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Guest commentary / Early disease prevention

The high cost of neglecting oral health

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By Dr. Jo Jackson and Dr. Eve Rutherford
There has been a lot of recent national attention focused on the problems many people have accessing dental care in this country. PBS's Frontline raised this issue in June, noting that 100 million Americans don't go to the dentist because they can't afford it. The U.S. Senate held a hearing on the lack of access to dental care, and the Pew Center on the States released a national report on the high costs when patients have no option but to seek pain relief in emergency rooms.
Oral health is a key component of overall health. Unfortunately, in our fragmented health-care system, oral health is too often overlooked. This needs to change.
Kids with painful decay are less able to learn. Adults with dental problems have difficulty finding jobs. Seniors with oral disease often don't get proper nutrition. Dental disease is a leading cause of school absenteeism, reduces economic productivity and contributes to higher health care costs. It also harms individuals who suffer from the terrible pain and stigma associated with untreated dental disease. Young children, seniors, pregnant women, and people with diabetes are especially vulnerable.
Poor oral health is expensive for families, for businesses and for taxpayers. The good news is dental disease is preventable and prevention saves money. Unfortunately when budgets are tight, disease prevention is often one of the first things that is cut. This is shortsighted. A failure to provide dental care will ultimately cost far more in the long run.
Recent research found a 32 percent reduction in medical costs for diabetics that received oral health care. The infection and chronic inflammation associated with gum disease can make it more difficult for diabetics to control their blood sugar levels. Uncontrolled diabetes can result in medical complications and costly hospitalizations. The same study determined that oral health care reduced hospital admissions for diabetic patients by 61 percent in the first year.
In Washington the opportunity exists to improve health and reduce costs by doing a better job of protecting oral health, especially for diabetic patients. There are approximately 60,000 diabetic adults covered by the state's Medicaid program. Bringing back dental coverage for this population would be a cost-effective policy solution.
One of the consequences of the 2011 cut to the Medicaid adult dental program is more people will seek expensive care in hospital emergency rooms. According to the Washington State Hospital Association, over an 18-month period the cost of more than 54,000 dental-related visits to ERs exceeded $35 million, and this was prior to the cut. Preventable trips to overcrowded emergency rooms are an unnecessary expense that increases the cost of Medicaid and wastes taxpayer dollars.
One way to avoid these unnecessary ER visits is engaging primary care medical providers in oral disease prevention. Healthcare delivery systems are moving towards the "Health Home" model in which primary care providers address health of the whole patient and coordinate care with specialists. Including oral health in the Health Home is an opportunity to catch dental problems early before they negatively affect overall health. In addition, patients can be referred to more cost-effective community resources for dental care.
Preventing dental disease by providing access to timely, effective dental care is a good investment. That is why state policymakers should take action to restore dental coverage for Medicaid-insured adults. The health dividends are significant, and so are the savings. Plus, it is the right thing to do because everyone deserves healthy teeth.

Jo Jackson, MD, is a lecturer and faculty physician in the University of Washington's Department of Family Medicine.

Eve Rutherford is a dentist practicing in Snohomish, a board member of Washington Dental Service Foundation.

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