Periodontal Care Cuts Admissions, Costs for Diabetes and CVD

Laird Harrison

March 21, 2014

Patients who get care for their periodontitis are less likely to require treatment for diabetes and cardiovascular disease or to have a preterm delivery, a new analysis of insurance company records shows.

The study supports the theory that treating periodontitis can improve other chronic diseases, lead author Marjorie Jeffcoat, DMD, told Medscape Medical News. "The results are big," said Dr. Jeffcoat, a professor of periodontics at the University of Pennsylvania, Philadelphia, who presented the findings on March 21 at the American Academy of Dental Research meeting in Charlotte, North Carolina.

Researchers have long suspected a relationship between oral diseases and those in the rest of the body, but studies looking for an effect of periodontal treatments on systemic diseases have produced mixed results, she noted.

Reduced Costs for Chronic Disease With Periodontal Care

To shed more light on the question, Dr. Jeffcoat and colleagues looked at the records of Highmark Health, which offers medical insurance in its own name and dental insurance through its subsidiary, United Concordia.

They used 2005–2009 claims data to identify 338,891 people with evidence of periodontal disease, of whom 91,242 also had type 2 diabetes, 81,439 had rheumatoid arthritis, 13,007 had cerebral vascular disease, 8458 had coronary artery disease, and 8342 of whom were pregnant with their first child. They compared those who had periodontal treatment with those who did not.

They found that those who chose the care were less likely to be hospitalized for illness associated with type 2 diabetes, cerebral vascular disease, coronary artery disease, and complications associated with the preterm birth of their children.

Overall, the patients who received periodontal treatment cost the insurer significantly less in claims associated with their systemic conditions, the researchers found.

Those who got periodontal care were also less likely to make claims or be hospitalized for reasons associated with their rheumatoid arthritis, but the difference was not statistically significant for this outcome.

Mean Reductions in Costs and Hospitalizations With Periodontal Therapy

Systemic condition Mean cost savings per subject/y ($) Mean reduction in costs per subject/y (%) P for cost reduction Mean reduction in hospital admissions per 1000 subjects/y (%) P for hospital-admission reduction
Type 2 diabetes 2840 40.2 < .04 39.4 < .05
CVD 5681 40.9 < .04 21.2 < .002
CAD 1090 10.7 < .04 28.6 < .01
RA 581 6.3 NS 4.5 NS
First pregnancy in period 2005–2009 2433 73.7 < .001 NA NA
CVD = cardiovascular disease
CAD = coronary artery disease
RA = rheumatoid arthritis
NS = not signification
NA = not applicable

"Cost is a good surrogate for whether or not the patient was sick," said Dr. Jeffcoat. Periodontal treatments might ameliorate many systemic diseases because inflammation plays a secondary role in them, she suggested.

On the other hand, the treatment might not have a significant effect on rheumatoid arthritis because it's primarily an inflammatory disease.

"Personally I feel — and I don't have data to show it — that if you have an inflammatory disease you have so many inflammatory mediators going around that upping them or lowering them a little bit you're not making a big effect in the outcome, whereas in a disease like diabetes, you are making a difference," she said.

"And you are making a difference in cardiovascular diseases because they are not [primary] inflammatory diseases."

No Proof of Cause and Effect but Good Dental Care Advised

But the study falls short of proving that periodontal treatment can improve systemic conditions, Elizabeth Seaquist, MD, president of medicine and science for the American Diabetes Association, told Medscape Medical News.

"All we can tell from this abstract is that it's an interesting association," said Dr. Seaquist. "I don't think we can say that there is necessarily a cause and effect."

For example, people who get treatment for periodontal disease might be more likely to take care of their health in general, which could explain why they need less care for other conditions, she said.

But Dr. Jeffcoat stressed that she and her colleagues did their best to control for this. "Whatever you measure, if you measure visits to the doctor, hospitalizations, they are all virtually identical at baseline, between the groups that chose to be treated once they had a diagnosis of periodontal disease and those that didn't," she said. "So that would militate against a role of these as people who just aren't taking care of themselves."

Both researchers have previously undertaken randomized controlled trials in search of more incontrovertible evidence.

In a study published last year (JAMA.2013;310:2523-2532), Dr. Seaquist and colleagues from multiple centers randomly assigned 519 people with both type 2 diabetes and untreated chronic periodontitis to either receive periodontal treatment or not.

They found no difference between the groups in HbA1c, a key marker of glycemic control in diabetes.

On the other hand, in a previous study (BJOG. 2011;118: 250–256), Dr. Jeffcoat and colleagues randomly assigned 322 pregnant women with periodontal disease to either receive periodontal care or not. Those who were successfully treated for periodontitis had a much lower rate of preterm birth than the others.

Regardless of these discrepancies, Drs. Jeffcoat and Seaquist both agree that physicians treating patients with systemic conditions like diabetes should make sure those patients are getting good dental care.

Dr. Seaquist is a member of advisory committees/review panels for and has received research grants from United Concordia Companies. Dr. Jeffcoat has reported no relevant financial relationships.

American Association for Dental Research. Abstract 690, presented March 21, 2014.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.