Targeting preventive services

The Cochrane Library recently updated its evaluation about the merits of a hygienist cleaning above and below the gum line. Its conclusion: target these procedures for those at very high risk of poor oral health because there is little evidence of clinical merit or cost-effectiveness for these hygiene procedures for adults at little or no risk.

While this makes sense, the reality is our dental insurance schemes in Canada do not recognize risk in their reimbursement for oral health services. Someone who is low risk has the same entitlements as those at high risk. Your gums are healthy — you get 10 units of scaling each year. Your gums are bleeding and inflamed — you get the same.

Inevitably, this leads to over-treatment and under-treatment. And this has consequences. Dental benefits become too expensive and are eventually cut back by the employer or the payer. And the high risk folks continue to be high risk folks — they don’t ever get better.

So is it possible to target periodontal services to those really in need?

Insurers with their legacy claims processing systems, might tell you it isn’t worth it, or isn’t possible without significant investment in smarter systems and software.

But targeting preventive care is always worth it. Better oral health is the only sustainable way to keep dental benefits affordable, and to keep the overall healthcare system sustainable.