Concordia (honoraria)

Nipul K. Tanna, DMD, MS

Assistant Professor of Preventive and Restorative Sciences, University of Pennsylvania, Philadelphia

Disclosure: Nipul K. Tanna, DMD, MS, has disclosed no relevant financial relationships.

Clay Hedlund, DDS

Dental Director, CIGNA Dental, Plano, Texas

Disclosure: Clay Hedlund, DDS, has disclosed the following relevant financial relationships:
Serves as an employee of: CIGNA Dental Health, Inc.

Michael Hahn, DDS

National Dental Director, CIGNA Dental, Philadelphia, Pennsylvania

Disclosure: Michael Hahn, DDS, has disclosed the following relevant financial relationships:
Serves as an employee of: CIGNA Dental Health, Inc.

Miles Hall, DDS, MBA

Chief Clinical Director, CIGNA Dental, Plano, Texas

Disclosure: Miles Hall, DDS, MBA, has disclosed the following relevant financial relationships:
Serves as an employee of: CIGNA Dental Health, Inc.

Robert J. Genco, DDS, PhD

Distinguished Professor of Oral Biology and Microbiology, State University of New York at Buffalo, Amherst

Disclosure: Robert J. Genco, DDS, PhD, has disclosed the following relevant financial relationships:
Served as a director, officer, partner, employee, advisor, consultant, or trustee for: Colgate, Procter and Gamble, SunStar
Received a research grant from: SunStar, Procter and Gamble
Received income in an amount equal to or greater than $250 from: SunStar, Colgate


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