Medical insurance for treatment of periodontal disease

We have witnessed a lot of discussion in the recent past regarding the scope of providing medical insurance for the treatment of periodontal diseases. There are sites in the social media, which have been debating on the pros and cons of this issue.

The possibility for this scenario rests on the relationship between periodontal disease and systemic diseases. There is a strong body of evidence today for the association between periodontal diseases and certain systemic diseases and conditions with negative systemic health consequences for the individuals. Direct confirmation of such links poses formidable difficulties arising from the long duration of chronic diseases, the multifactorial nature of various medical diseases, and the ethical issues surrounding controlled clinical trials. Consequently, the evidence concerning the systemic effects of periodontal diseases remains inconclusive.

A study conducted by Jeffcoat et al.[1] estimated the effects of periodontal therapy on medical costs and hospitalizations among individuals with diagnosed type 2 diabetes mellitus, coronary artery disease, cerebral vascular disease, rheumatoid arthritis, and pregnancy in a retrospective observational cohort study. The study showed lower medical cost and hospitalizations in the time period following periodontal treatment in patients, in four of the five medical conditions examined except rheumatoid arthritis.

However, this cannot answer the crucial question of whether the improvements are caused by periodontal therapy alone or whether a patient's completion of periodontal therapy and improvement in systemic parameters, arises from a complex factors that tend to improve health outcomes irrespective of periodontal disease.

We accept the fact that periodontitis is only an aggravating/contributing risk factor and not a causative factor for the various systemic diseases like diabetes mellitus. But then for the various chronic multifactorial systemic diseases there are only risk factors. There is no single causative factor as in the case of classic infectious diseases or genetic mutations.

The awareness about the perio-systemic interrelationship is rather low among the medical practitioners. We have to educate our fellow medical professionals regarding the perio-systemic link and the seriousness of the issue through interaction with the Indian Medical Association and other similar professional bodies. We need to carry out multi center studies and involve medical practitioners such as endocrinologists, gynecologists, pulmonologists, etc., in the research activities, and publish the work in medical journals. In this era of evidence-based treatment approaches credible data should be generated to establish this link effectively. Thus, we would be able to highlight the role of periodontitis as a risk factor for various systemic diseases

Health insurance records can be a rich source of research data, however, careful steps should be taken to protect the patient's confidentiality. In the medical field to get insurance cover several guidelines have to be followed. A prescreening and recording of findings is a must for insurance cover. Proper documentation has to be practiced which will help to make our specialty more acceptable by the medical insurance industry.

If evidence continues to accumulate that an oral systemic health link not only exists but can also be exploited to improve general health, two important consequences can be expected. Clinically, it would be logical for assessment and treatment of periodontal disease to be routinely considered in the management of specific medical conditions. Scientifically, further research, clinical, and otherwise, could be better focused on the underlying pathways and causal factors.

The findings currently available are inadequate to effectively prove the perio-systemic link. However, it is a fact that simple nonsurgical periodontal treatment comes at a modest cost to the patient, therefore although it's interventional efficacy remains open to debate, periodontal treatment should be recommended to be considered as part of the preventive treatment options for management of certain types of chronic diseases.

Our profession should adopt a practical and evidence-based approach regarding this issue rather than exaggerating things. We need to present credible evidence to the statutory bodies, government, etc., and mere resolutions will not be of any help to further this cause. Let us be optimistic about a future scenario wherein the importance of treatment of periodontal diseases will be recognized by the medical profession and medical insurance provided by the insurance agencies for the same.