Table of Contents

Cover Story
Implants

Inside Dentistry

January/February 2006, Volume 2, Issue 1
Published by AEGIS Communications

CIGNA Launches Oral Health Maternity Program

Allison DiMatteo, BA, MPS

Possible oral-systemic link to prenatal health drives decision to remove barriers to care

Earlier this year, CIGNA Dental launched a groundbreaking new Oral Health Maternity ProgramSM for members with both CIGNA medical and fully-insured dental coverage. The benefit enhancement covers periodontal scaling and root planing at 100% when performed during pregnancy; an additional cleaning during pregnancy for women who don’t require scaling and root planing, based on the potential risk of “pregnancy gingivitis”; and treatment of inflamed gingiva around wisdom teeth during pregnancy at 100%.

The decision to create this maternity benefit was based on published studies regarding the possible correlation between periodontal disease and premature, low birth-weight babies and the desire to remove barriers that might keep expectant mothers from getting the proper oral care they need. In particular, a growing body of research suggests that pregnant women who have periodontal disease may be as much as 7 times more likely to have a premature baby. This is believed to be a result of the body’s immune response to oral infection and the passage of related byproducts through the bloodstream to the uterus.

According to Miles Hall, DDS, national dental director for CIGNA Dental, the new benefit program removes such potential barriers as out-of-pocket coinsurance payments for scaling and root planing and gingival treatments, as well as frequency limitations for cleanings. In conjunction with the new benefit enhancement, CIGNA’s Web site also features research-based information about the importance of oral health to overall prenatal health that is targeted to prospective parents and pregnant women.

“This is a very positive step in that it shows the importance of dental research actually translating into healthcare policy and changes in practice that have the potential to benefit the health of the public,” commented Steven Offenbacher, DDS, MS, PhD, a distinguished professor in the department of periodontology and dental research at the University of North Carolina School of Dentistry. Offenbacher is among the researchers who have investigated the associations between periodontal disease and adverse pregnancy outcomes. “Researchers try very hard to understand the mechanism of disease so that we can improve the health of the public, and this is a wonderful example of how research supported by the National Institute of Dental and Craniofacial Research (NIDCR) has had an impact on the care that patients will receive.”

WEIGHING THE COST OF ORAL HEALTHCARE DURING PREGNANCY

“Waiving the frequency limitations and the coinsurance payment represents a very small cost compared to what might be spent on the medical side as a result of a premature birth,” Hall said. “Of course, if an expectant mother receives scaling and root planing, it doesn’t mean that she’s absolutely going to avoid a premature delivery, but certainly a lot of data is starting to suggest a correlation.”

The company already pays between 70% to 80% of the charges for scaling and root planing, with the CIGNA plan member paying the remaining percentage as a coinsurance payment. Under the new Oral Health Maternity Program, however, the coinsurance payment expense is absorbed by CIGNA for treatment received during pregnancy. Additionally, while a certain number of routine dental cleanings per year are a standard covered benefit, if an extra cleaning is required during pregnancy, CIGNA will absorb that expense as well.

“We know the availability of health and dental insurance coverage drives and can improve healthcare,” observes Judy Meehan, executive director of the National Healthy Mothers, Healthy Babies Coalition (HMHB). “Naturally, if someone has coverage for a specific treatment, the likelihood of her seeking out and receiving that care is higher.”

Compared to the medical costs associated with preterm, low birth-weight babies, the costs of providing the Oral Health Maternity Program benefits really are minimal. For example, based on information from the March of Dimes, hospital charges in 2003 for newborns without complications averaged $1,700. The average length of hospital stays for such infants is 2 days. On the other hand, hospital charges for infants born too soon or too small averaged $77,000. The average length of hospital stays for infants born with any diagnosis of prematurity or low birth weight is 13.6 days; for a principal diagnosis of prematurity or low birth weight, the average length is 24.2 days.

Unfortunately, an estimated 500,000 babies in the United States are born prematurely, meaning they are born before the 37th completed week of pregnancy. This represents 1 in 8 babies, or 11%. According to the March of Dimes, hospital charges in 2003 for all infants totaled $36.7 billion, but nearly half of that—$18.1 billion—was for babies with a diagnosis of prematurity or low birth weight.

CARE THAT BENEFITS MOTHER AND CHILD
Meehan asserts that oral healthcare needs to be included with all of the other recommendations that are perceived as important for a healthy pregnancy, such as not smoking, not drinking, and being properly immunized. In fact, she notes that ensuring an expectant mother’s oral health is part of ensuring that she’s in the best possible health during pregnancy to help ensure the health of her child. In its 2001 “Oral Health and Pregnancy Position Statement,” the HMHB Coalition advocated increased awareness of, and support for, research regarding the possible association between periodontal disease and preterm, low birth-weight babies.

During pregnancy, elevated hormone levels have been associated with increased gingival inflammation, also called “pregnancy gingivitis.” When this occurs, having an additional cleaning during the second trimester or early third trimester may help pregnant women to avoid more involved periodontal problems.

Offenbacher, who was recognized several years ago by HMHB with a Special Impact Award in honor of his research, said the evidence is continuing to mount to suggest that mothers with periodontal disease or who develop pregnancy gingivitis are placing the fetus at risk for exposure to the infectious organisms. Therefore, he says, improving the oral health of these individuals remains a prudent exercise, is of real benefit, and may just improve the pregnancy outcomes, also.

However, Offenbacher also acknowledges that definitive studies to prove that treating periodontal disease reduces these risks have not yet been completed. Currently, the NIDCR is supporting 2 large, multicentered, randomized clinical trials to test the hypothesis that treating pregnant women will reduce the rate of preterm delivery.

“Early findings from 3 small randomized clinical trials have in fact shown benefits of therapy in terms of improving the mother’s oral health and in reducing the risk of preterm delivery,” he explained. “The potential for having a marked benefit on obstetric outcomes has tremendous implications for healthcare if it can be confirmed in larger studies.”

According to the March of Dimes, premature birth can lead to serious consequences for the baby and is the leading cause of neonatal death within the first month of life. In fact, premature babies are not just small, they are babies that have not yet finished developing. As such, premature birth can lead to lifelong health problems, including mental retardation, blindness or hearing loss, chronic lung disease, gastrointestinal problems, and cerebral palsy.

EVERY BIT HELPS
CIGNA executives note that many dental insurance companies provide coverage for scaling and root planing, as well as routine dental cleanings. However, CIGNA is the first to say specifically that pregnant plan members won’t have any financial burden or frequency limitations that might prevent them from obtaining the oral care treatments they may need.

“Covering this type of proactive treatment for expectant mothers is groundbreaking,” notes Meehan. “It goes beyond being family friendly and helps to ensure that every woman has the best possible chance at having a healthy baby.”

To help reinforce the message that oral care is an important part of prenatal care, resources are available for dental practitioners interested in taking a more proactive approach to caring for their patients that are of childbearing age and/or pregnant. Copies of the Fast Facts for Families brochure—produced by the HMHB Coalition and sponsored by Sunstar Butler—are available for dentists to use in their practices when discussing the importance of maintaining good oral health during pregnancy. The question-and-answer format makes the topic easy to understand and is intended to promote conversations with healthcare providers.

Additionally, Meehan encourages dentists to interact collaboratively with the patient’s obstetrician during her pregnancy so that both professionals can be aware of and responsive to any interrelated issues. Dentists need to know what stage of pregnancy a patient is in, and obstetricians need to be kept abreast of changes in the patient’s condition that the dentist notices, she said.

References & Resources

 
The Fast Facts for Families brochure—produced by the HMHB Coalition and sponsored by Sunstar Butler—is available for dentists to use in their practices when discussing the importance of maintaining good oral health during pregnancy.