Unintended consequences: could cuts to Medicaid dental coverage lead to more preterm births?

Pregnant woman at a WIC clinic in Virginia. Photo by Ken Hammond (USDA).

States are slashing Medicaid benefits as an attempt to get ballooning health care costs under control. As the New York Times reports, dental coverage for adults is often one of the first items on the chopping block. Now, in about half of the states, dental coverage from Medicaid will only cover pain relief and emergency services. Time will tell if shifting dental care to already overburdened ERs will actually save states money. A study looking at pediatric patients with dental problems found reimbursement rates from emergency rooms were ten times the predicted cost of preventative care. There is already a shift toward more patients using the ER for dental emergencies. From 2006 to 2009 the number rose by 16%. This is a prime example of an unintended consequence.

But when I read the NYTimes piece, I thought of another unintended consequence–one that could impact future generations. This is because I knew there was an association between gum disease and preterm birth (probably something that stuck in my brain from all the reading I did while pregnant). In fact, a pregnant woman with periodontal gum disease is 4.3 times more likely to have a preterm baby than is a healthy pregnant woman. [In one sad case, the death of a stillborn baby was linked to bacteria from the mother’s gum disease]. One study found that treatment of pregnant women with gum disease prevented this adverse result–but only if the treatment was successful at getting rid of the disease. Some states offer dental coverage for pregnant women. But many others do not, and as the study cited above indicates, this coverage may be too late for preventing early births. Preterm birth is a risk factor for a host of issues–from increased infant mortality to cerebral palsy to developmental delays.

The Affordable Care Act requires insurers to cover dental care for kids and also includes funds for opening more dental clinics and for public awareness campaigns about preventing oral illnesses. The ACA does not, however, force insurers to offer dental coverage to adults. According to a Senate report from earlier this year, 42% of Americans —130 million people–don’t have any form of dental insurance.  Given these numbers, it may be unsurprising that a recent study found that over 47% of adult Americans have some form of periodontal disease. If we want to prevent all of the complications associated with gum disease (and the health care dollars associated with these problems), we should be expanding dental insurance for preventative care. And such coverage shouldn’t be limited to children and women of childbearing age. This is blatantly obvious when we consider evidence from even more studies, which show that gum disease puts adults with poor dental health care at risk for other conditions, including heart attacks and pancreatic cancer. Now I really need to schedule that cleaning…

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