The editorial vision of Grand Rounds in Oral-Systemic Medicine™ notes that “scientific study that is not translated and used in daily practice ultimately is wasted”, and cites as one of its goals the stimulation of “collaboration and innovative thinking on how to transcend professional boundaries to integrate clinical protocols that include application of oral-systemic medicine in everyday patient care”. The dental insurance industry shares this vision, as we seek to develop products and services that are clinically efficacious, cost effective, and value-added for members and payers. In two previous editorials, my colleagues at other leading dental insurance companies did a fine job of sharing their organization’s growing efforts in the area of oral-systemic health. While continuing in the same spirit, this editorial will shift the focus somewhat to the principles and considerations that underlie UnitedHealthcare Dental’s current and future efforts in oral-systemic medicine.

We will be seeing a variety of dental carriers offering increased levels of programs and products, including stand-alone dental plans; however, integrated medical-dental systems are likely to be at an advantage. This is due to the growing evidence that access to dental benefits helps reduce morbidity and mortality. UnitedHealthcare Dental works closely with other UnitedHealth Group companies to develop programs and products to impact populations across company lines. Examples include UnitedHealthcare, which offers consumer directed health benefit plans and services for individuals, and small and mid-sized employers; Uniprise, a leading provider of benefit delivery and service solutions for large employers; AmeriChoice, which organizes healthcare benefits and services for beneficiaries of Medicaid and other government-sponsored healthcare programs; Ovations, which provides health and well-being services to Americans age 50 and older; and Optum, which delivers integrated, cohesive personal health management solutions such as consumer health information, education, and decision support services. Through these different companies, UnitedHealthcare Dental can tailor oral health solutions, for various systemic conditions, to different markets.

In the future, we believe dental benefits will be seen as an “essential” benefit for total health. As the evidence supporting a relationship between periodontal disease and various systemic conditions - such as pregnancy, cardiovascular disease, diabetes, and more recently osteoporosis - continues to grow, dental benefits, particularly preventive and periodontal benefits, will be seen as essential components in managing these conditions. As an example of our own efforts, UnitedHealthcare Dental recently launched its Prenatal Dental Care program, offering pregnant women increased levels of preventive and periodontal services. Indeed, as the evidence of linkages grow, it is likely that dental liability will increase, as the failure to diagnose and treat periodontal needs will be perceived as having catastrophic consequences.

Consumers will expect exchange of information among medical and dental providers. Through UnitedHealth Group’s technology company, Ingenix, we maintain common databases and data management to help employers, dentists, physicians, and other healthcare providers improve healthcare delivery and operations. Using personal health management solutions offered through Optum, including services noted above, individuals have access to information to educate themselves about their condition so they can make informed choices about their care. Employers who self-insure will have the growing expectation that plans will be able to manage dental claims initiated by physicians, and be able to provide data linked to disease management processes.

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Government programs will need to be included in any oral-systemic solution. Patients eligible for Medicaid may be at higher risk for diabetes, cardiovascular disease, or pregnancy resulting in low birth weight infants and/or pre-term deliveries. As evidence grows for the link between periodontal disease and other health conditions, dental benefits will increasingly be seen as essential to improving affordability and quality of care. Through AmeriChoice and our private label Medicaid managed care partners, UnitedHealthcare Dental can offer programs that will reach this vulnerable population.

Products and services in the area of oral-systemic health will need to balance the seeming contradictions in the literature. With the growing interest in this burgeoning area comes a risk that the hype will outpace the science. The vision statement of Grand Rounds in Oral-Systemic Medicine™, shared at the beginning of this editorial, also notes that “Unlike past epidemiological eras, when scientists were able to uncover a direct cause and effect relationship ..., the chronic inflammatory disease states ... that define this era are interconnected within a complicated web of multiple inflammatory and genetic factors which include infections and pathologies of periodontal and other oral origins.” Indeed, the challenges cited here are also reflected in the outcomes noted in the literature (particularly at the moment, in the literature on periodontology and pregnancy), which often appear to contradict each other. This makes it difficult to define an approach that is consistent with published scientific research. In fact, in the case of periodontal disease and pregnancy, specialty societies in dentistry appear to have taken a stronger stand than they have in medicine.

Programs in oral-systemic medicine should be aligned with overall efforts in disease and risk management. These include management of dental caries in children, management of high-risk adults and seniors, screening and management for oral cancer, and oral care for patients with cancer and other conditions associated with immune suppression. These programs will not only involve member education, outreach, and tracking, but also formation of partnerships with physicians, nurses and disease management professionals who will be working with these patients; such partnerships can include UnitedHealthcare Dental in efforts to coordinate and manage care.

Oral-systemic medicine is the centerpiece of a larger effort to integrate medical and dental care. Other facets of this effort include educating and involving dentists in helping patients better manage their medical care; educating and involving physicians in helping patients better manage their dental care; and coordinating those areas that fall between medical and dental care, such as temporomandibular joint and oral care for cancer patients. These opportunities extend to Medicaid, where AmeriChoice has already been a leading advocate for involving dentists in helping patients manage their overall health.

We are clearly in the early stages of research and development in oral-systemic medicine, and much work is yet to be done. Based on these principles, and others that will emerge as the science evolves, UnitedHealthcare Dental will continue to look for opportunities to expand its portfolio of products and to work closely with others in the UnitedHealth Group family of companies, to provide access to high quality, affordable care that empowers individuals to better manage their own overall health.

Michael D. Weitzner, DMD, MS, Vice President, Clinical Product Development, UnitedHealthcare Dental