There are plenty of statistics and a growing volume of research on the links between dental health and overall wellness. And we’ll get to those.

But let’s start with a visual image, courtesy of Dr. Fred Eichmiller, vice president and science officer for Delta Dental of Wisconsin.

Hold your hand up in front of your face. Face the palm inward, and take a good look. Note the lines, the callouses, the faint trace of spaghetti sauce left over from lunch.

Now picture the entire palm as an open bacterial infection.

That’s what you’ve got when you battle gum disease, at least in terms of surface area. And if you can imagine how that kind of ailment can undermine your immune system’s efforts elsewhere in the body, you’re already starting to connect the dots. That relationship between oral health and conditions such as diabetes, heart disease and premature births is the latest tool for insurance carriers to use in emphasizing to employers the importance of offering dental coverage.

While you try to shake Dr. Eichmiller’s gruesome comparison from your mind’s eye, let’s examine the specific links researchers have established.

“Diabetes is the one that really caught the eye of the medical community,” says Eichmiller.

As the American population becomes ever heavier and more sedentary, the prevalence of diabetes has erupted. By at least one estimate, diabetes in this country has grown 136 percent since 1980, to more than 24 million Americans.

Dental and whole-body health

In the last 10 years, researchers have been able to establish that patients with gum disease have a harder time controlling their blood sugar, which can lead to an increase in diabetic complications. That link works in reverse; the Center for Disease Control reports that persons with poorly controlled diabetes are three times more likely to have severe gum disease than persons without diabetes.

These links have been observed by dentists for a long time, Eichmiller says, but without qualified research, it was harder to bring medical doctors on board. With a firm cause-and-effect now established between diabetes and gum disease, the door swung open.

“It’s very common [for doctors] to refer patients to a dentist,” Eichmiller says. “That’s something we never saw in the past. It’s partly because the CDC and other groups include dental care as part of a regular treatment protocol for diabetes.”

On the heels of the diabetes link came other connections:

• Eighteen percent of premature and low birth weight babies are linked to gum disease, says Larry Schreiber, president of Anthem Blue Cross and Blue Shield in Wisconsin. “If we can treat this in pregnant women,” he says, “we can reduce those by 84 percent.”

• Chemotherapy and radiation will kill cells that help defend the mouth against gum disease.

• Strokes, heart attacks and even kidney disease show at least preliminary links to poor oral health.

Dental costs and bundling

As this connection grows, the number of employers offering dental coverage to their employees has increased. The National Association of Dental Plans queried companies in nine categories, based on the size of their work force. In seven of those nine categories, the number of companies offering dental benefits stayed level or grew between 2005 and 2008. Among companies with at least 100 employees, approximately 90 percent offered that coverage.

Smaller companies are much less likely to present that option, and all the experts say cost is the No. 1 objection they hear from companies of all sizes. Soaring costs for medical premiums colliding head-on with the recession leave little for additional benefits. Insurance carriers are adjusting with new programs and bundled coverages.

Traditionally, medical insurance is sold separately from dental. Research provided by Delta Dental found that 97 percent of group dental coverage was offered separately from medical coverage. The reason isn’t found on any grassy knoll. Hospital coverage simply came first, followed by physician coverage, which begat ancillary providers bringing in vision and dental coverage. Spurred by the new links between oral and overall health, however, that’s changing.

“Whole-body coverage is kind of the buzzword right now,” Schreiber says.

Whole-body coverage is the practice of putting all plans – medical, dental and vision — into one tidy package with the same provider. Bundling coverages makes sense for a company like Anthem on multiple levels, Schreiber notes. Not only is it a logical extension of their medical offerings, but “clearly it makes our relationship more sticky with that employer,” he says.

Anthem also has the flexibility to provide a discount on medical premiums for employers who choose to bundle coverages.

At Delta Dental, Director of Sales Dave Peterson can bundle the company’s vision coverage with dental. In addition, Delta has a marketing agreement with Wisconsin Physician Services to include health coverage, as well as an HMO partner in south central Wisconsin. Delta also presents employers with more comprehensive packages that acknowledge the increasing emphasis on dental health.

Their evidence-based dentistry program provides recommendations and additional coverages based on the emerging science linking oral health to overall health. For example, one module within the evidence-based program allows for additional dental visits for diabetics, under the theory that more regular cleanings can limit complications from the disease. The same goes for patients who are enduring chemotherapy and other cancer treatments.

Finally, Delta Dental anticipates rolling out a new reporting package beginning in 2011 that should help larger employers understand the overall dental health of their workers. From that data, Delta Dental can make recommendations for more appropriate coverage.

“From an oral health perspective, periodontal disease is probably the biggest issue,” Peterson says. “One, a lot of people have it, and two, if you don’t get it in check it can really cause some major issues.”

There is also the fact that those who have dental insurance use it, and that can also head off more serious issues down the road. Peterson said about 80 percent of covered individuals make regular visits to the dentist, against 34 percent of those who don’t. That’s true not only for employees, but also for their children. Eichmiller says the change in attitudes and care for children is dramatically improved, along with their oral health.

“Prevention in children has made such a huge impact,” Eichmiller says. “We’re seeing a whole new generation right now of children who don’t have a filling and probably never will.”

Peterson concurrs: “When I was a kid, when you went to the dentist, you’d go back to school and they’d ask, ‘How many cavities do you have?’ Now, kids have very few.”

And by having positive dental experiences early, they’re more likely to not only continue with regular checkups, but to value dental coverage as a benefit when they become job seekers themselves. A study by the National Association of Colleges and Employers that finds dental coverage among the five most valued workplace benefits by graduating students and alumni.

Anthem’s Schreiber thinks dental coverage may become a differentiator, especially for small employers, in a post-health care reform environment. He thinks many of them may rely on federally mandated exchanges to provide health insurance, then kick in with a dental plan to lure and retain better workers. Dental coverage is not yet touched by the health-care-reform wand, but it will be years before the full impact of the new legislation is established.

In the meantime, researchers will continue to examine possible links between the condition of our mouths and the rest of our bodies. If they are successful, it could have great impact on how employees — and employers — view dental coverage.

By Matt Schroeder

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