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

Our Study: Insured People With Diabetes

This commentary presents new data from a substantial population of individuals, with both medical and dental coverage from the same carrier (CIGNA, Philadelphia, Pennsylvania). For the analysis, insured persons with diabetes were divided into 2 groups:

  • Those who had received treatment for their periodontal disease and were well maintained; and

  • Those who did not complete periodontal treatment or maintenance.

The medical costs in each of these groups 2 years after the periodontal treatment were compared to test the hypothesis that periodontal treatment was associated with a reduction in the cost of medical care in patients with diabetes. This retrospective study used a merged medical and dental claims database (stripped of patient identifiers) and was classified as exempt by the University of Pennsylvania Institutional Review Board. The data covered a 3-year period (2006-2008), and included 46,094 patients.

In addition to medical costs, the database included the medical diagnostic group Episode Treatment Group® (ETG®, Ingenix, Eden Prairie, Minnesota), and dental procedure codes. To be eligible to be included in this analysis, the medical practitioner must have classified the patient as having diabetes (ETG 1630) in the year 2006.

Because dental diagnostic codes are not currently in use, a presumptive diagnosis of periodontal disease was made if there was evidence of active periodontal therapy using the CDT dental procedure codes (D4210, D4211, D4240, D4241, D4245, D4260, D4261, D4263, D4264, D4265, D4266, D4267, D4274, D4341, D4342, D4381, and D4910). The first group included patients who received active periodontal therapy in 2006 and were well maintained thereafter (active periodontal treatment group). The second group included patients who received 1 or 2 procedures for treatment (usually incomplete scaling and root planing) of their periodontal disease before or during 2006, but did not complete their periodontal care or seek regular maintenance thereafter (control group). Both groups of patients were assumed to have periodontal disease, because they received at least some periodontal therapy. Patients in either of these groups may have been treated by a dentist for other conditions, including restorative needs.

Comparison of Medical Costs

The active periodontal treatment group received periodontal care in 2006 and maintenance therapy from 2006 to 2008. The control group did not follow through with periodontal care, including maintenance. A multifactorial analysis of variance was performed. Independent variables included age (in 2006), sex, and periodontal treatment (active periodontal treatment or control group). The dependent variable was the total cost of medical care in 2008 (2 years after active periodontal treatment). The results are shown in the figure (Figure).

Figure. Medical costs before and after periodontal treatment.

Medical costs did not differ between the 2 groups for the baseline year, 2006. In 2008, the control group had significantly higher medical costs than the active periodontal treatment group. (P = .021). A mean yearly savings of $2483.51 per patient was realized, independent of age. These savings occurred 2 years after periodontal treatment, suggesting that periodontal treatment had a lasting effect on these patients with diabetes. In men, the savings were $3212.36 in medical costs per patient, favoring the periodontal treatment group (P < .03). In women, the savings were smaller ($735.27 per patient) but still significant (P < .05).

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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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