COMMENTARY

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

In This Article

The Evidence: Diabetes and Periodontal Disease

Strong and growing evidence points to an association between diabetes and oral health. One third of patients with diabetes have oral complications, mainly periodontitis and tooth loss[1,2] and a large body of evidence suggests that periodontal disease is a complication of diabetes mellitus.[3,4] A recent meta-analysis shows that periodontal disease is more severe in individuals with diabetes than in individuals without diabetes, especially in those with poor glycolic control.[5]

Perhaps more intriguing is the expanding body of literature implicating severe periodontitis as a risk for poor glycemic control in type 2 diabetes.[6,7]Periodontitis puts these patients at greater risk for diabetic complications, including mortality from cardiovascular disease and diabetic nephropathy.[8,9] Periodontal treatment in individuals with diabetes can improve glycemic control,[10,11]potentially leading to a reduction of the effects of diabetes per se, and its complications.

Given such findings, one can easily visualize a vicious cycle in which diabetes leads to worsening periodontal disease, and periodontal disease leads to worsening glycemic control. Our study's hypothesis was that periodontal treatment might contribute to the successful management of diabetes, and lead to reduced cost for medical care.

Cost of Medical Care in Diabetes

Diabetes mellitus is a chronic illness affecting about 23.6 million people in the United States. In 2007, direct medical expenses were estimated to be $116 billion,[12]with an additional $58 billion in indirect expenditures related to disability, work loss, and premature death. These costs represent approximately 20% of the total healthcare expenditures in the United States.[13]This economic burden can be expected to grow with projected increases in the incidence of diabetes.[14]

Insurance databases that include patients covered by both medical and dental insurance have been used to assess the effects of dental care on medical conditions. For example, Spangler and colleagues[15] showed that glycosylated hemoglobin was reduced in insured individuals with diabetes who had periodontal therapy, and that the reduction was greater with more intense periodontal treatment. Another study that used an insurance database showed that periodontitis treatment had an impact on medical costs for those with diabetes mellitus.[16]

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