Dental Insurance New Tools, New Benefits Dental Advances Give Patients And Insurers Something To Chew On

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The day approaches when vaccines will prevent the onset of cavities and gum disease, when medical therapies will eliminate the need for drills and needles, when we will be able to regrow tooth tissue and bone. All of this may sound like fiction, but it isn’t. A new generation of dental procedures is emerging from research, and these techniques will have a dramatic impact on oral health.

Dentistry of the future will focus on preventing the causes of dental disease before symptoms develop. More information is needed before promising technologies can be implemented in the field. However, once their health outcomes and cost implications are known, dental insurance companies can begin to incorporate new tools and treatments into their benefit plans. Watch for the following:

Advanced testing. Cavities are a symptom of an infection caused by high levels of bacteria. Mothers can transmit this infection to their young children by testing their food or kissing them on the mouth. There is a now a simple saliva test to identify children at higher risk for tooth decay based on their mothers’ bacteria levels. If bacteria levels are high, the mother can be treated with an antimicrobial mouth rinse or xylitol chewing gum. Alternatively, the child can be treated directly with topical fluoride varnish.

Pilot dental insurance programs in two states are working with pediatric physicians (rather than dentists) to teach them how to identify high-risk infants and are covering benefits for physician assistants to place fluoride varnish on the infant’s teeth to reduce the transmission of decay-causing bacteria.

A test has also been developed that can immediately tell whether someone has elevated levels of cavity-causing bacteria, and clinical studies on it have been highly promising. Another promising tool in the pipeline is a prognostic test that could potentially identify patients with a genetic predisposition to gum disease, thereby allowing dentists to plan targeted preventive treatments.

Some insurers are also working with progressive purchasers to pilot benefit designs that determine the type and frequency of preventive care based on the ‘risk status’ of the patient.

Vaccines. Tooth decay remains the number-one chronic childhood disease. But we may soon have vaccines that will safeguard millions of children against cavities.

Scientists at Boston’s Forsyth Institute are developing a nasal-spray vaccine based on their discovery of a new antigen. This vaccine stimulates the body’s immune system to attack the enzyme that allows harmful bacteria to accumulate on the teeth. Other scientists are developing vaccines that use the passive administration of antibodies — such as through toothpaste, mouthwash, or even candy — to destroy or neutralize cavity-causing organisms. Researchers have already demonstrated they can use vaccines to control the bacteria that cause gum disease in animals. The research continues on effective vaccines for humans.

Remineralization. Most dentists in the United States treat cavities by drilling the tooth and placing a filling. Elsewhere in the world, tooth decay is successfully treated through a simple remineralization procedure that restores tooth structure as well as protects the tooth from future damage.

Tooth enamel demineralizes when acid depletes calcium and phosphate in it. Fluoride promotes remineralization by saliva, a natural source of calcium and phosphate. Dentists can enhance the body’s natural remineralization process through the application of fluoride varnish, which can increase fluoride absorption by as much as 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. The more progressive dental insurers are redefining ‘topical fluoride’ to include use of fluoride varnish to remineralize early tooth decay.

Primary periodontal care. Advanced forms of gum disease have traditionally been dealt with surgically. But advances in oral medicines have made less invasive treatments possible. Several clinical trials have documented the effectiveness of different antibiotic- and antimicrobial-based therapies.

Many insurers are now beginning to cover ‘localized delivery of chemotherapeutic agents,’ which is a fancy way of saying that they will pay for the use of antimicrobial drugs to fight the bacteria that cause periodontal disease.

Nanotechnology. This refers to technology executed at the molecular level. By harnessing molecular technology, scientists are exploring the possibility of the body rebuilding lost tooth structure. Even more intriguing are efforts to grow whole teeth based on genetic information. Scientists at the University of Texas have already grown mouse teeth in the laboratory. Someday a person who has had a tooth extracted could have a ‘seed’ inserted into the extraction site, which will then grow into another tooth.

Former dental breakthroughs like fluoride and sealants have resulted in dramatic improvements in oral health. The new batch of technological improvements is expected to do the same. There is always lag time, however, between the discovery of new technologies and their implementation. Before any new procedure or therapy appears in dental offices, it must undergo extensive clinical research and evaluation by dental professionals. Once the technology is proven effective, it is up to dental schools and dental associations to educate professionals on how to use it.

Dental insurers play an important role in the process. They underwrite extensive research on new technology and procedures to determine their viability and then help develop programs to encourage dentists to incorporate effective technologies into their practices. As more research is published on new advances, dental insurers can adapt their coverage. In the future, dental benefits plans will increasingly focus on risk assessment and targeted preventive care versus drilling and cutting.

Dr. Robert Compton is director of disease management for Delta Dental of Massachusetts, the state’s largest provider of group dental benefits. Delta Dental is based in Boston and is a member of the Delta Dental Plans Association, the nation’s largest provider of group dental benefits. Dr. Compton can be reached via e-mail at rcompton@deltamass.com.