The Effect of Periodontal Treatment on Medical Costs

Objectives: Chronic conditions have been associated with periodontal disease. It is unclear if periodontal treatment can contribute to a reduction in overall risk and medical expenditures for three chronic conditions [Diabetes Mellitus (DM), Coronary Artery Disease (CAD), and Cerebrovascular Disease (CVD)]. This study investigated the effect of periodontal treatment on Per Member Per Month (PMPM) costs within DM, CAD, and CVD, in a population of insured patients with concomitant medical and dental insurance. Methods: This study examined data from 144,225 enrollees with one of three chronic conditions (DM, CAD, or CVD), participating in a PPO plan with continuous dental and medical coverage between January 1, 2001 and December 30, 2002. Cost of medical care was measured in PMPM dollars by aggregating ICD-9 expenditures. To control for differences in the overall disease burden of each group, a previously-calculated retrospective risk score utilizing Symmetry Health Data Systems Episode Risk Groups was utilized for DM, CAD or CVD, within distinct dental categories. These included periodontal treatment commenced in 2001 (PT2001) or in 2002 (PT2002), dental maintenance services (DMS), or other dental services. Results: The PMPM expenditures were lower for DM and CAD if periodontal disease treatment commenced in the first year of the two-year retrospective study (p<.01). There were significant differences in PMPM expenditures for enrollees in the PT2001 and PT2002 group when compared to members who did not receive periodontal treatment and had only DMS procedures (p<.05). When PMPM was risk-adjusted, a significant sequencing effect was maintained for early periodontal treatment (PT2001) vs. later periodontal treatment (PT2002) (p<.05). Conclusions: Periodontal care appears to have a sequencing effect on the cost of medical care in this two-year study, with earlier treatment resulting in lower medical costs for DM, CVD, and CAD.

Supported by grants from the Robert Wood Johnson Foundation, and Aetna Dental.