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July 17, 2007

Stuart Lieberman, DMD, MBA, Associate Dental Director, CIGNA Dental

When evaluating the connection between oral health and overall health, it helps to separate the known and the unknown. Recent studies continue to demonstrate a connection between oral health and overall health.¹ These studies have shown that periodontal disease is connected to preterm birth, diabetes, cardiovascular disease, and other health complications. While this connection has been confirmed through research, it is still unknown among many employers and consumers. Therefore, as a dental insurance plan it becomes important for us to make that connection for our customers so that they too realize how their oral health can affect the rest of their bodies.

As part of this task, CIGNA has created several programs which address this connection. In addition to educating members, these programs remove cost as a barrier to receiving treatment for periodontal disease. For example, CIGNA’s Dental Oral Health Integration Program (OHIP) turns evidence into action with its industry-leading benefit enhancements for members who are pregnant or may be suffering from diabetes and/or cardiovascular disease.

Through this program, CIGNA has enabled integrated care between its dental and medical plans in an effort to improve outcomes and reduce dollars spent on high risk medical conditions. Eligible members with CIGNA medical and dental coverage may receive 100 percent reimbursement of their co-pay or coinsurance for certain dental care services, like periodontal scaling and root planing and periodontal maintenance.

For the maternity component of this program, CIGNA leverages its Healthy Babies^® program. As part of this program, medical plan members receive a comprehensive kit of information and resources to help them have a healthy pregnancy. They have access to nurses who reinforce the importance of dental care, including routine dental cleanings. The soon-to-be mother is educated on how better oral hygiene is connected to healthier pregnancy outcomes. Research supporting this connection was published in the Journal of Periodontology’s August 2003 issue.² Engaging and educating members to obtain the proper dental treatment, and reimbursing them for certain treatments received during pregnancy, can help avoid the potential emotional and financial impacts associated with preterm births.

In addition, long-term clinical observations detail the relationship between oral health and diabetes. In fact, patients with diabetes may have a more difficult time controlling their blood sugar levels, which could also make it more difficult for them to heal and maintain a healthy lifestyle. This wound healing delay, which many diabetic patients suffer from, could cause an increased risk of systemic illness and result in more extensive, possibly life-threatening complications.

Further research also points to a relationship between periodontal disease and heart disease. Bacteria and bacterial byproducts from the periodontal tissues have been found in the heart and valves of the heart, resulting in serious medical conditions. If circulated in the bloodstream, these bacteria may cause blood clots in the heart and brain, potentially leading to strokes and/or death. By reducing bacterial byproducts in the oral cavity through root planing and scaling procedures, one can reduce the potential negative effects on cardiac conditions.

Fortunately, CIGNA Dental is able to leverage the clinical capabilities of the CIGNA HealthCare disease management program for diabetes and heart disease. Program nurses and case managers can identify those at-risk and communicate the importance of appropriate dental care.

CIGNA Dental is also committed to early detection of oral cancer and added coverage for brush biopsy to all of its dental plans in January 2006. Oral cancer is the sixth deadliest cancer in America. In addition, oral cancer is particularly dangerous because it has a high risk of producing second, primary tumors.³ As a result, patients who survive a first encounter with the disease have up to a 20 times higher risk of developing a second cancer. By using the brush biopsy procedure to evaluate questionable lesions or spots, cancerous or precancerous lesions can be diagnosed at a very early, highly-curable stage.

Most recently, CIGNA Dental has begun evaluating the integration of benefits related to periodontal disease and osteoporosis, specifically their relationship to oral bone disease. In August 1999, the Journal of Periodontology published a study concluding that estrogen supplementation in women within 5 years of menopause slowed the progression of periodontal disease.⁴ This, in turn, protected the teeth from developing oral bone disease. Confirming these findings, further studies done by the University of Buffalo found that most people diagnosed with periodontal disease may be at a higher risk of underlying osteoporosis.⁵ This results in a strong relationship between the advanced form of gum disease that causes bone loss, gum attachment loss, tooth loss, and osteoporosis.

Fortunately, screening and detection are possible through the use of routine dental radiographs. CIGNA Dental plans provide for diagnostic services, such as bitewing and periapical radiographs. A panorex radiograph is also allowed for diagnostic purposes.

To stay on top of emerging research and trends in oral health integration, CIGNA established a clinical advisory panel consisting of well-known leaders and researchers in the dental profession. Their scientific knowledge and input helps us continue to create and deliver innovative coverage options that address medical/dental integration, as well as new and developing dental technologies.

CIGNA also provides a medical claims integration credit for new clients who package CIGNA medical and dental plans. The credit is a percentage of their claims and may increase when CIGNA’s disease management programs for diabetes and heart disease are added. Similar credits may also be applied to existing accounts that add a CIGNA medical or dental plan. This credit serves as an extra incentive for our customers to make that connection between oral health and overall health and also help their employees make oral health a priority, because dental disease accounts for over 164 million lost work hours each year.¹ By educating and encouraging members to obtain routine, preventive care and dental treatments recommended by their dentists, CIGNA hopes to improve health outcomes, which in turn increases productivity for employers.

In summary, we know from recent research that a compelling link exists between oral health and overall health. As a multi-line carrier, CIGNA can clinically integrate its plans in an effort to create and implement programs that engage members in their own health improvement. By promoting and removing cost barriers to dental care, CIGNA Dental is working to increase member access to care, while raising awareness of the importance of oral health.

References

1. US Surgeon General’s Report, 2000. Available at: http://www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.htm. Accessed Apr 4, 2007.
2. Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and preterm birth: results of a pilot intervention study. J Periodontology. 2003;74:1214-1218.
3. The Oral Cancer Foundation. Available at: http://www.oralcancerfoundation.org/facts/index.htm. Accessed Apr 4, 2007.
4. Reinhardt RA, Patne JB, Maze CA, et al. Influence of estrogen and osteopenia/osteoporosis on clinical periodontitis in postmenopausal women. J Periodontology. 1999;70:823-828.
5. Wactawski-Wende J, Genco RJ. Factors affecting bone metabolism leading to osteoporosis, periodontitis, and tooth loss in postmenopausal women: NHANES III. Meeting of the American Association for the Advancement of Science. February. Philadelphia, PA.

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