A visit to the dentist could soon give patients a better understanding of their diabetes status, information that can help them improve both oral and medical health if they are living with the potentially deadly condition.
Starting next year, dentists in certain states — including New Jersey — will be able to get paid for performing chair-side diabetes screenings for at-risk patients. Advocates hope the change will enable dentists to offer more effective care, while empowering patients with important health information.
While dentists traditionally take health histories on their patient, and may even perform select screenings, the focus has generally been the safety and efficacy of oral health treatments.
Dr. Keith Libou, the chief clinical officer for Delta Dental New Jersey, a dental benefits company that covers 1.5 million people in the Garden State and Connecticut, believes this is this is the first time dentists are becoming involved in medical tests in a “formal way.”
Breaking down silos
“This is a very positive footstep toward de-silo-ing the professions,” said Libou, who led the charge for the change. “It is really sort of bridging the two professions.”
“It is really evolving into the dentists role as a diagnosticians and their ability to not only treat patients safely, but to contribute to their overall wellbeing,” he added.
While dentists can identify a number of health concerns during even routine assessments and treatment — including oral and neck cancers and autoimmune disorders — Libou said diabetes is particularly critical. Studies have shown that diabetics are more likely to suffer gum disease, and those with periodontal concerns are more prone to diabetes.
“We’re not at the point where we can say one causes the other, but there is a statistical relationship,” Libou explained.
In New Jersey, nearly 600,000 people were diagnosed with diabetes in 2012, according to state Department of Health statistics, and the prevalence – 9.2 percent – was on the rise. Diabetes, or elevated blood sugar, can cause obesity, high blood pressure, and heart, kidney, and other organ failure.
In the dark about diabetes
But 2014 data from the American Diabetes Association suggests that the disease has infected more than 900,000 Garden State residents, or nearly 12 percent of the population, including 235,000 who don’t know they have the disease. Nearly 2.5 million more are considered “pre-diabetic,” or at-risk for diabetes, and black and Hispanic individuals are more likely to be diagnosed and die from the disease.
Libou said one motivation for Delta Dental was to try and identify some of these borderline or undiagnosed patients, including those who might not see a medical doctor regularly. “We need to take on that role as a key health provider,” he said.
The financial factor
The missing piece was enabling the dentists to get paid. To address that, advocates called for a small but critical reform: a new insurance billing code. In March, the American Dental Association approved the code — D0411 — that will enable dentists to charge for the test equipment and their time.
While the ADA’s approval is national, the tests must be within the scope of practice as defined by each state’s licensing board — something New Jersey regulators did years ago. Dentists must also obtain permits to draw even a small amount of blood.
New Jersey’s board — one of dozens of licensing bodies overseen by the state’s Division of Consumer Affairs — made the decision after Delta Dental asked permission to run a pilot program to test the concept, Libou explained. Delta pitched it as a public health concern, he said, calling the board “extremely forward thinking” for its approval. Not all states have been so proactive, he added.
Picking up tab for extra costs
Delta launched its pilot program with help from several dozen large urban dentistry practices in 2014, the company said. They offered to pay for any extra costs, including the dentists’ time and materials for the simple finger-prick test, which produces a drop of blood that can be used to identify the sugar level. Delta also helped dentists obtain any permits or other regulatory permission.
Dentists identified and tested patients who were considered at-risk for diabetes (including having a family history of the condition, high blood pressure, obesity, and other factors) — some with Delta benefits and some without. Libou said the 18-month study did not track the diagnoses rate, since it was designed to test the screening concept, but hundreds were flagged and referred for follow-up medical care.
Identifying these patients also enabled the dentists to provide better oral healthcare, Libou noted. Patients with diabetes may have wounds that don’t heal well, so a dentist may choose to delay a surgery or other treatment, or provide additional antibiotics to avoid complications, he said.
Libou hopes other states will also ensure their licensing enables the test and take action to promote the protocol; ADA guidelines can help with this process. Adding diabetes screening helps dentists, doctors, patients. and even employers, he noted, since it can help maintain a healthier workforce.
“It’s really a win for, above everybody else, the patient, but it’s one of those scenarios where no one comes out on the short end,” he said. “This is a solid, concrete step forward.”