Preventive Visits Matter—A Lot

By Dr. John Luther, DentaQuest Chief Dental Officer

This week, a study featured in the June issue of Pediatrics, conducted by the Department of Health Care Organization and Policy and Lister Hill Center for Health Policy of the University of Alabama at Birmingham School of Public Health, raised a few eyebrows within the dental care community.  The study reported more preventive visits for children do not reduce overall dental or medical (inclusive of dental) expenditures.

Study researcher Bisakha Sen, PhD, and colleagues analyzed data from Alabama's Children's Health Insurance Program (CHIP) between 1998 and 2010. The database included 14,972 children younger than 8 years and 21,833 children aged 8 years or older. 

The study concluded that more preventive visits were associated with fewer subsequent non-preventive dental visits and lower non-preventive dental expenditures for both groups. However, the study also concluded preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures. 

The American Academy of Pediatric Dentistry (AAPD) responded to these conclusions by providing some important contextual considerations for the results, including the family’s ability to access care and preventive services, the levels of health literacy of the family, and social, cultural and economic pressures. 

As a dental administrator for many state health plans, DentaQuest understands that CHIP programs are the vehicle for many at-risk children to get dental care.  These children often start at a deficit, with multiple unaddressed dental needs, some more pressing than others, and therefore they need an ongoing treatment plan.  And, as the AAPD response points out, there are other costs not counted as dental, such as dental emergency room visits and services that must be performed under general anesthesia.

Preventive care is important for everyone, but especially for children. Dental disease is caused by a bacterial infection. It is the most common disease of childhood. Children with untreated dental disease have difficulties eating, learning to speak, and even stay focused in school. The impact of untreated dental disease stays with the child as he or she grows into an adult.

My key takeaway from this study is: “more preventive visits were associated with fewer subsequent non-preventive dental visits and lower non-preventive dental expenditures.” And that’s a good thing.

Prevention is a long term investment in improving lives.

Oral Health Literacy and Health Equity

By Ralph Fuccillo, DentaQuest Chief Mission Officer

Nearly nine out of ten U.S. adults find it hard to use the health information they get from their dentist or doctors’ office, in the media and even in their communities.¹

 

That is a real problem.

Limited health literacy leads people to incorrect conclusions about helpful oral health actions -- like community water fluoridation, eating a healthy diet, brushing and flossing every day, even getting regular preventive dental care visits. Limited oral health literacy is a contributor to the growing number of very young children (age 1-5) with Early Childhood Caries – aggressive dental disease –in need of repair (root canals and crowns) in operating rooms. Health literacy is something we all need to pay more attention to – as consumers, care providers, and public health advocates.

I am pleased to see that oral health literacy is gaining importance as a public health priority. Last year, I had the honor of joining a number of key national oral health leaders at the Institute of Medicine (IOM)’s Roundtable on Health Literacy. Oral health is now included on the IOM Health LiteracyRoundtable through the participation of the California Dental Association. The oral health literacy roundtable explored ways to bring oral health literacy research into oral health practice, and to do this in a way that everyone can understand. As a speaker, I had four key messages:

• The mouth is part of the body
• Cavities and gum disease are the result of a bacterial infection in the mouth
• Dental disease is preventable
• Oral health literacy is everybody’s business

As part of my presentation, I also spoke about my personal experience volunteering at a Mission of Mercy free clinic in rural Virginia. It is impossible to overstate the desperation and gratitude that I saw. I left with a different perspective on our current care delivery system. People are being left behind. People don’t have the information they need to be healthy.  

This experience motivated me to become involved in the establishment of the US National Oral Health Alliance and the DentaQuest Foundation’s multi-year Oral Health 2014 initiative. Both work to improve oral health literacy, and ultimately, the oral health of all.

In June 2012, the U.S. National Oral Health Alliance hosted a national learning event focused on Oral Health Literacy as a Pathway to Health Equity. Participants worked to develop common ground messages about oral health literacy that we can all work to achieve. I share them below because they are simple, yet so important. I hope you will consider using them in your work and your lives.

• Everyone has a stake in oral health literacy.
• Health literacy is based on genuine compassion and care. We all need a sense of empathy to meet people where they are, to listen to, learn from, and respect one another
• Prevention is the starting point for health.
• We need to use simple, clear and consistent educational messages if we are to motivate action to improve their oral health. It is important to be patient-centered and respectful of cultures, languages and customs.

1.     Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2006.

Bacteria in the Mouth are Not Harmless

By John Luther, DDS, Chief Dental Officer, DentaQuest

As a dentist, one of the first things I tell new parents is not to put something that has been in your mouth into your baby’s mouth.

So you can imagine my surprise when I heard about a Swedish study, which found that babies whose parents sucked on their pacifier to cleanse it were less likely to get eczema and asthma, two conditions caused by allergic reactions. 

The study concludes that when parents suck their child's pacifier clean, they transfer some of the harmless bacteria in their mouths to their child which makes those types of allergic reactions less likely. 

Despite this study, there is significant other research that shows that not all bacteria in the mouth are harmless. 

Cavities (caries) are the result of a bacterial infection and young children can “catch” the harmful bacteria that causes cavities. While everybody has bacteria in their mouth, it’s important to try to keep these harmful bacteria from our children’s mouths during their first year or two or they become the dominant bacteria and the child could experience a lifetime of tooth decay.

Babies most often get these bacteria from a family member who has the bacteria in his/her mouth. Cavity-causing bacteria in the adult’s mouth can be transferred easily to a child’s mouth through something as harmless as testing food to be sure it isn’t too hot, sharing a spoon of ice cream, “cleaning” the pacifier that fell on the floor in your mouth, biting off a piece of apple to share with a child, even kissing. If cavity causing bacteria are transferred to the child too early, they can be dominant for life.

Tooth decay is the most common chronic disease of childhood. It is five times more common than asthma. Untreated, tooth decay can have serious, negative effects on a child’s physical and educational development. Mouth pain makes it difficult to eat a healthy diet, to learn to speak properly, and to concentrate in school. Untreated tooth decay in baby teeth can damage a child’s permanent teeth. 

We need to remember there are a lot of studies out there. Occasionally doing something helpful in one area can cause harm in another. Early tooth decay can quickly put kids at a lifelong disadvantage. Taking care to reduce the risk of transmitting cavity-causing bacteria to babies and toddlers will better position them to fight off tooth decay as they grow.

How Data Analytics Creates Value in Dental Care

By: Shaju Puthussery, Chief Analytics Officer

As components of the Affordable Care Act (ACA) go into effect, dental benefit management is keeping pace. Health plans need a dental partner that provides products and services at attractive prices, but also one with experience in commercial and government spaces, as well as on a public exchange. And perhaps most importantly, a dental benefits partner should have the ability to go beyond claims processing into deep data analytics that create cost savings – including the potential for lower premiums – as a result. This new model goes beyond claims adjudication to collaborative engagement with providers and patients. 

In  order to gain cost savings from these partnerships, plan administrators must be able to understand and predict provider and patient behaviors and then put these assessments into action. Data analytics are the key to understanding those behaviors. With the right kind and amount of data, we can build predictive models that ultimately result in better quality of care from providers and better oral health outcomes for patients. That’s a win-win under any circumstances. But add to that the ability to control costs, and you can see why data analytics are a necessity for success in the world of consumer-driven healthcare.

Not every dental benefits organization can leverage data effectively, though. To create effective predictive models, you must start with a wealth of data. DentaQuest, for instance, has access to many years of data from more than 18 million members and thousands of providers. This is where effective modeling begins, as we use external data coupled with claims pattern data and provider utilization data. 

To find out more about how data analytics creates cost savings, sign up for our America Health Insurance Plan (AHIP) webinar, titled “Health Reform Dental Mandate and What It Means to You: The Role of Data Analytics In Value-Based Healthcare.” The webinar is on Wednesday, May 8, 2013 from 2 p.m. to 3 p.m. ET and offers an opportunity to ask our on-staff experts about dental benefits, data analytics, and how to create value in the new healthcare environment. Register today by visiting http://ahip.org/Webinar/DentalMandate/.

With the changes resulting from ACA mandates, health plans are looking for ways to differentiate themselves from competitors. Integrating high-quality dental benefits into their products is an excellent way to do this and an effective strategy to retain and grow membership.

Committed to Health Equity

By: Ralph Fuccillo, DentaQuest Chief Mission Officer

DentaQuest’s mission of improving the oral health of all includes an obligation to ensure equitable access to oral health care and prevention.  We believe everyone should have the opportunity to live a healthy life regardless of their background.

During April, the U.S. Office of Minority Health recognizes National Minority Health Month to raise awareness about health disparities that affect  people across this nation and to familiarize the public with the healthcare law's groundbreaking policies to reduce disparities and achieve health equity. 

This includes oral health. Every day, millions in America do not receive the oral health care they need for various reasons, including cultural, ethnic or language barriers, lack of oral health education, no insurance access, age or medical issues, geographic and transportation obstacles, and even roadblocks to accessing qualified oral health professionals.

Whatever the reason, the costs of inequity – with 51 million school hours and 164 hours of work missed due to due to dental problems and visits – are staggering.

As a leading U.S. oral health company, DentaQuest is in a unique position to make a difference. We serve 18 million individuals from all walks of life through Medicaid, CHIP, Medicare Advantage, commercial and individual plans. We make a particular effort to reach those who are most in need by:

• Sponsoring outreach programs focused on education and prevention through community ambassadors and local languages;
• Supporting  programs that provide dental care for adults and children with intellectual and physical disabilities;
• Providing customer care in multiple languages for our members;
• Ensuring safety net dental programs in community health centers across the U.S. are prepared to provide for the large numbers of individuals who will become eligible for dental services through the ACA, including 20 million children through the essential pediatric dental benefit, in 2014;
• Co-chairing the Region 1 Health Equity Council and making sure oral health is addressed ; and
• Advancing local leaders in 25+ states through the Oral Health 2014 Initiative, which was created to ensure oral health is part of state and community health policy.

All of us at DentaQuest are committed to removing barriers to care by emphasizing prevention and celebrating differences among our colleagues and community partners.

To learn more about National Minority Health Month and find events in your communities to become involved in health equity, visit: http://minorityhealth.has.gov/actnow/.

Ensuring All Children Have Access to Dental Care

By: DentaQuest Government Affairs and Policy Team

One of the key oral health elements of the Affordable Care Act (ACA) is the inclusion of pediatric dental as an essential health benefit (EHB). Recognizing the importance of having this benefit, HealthReformGPS recently posted a brief about how exchanges will offer pediatric dental benefits. We applaud the attention to this important benefit, and would like to add a few statements to further clarify the issue.

The HealthReformGPS brief points out there are two ways pediatric benefits will be offered: through a comprehensive plan that offers both medical and dental or through a stand-alone dental plan.  

Inside State and Federal Marketplaces

Under ACA, if an exchange offers stand-alone dental plans, qualified health plans on that exchange are not required to offer pediatric dental benefits. There is the assumption among many people that when a stand-alone dental plan is offered, the exchanges will “package” the medical and pediatric dental plans together, so the purchaser ends up with both. While this may be an option on some state-based exchanges, it is not the case universally.  

In fact, according to guidance from the United States Department of Health and Human Services (HHS),

a) the pediatric dental benefit is not required to be purchased by those shopping on an exchange, even by those with eligible children, and 

b) the Federally-Facilitated Marketplaces operated by HHS will not be able to support the offer of bundled medical and pediatric dental plans, at least in the first year. 

The unfortunate consequence is that people may purchase a qualified health plan on an exchange and not get the important pediatric dental benefit coverage.  This runs counter to intent of the ACA and its goal of ensuring all children have access to pediatric dental benefits. 

Outside the Marketplaces

Ironically, when a health plan is purchased outside of an exchange, the ACA requires that the pediatric dental benefit be included. The only way that a health plan can opt not to include the pediatric dental benefits is if the purchaser has already purchased the pediatric dental benefits from an exchange-certified stand-alone dental plan. The unfortunate consequence of the law as it is currently written is that low-income, childless adults will also be required to purchase a pediatric dental benefit that they cannot use. While we agree that families with eligible children should be enrolled in pediatric dental benefits, we hope the law is amended to exclude childless adults from this requirement. 

Tax Credits

The HealthReformGPS brief also discussed the credits available to low-income families to purchase insurance through the exchanges. The credit available to families will be calculated based on the premium associated with all 10 EHBs, including dental. When dental is purchased separately, the amount of the credit will be allocated first to the Qualified Health Plan and then to the dental plan. 

Essential is Essential

We believe the most important piece on which to focus the discussion is ensuring that all children have pediatric dental coverage whether their plan is purchased on or off the exchanges.  That is the intent of the ACA. Tooth decay is the most common chronic illness among school-age children. It affects one in every four children, yet it is almost entirely preventable when children have access to care and preventive education. The rate of tooth decay among low-income children is more than twice that for children with more income (31 percent versus 14 percent), according to the Kaiser Family Foundation. 

Clearly, it is imperative that all children have access to dental benefits. The ACA is a major step in making this happen by including pediatric dental and vision as an essential health benefit. That’s not exactly how the rules are working today. With our colleagues in the dental community, we are working with federal policymakers to ensure that all children have this benefit.

Conversations with your Dentist About Office Safety

By: Dr. John Luther, Chief Dental Officer, DentaQuest

Following the recent news about unsanitary conditions in one Oklahoma dental office, you may have wondered – if even for a second—what your dental office is doing to ensure you are receiving the best and safest dental care. Healthy teeth and gums are essential to your overall health. Dentists take their role to keep you healthy very seriously; this includes proper infection control. Your safety and well-being are their priority.

At DentaQuest, we encourage patients to have an open dialogue with their dental care team about their care; sanitation and safety concerns should be part of that. Often, as patients we become so wrapped up in the services we are receiving that we forget to ask questions to make us feel comfortable about the care. It's okay to ask your dentist about sanitary procedures of his or her office.

Here are questions to discuss with your dentist prior to your service:

• What is the sterilization process? How are non-disposable items, like the dental tools, cleaned and sterilized between patients?
• Are dental anesthetics provided using sterile, single-use needles and cartridges of anesthetic? Are these items properly discarded after each patient?
• If IV medications are needed, are the medications from single-dose vials or from multi-dose vials? How do they manage sterile procedures when using multi-dose vials? 
• Does your dentist follow the evidence-based infection control precautions outlined by the Centers for Disease Control and Prevention?
• Are all procedures requiring licensure or certification provided only by licensed professionals?

And here are some important things you can look for:

• Are the dental instruments that will be used during your visit maintained in sterile pouches until they are used? The office staff may unwrap them just prior to your entering the room while setting up for your procedure so confirm that they were sterilized and protected prior to your arrival.
• Are disposable items like needles or gauze placed in special bags or containers?
• Does the dental staff use appropriate protective garb such as gloves, masks, gowns and eye wear?  Ask how they clean or dispose of these items between patients.

The case in Oklahoma is unfortunate. However, it is not at all representative of the vast majority of dental offices that adhere to the highest standards of sanitation and infection control.