Don’t overlook these dental benefits innovations

When was the last time your clients seriously revamped their dental benefit

Can’t remember? You’re not alone. Here’s why: the annual maximum dollar limit for dental is typically lower than the annual deductible for medical. Hence, employers feel that they don’t spend much money on dental, even if their employees do. 

But “not spending much money” adds up when you consider all the downstream costs of dental issues. So much so that tooth decay ranks as the ninth-largest healthcare expense driver for healthcare payers, right behind smoking.

That is in part because filling cavities is their No. 1 medical “procedure.” To put that in perspective, every 1,000 people covered will fill about 300 to 400 cavities a year, but 1,000 covered people only generate one admission to the hospital primary-coded for diabetes. (Adding non-primary codes still only brings that up to about eight.)

Read more: It’s time to believe the research: Wellness isn’t working

“Yes,” you may think, “but my client’s employees are sicker and have more diabetes.” That probably also means they and their families get many more cavities, too. Not to mention more root canals, crowns, extractions, gum disease and abscesses.

And while many medical problems disappear on their own, most dental problems do not.  Yet many employees don’t treat them due to cost or fear of the dentist. Fortunately, your clients can address both by revamping their dental benefit.

For instance, today employers probably fully cover exactly two preventive dental visits a year. However, as with checkups (where only a portion of the working-age population should get them annually), the right number of dental checkups varies from person to person. Some people are fine with one, while others need three or four. And it’s that latter category, which gets no economic support in a typical dental benefit, that’s most likely to have cavities turn into root canals or abscesses – or even significant medical issues.

That “visit your dentist twice a year” mantra has no basis in science. (Quite the opposite: it can be traced to an old Pepsodent ad from 1931.)

Read more: How data can bring clarity to health plan management

For probably about the same cost as covering two visits at 100%, your clients could cover four at 80%, thus largely removing the financial barrier from employees and dependents who need three or four to prevent more serious problems down the line. 

There is still the fear-of-needles factor. But the majority of cavities no longer need to be drilled-and-filled. Instead, they can be treated painlessly with Silver Diamine Fluoride (SDF), the only dental innovation ever to be awarded “Breakthrough Technology” status by the FDA. Application of SDF takes two very painless and needle-free minutes, and costs less than $40. 

The only downside? The decay turns black. Dentists, who with few exceptions are generally opposed to SDF because treating every cavity that way (as they do in Japan) would cost them a large chunk of income, describe this as a horribly disfiguring outcome.

Perhaps your clients can reimburse a fixed amount (like $70) per cavity at least for a year or two, so that employees could actually make money by treating cavities. It may seem counterintuitive to pay people to seek medical care, but employers may already do that with workplace screenings and/or annual checkups, and SDF has much more value.

Not all cavities can be treated this way, especially if they get too deep. For kids who get their two checkups, perhaps your clients can cover cavities that are too deep for SDF at 100%, since the parents did their best.

Read more: ‘Prevent consent’ form eliminates surprise bills from ER visits

The hard part is that while SDF is clearly the right choice for most cavities, dentists are very unlikely to mention this option without prompting. For children, the American Association of Pediatric Dentistry requires dentists to suggest it, but has yours? If not, it’s because the revenue hit for them is too great. Filling cavities is a large part of their income.

That’s why employee health education is so important here. Employees must understand SDF, bring it up and be rather insistent. The only way that happens is if your clients educate them not just on the financial benefit to them, but much more importantly on the health benefit. 

Employer clients are saving money, and the amount of employee time at the dentist will decline significantly. (In addition to taking minutes and being applicable during the same visit as a checkup, multiple cavities can be treated at once.) And children will be saved from unneeded trauma or even treatment under general anesthesia, carrying a four-figure bill.

Best of all, you’ll be putting a smile on the faces of 30% of the employee populations you serve, or their kids, every year. Dentists will say those smiles will include a black spot where the decay was, of course. But just like they won’t tell you that SDF exists, they also won’t mention that a simple follow-up application of potassium iodide will lighten those spots to the point where, except on front teeth, they won’t be noticeable.

All this savings, productivity increase and morale improvement requires only a simple tweak to the dental benefit and a little employee education, and it’s not too late to implement it for 2023.


Leave a Reply

Your email address will not be published.