HJAR Jul/Aug 2021

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2021 43 Niki Carter, D.M.D. Dental Director Delta Dental of Arkansas therapy, pneumonia, joint replacement, organ transplants, stroke, irregular heart rhythms and deep vein thrombosis. The two conditions that Medicare Advantage will benefit are (1) diabetes and periodon- tal disease and (2) heart disease and peri- odontal disease. Diabetes and periodontal disease are both chronic disease states. In uncon- trolled periodontitis, the mode of trans- mission is that bacteria enter the blood- stream and travel to other parts of the body. Diabetic patients have impaired wound healing and have a harder time fighting infections throughout the body. Periodontal treatment decreases diabetic symptoms and aids in glycemic control. Evidence has shown that cleanings reduce the amount of bacteria by removing the plaque and bacterial colonization. The major difference in diabetic pa- tients who also have periodontal disease is that there exists a bi-directional link. This means that diabetes increases the risk for periodontitis, and this periodontal inflam- matory process negatively affects the gly- cemic control of diabetic patients. Diabetes and periodontal disease have a unique re- lationship since both conditions have the ability to induce an inflammatory response. Diabetic patients with poor blood glucose control get periodontal disease more often than those whose diabetes is well controlled. The good news is that periodontal treatment decreases diabetic symptoms. Habits such as smoking make the problem worse due to the stain and sticky properties of nicotine. Dry mouth, bleed- ing gums, impaired taste and halitosis may be signs and/or symptoms of undetected diabetes. Patients who have these habits and symptoms and who also have diabe- tes require constant maintenance and den- tal visits. These two chronic diseases impact public health significantly in quality of life, life span and healthcare cost. The public health im- pact of diabetes in the U.S. is enormous. Un- fortunately, many who suffer from diabetes are totally unaware they have the condition, as are those who have periodontal disease, known as the silent disease. Diabetes could be the most dreaded and silent epidemic health problem in the near future. There are 415 million adults ages 20 to 79 who have diabetes worldwide, which includes 193 million individuals who re- main undiagnosed. The incidence of diabe- tes is estimated to increase to 640 million by 2040. Ninety percent of the Nation’s $3.8 trillion annual healthcare expendi- tures are spent on people with chronic medical and mental health conditions. The other condition to note is the as- sociation of heart disease and periodontal disease. Oral bacteria have a predilection for heart tissue. There is increased risk for heart disease if the patient has periodontal disease in moderate or advanced stages. Oral bacteria enter through the blood- stream and infect heart tissue, moving to other parts of the circulatory system and contributing to the formation of cardio- vascular disease. Oral bacteria have been found in fatty deposits of people with ath- erosclerosis. Cardiac valve disease, heart arrhythmias and deep vein thrombosis can be a concern for needed dental treatment due to medications that are indicated for preventing clots and thinning blood. These patients need frequent dental cleanings to make sure their oral cavity is healthy. The physician and dentist must work collaboratively to plan for optimal treat- ment outcomes for the patient. A key take- away is that oral health and heart health are intricately linked. Patients must be educated to take care of their oral cavity, which affects their health condition and treatment outcomes. As medical-dental integration pro- gresses, this approach to overall care will benefit patients in public health compre- hensively. The takeaway message is that increased frequency of cleanings and dental visits assist in maintaining overall health states in patients who have heart disease and are diabetic. Delta Dental recently partnered with a local Medicare Advantage insurance car- rier to encourage plan members to receive their regular cleanings through the reward of gift cards. This program has an empha- sis on educating members with heart dis- ease and/or diabetes on the importance of preventive oral health. n