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: Promoting Annual Dental Visits in the MSHO and MSC+ Populations Scenario Guide
Blue Plus Care Coordinators: Please use this guide when talking with your member about their questions or concerns related to receiving an annual dental visit.
Scenario 1: Member cannot find a dentist who will accept their Medicaid coverage.
Provide the member with the phone number to Delta Dental Member Services: 1-800-774-9049. Delta Dental will give the member contact information for three network providers. If the member is unable to schedule an appointment with any of the providers, Delta Dental Member Services will transfer them to the Delta Dental Care Coordination team for further assistance. Members cannot contact the Delta Dental Care Coordination team directly.
OR
As a Blue Plus Care Coordinator, you may contact the Delta Dental Care Coordination Team at 1-866-303-8138* and request that a Delta Dental Coordinator find a provider and schedule an appointment on the members behalf. The Dental Coordinator will also arrange transportation and/or an interpreter, if needed. Have the following information available when you call:
Member name, PMI number, health plan
Current dental need (preventive or restorative)
The date of the members most recent dental visit, and the providers name, if applicable
A phone number and contact name for follow up
*NOTE: This phone number is not for member use.
Scenario 2: Member declines an annual dental visit because they are not experiencing pain/discomfort and have no concerns about their teeth.
Provide the member with the How Oral Health Affects Overall Health handout available on the Care Coordination Portal.
More information about the mouth-body connection is available on the Delta Dental web site at HYPERLINK "http://www.DeltaDentalMN.org/oral-health" www.DeltaDentalMN.org/oral-health.
Reference these talking points:
50% of older adults have untreated root cavities, and 70% have gum disease, or Periodontitis, which causes inflamed gums and weakens the bone structure of the jaw.
In addition to causing pain and difficulty chewing, untreated cavities and gum disease contribute to a range of conditions and disorders. This is because bacteria from the mouth and chemicals from inflamed gums get into the bloodstream and airways and travel to other organs and systems causing or worsening the severity of: Heart disease, stroke, respiratory diseases and aspiration pneumonia, diabetes, rheumatoid arthritis, high blood pressure, immune disorders, osteoporosis, and cognitive decline and dementia.,
Studies show that people who have a good daily oral hygiene routine and who visit their dentist at least once per year can reduce the amount of bacteria in the mouth and slow the progression of gum disease.
As one ages, it is common for the gums to recede and expose the teeths root surfaces, increasing the risk of root decay. Root decay can progress quickly. Regular dental cleanings help to prevent root decay or detect it early when its still treatable.
Regular dental visits can also help detect oral cancer early, when it can be easier to treat.
More than 120 medical conditions can be detected by signs and symptoms in your mouth. Signs and symptoms to watch out for, include: swollen gums, bleeding gums, ulcers, dry mouth, bad breath, metallic taste, burning sensation, growths (tumors). If the member is experiencing any of these symptoms, they should see a dental provider as soon as possible.
Scenario 3: Member is managing multiple chronic or acute conditions and they, or their caregiver, does not believe oral health is a current priority.
Oral health may not be a priority for families who are attending to the members other health concerns. However, caregivers should be informed about how good oral health can improve the comfort of their family member and prevent other health complications, so they can make an informed decision about scheduling a dental visit.
For example, research shows that treatment of periodontal disease helps people with diabetes control their blood sugar levels. The Delta Dental web site has more information about the connection between oral health and diabetes: HYPERLINK "https://www.deltadentalmn.org/oral-health/diabetes/" https://www.deltadentalmn.org/oral-health/diabetes/
There are more than 400 drugs, many of them prescribed to treat chronic conditions, that cause dry mouth. Dry mouth is the largest cause of poor oral health and increased risk for oral disease among older adults. A dentist can prescribe prescription-strength fluoride toothpastes and mouthwashes, or an artificial saliva, that will provide relief for the discomfort of dry mouth and lower the risk of oral disease.
Other common side effects of medications include gum overgrowth, yeast infections, staining of teeth, and excessive bleeding. If a member is experiencing these symptoms, they should speak with their provider about managing medication side effects.
Scenario 4: Member resides in the Nursing Home and it is difficult and uncomfortable to travel to the dental office.
Some families may determine that it is not in the best interest of their family member to have a dental exam or cleaning. However, caregivers should be informed about the dental services that are available to nursing home residents, so they can make an educated decision on behalf of their loved one.
There is federal and state legislation that requires Long Term Care Facilities to provide dental care either onsite or offsite for all residents. The Care Center should have an agreement with a dentist to deliver oral health care services and make referrals. If the member needs or wants to be seen offsite, the Care Center is required to assist in scheduling the dental appointment and arranging transportation.
Online resources for caregivers are available on Oral Health Americas web site for older adult oral health: HYPERLINK "http://www.toothwisdom.org" www.toothwisdom.org.
During your review of the Nursing Home Assessment and Care Plan, the Care Coordinator should verify that the Facility has offered the appropriate services and assistance to the member.
Scenario 5: Member/caregiver declines an annual dental visit because they do not have any of their original teeth.
Bacteria and chemicals still build up in the mouths of those with dentures, passing into the bloodstream and affecting the health of the rest of the body.
Those with full or partial dentures should see a dentist twice a year, the same as someone with all of their original teeth.
Everyone, including older adults with dentures, needs an annual oral cancer screening. The risk for oral cancer increases with age, and regular dental visits can help detect oral cancer early, when its easier to treat.,
Regular dental visits also help ensure that dentures are fitting properly and that the patient can comfortably chew a variety of foods to maintain a nutritious diet.
Individuals with dry mouth can have difficulty wearing dentures because there isnt the thin film of saliva to help hold them in place. A dentist can provide a prescription for artificial saliva to help address this problem.
Scenario 6: The member is concerned about the out-of-pocket cost of additional services if problems are detected during a preventive dental exam.
There is no cost to MSC+ and SecureBlue (MSHO) members for these preventive dental benefits:
One dental exam per calendar year Routine dental exams include a cleaning and x-rays.
Fluoride varnish (once per calendar year)
Fillings
Blue Plus covers additional dental benefits for SecureBlue (MSHO) members:
One additional routine dental exam per calendar year
Two deep cleaning or perio-maintenance dental visits These cleanings help remove plaque, bacteria and debris at the gum line.
One root planing and scaling service every two calendar years This service helps treat existing gum disease.
If the member has questions about their dental benefits, they should call Delta Dental Member Services at 1-800-774-9049.
Scenario 7: The member has anxiety about seeing a dentist.
Explain to the member or caregiver what they should expect at the dental appointment:
The dentist will probably ask you to answer a few questions, including the date of your last checkup, any health updates or changes, and any tooth sensitivities.
Besides carefully checking your teeth and gums, your dentist will check your bite (how your teeth come together) and your jaw (for any clicking or popping).
If you wear dentures, your dentist will ask you a few questions about when you wear them and look for any signs of irritation.
Determine who can give informed consent at the dental office and ensure they are present at the appointment
The member may be more comfortable seeing a dental provider with specialized expertise in treating geriatric patients, such as the University of Minnesota School of Dentistry, Walker Methodist Dental Clinic, or Apple Tree Dental.
Blue Cross and Blue Shield of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association
Gupta S. Why are older adults at an increased risk for mouth & gum disease? Oral Health America Web site. HYPERLINK "http://www.toothwisdom.org" http://www.toothwisdom.org. Accessed February 13, 2018.
Hajishengallis G. Periodontitis: From microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015; 15:30-34.
Gum Disease and other Diseases. American Academy of Periodontology. Retrieved October 28, 2012 from: HYPERLINK "http://www.perio.org/consumer/other-diseases" http://www.perio.org/consumer/other-diseases.
Periodontal (gum) disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research Web site. HYPERLINK "https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm" https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm. Accessed February 13, 2018.
Gupta S. Why are older adults at an increased risk for mouth & gum disease? Oral Health America Web site. HYPERLINK "http://www.toothwisdom.org" http://www.toothwisdom.org. Accessed February 13, 2018.
Brocklehurst P, Kujan O, O'Malley LA, Ogden G, Shepherd S, Glenny A. Screening programmes for
the early detection and prevention of oral cancer. The Cochrane Library. 2013.
Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient (7th ed.). St. Louis, MO: Mosby Elsevier; 2008.
Oral manifestations of systemic disease. American Academy of Family Physicians Web site. HYPERLINK "http://www.aafp.org/afp/2010/1201/p1381.html.%20Accessed%20February%2013,%202018.%20%20" http://www.aafp.org/afp/2010/1201/p1381.html. Accessed February 13, 2018.
Taylor GW, Borgnakke W. Periodontal disease: Associations with diabetes, glycemic control and
complications. Oral Dis. 2008; 14(3):191-203.
Periodontal (gum) disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research Web site. HYPERLINK "https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm" https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm. Accessed February 13, 2018.
Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P. Reversal of primary root caries
using dentifrices containing 5,000 and 1,100 ppm fluoride. Caries Res. 2001; 35(1):41-46.
Smith RG and Burtner AP. Oral side-effects of the most frequently prescribed drugs. Spec Care Dentist. 1994 May-Jun; 14(3):96-102.
The Association of State and Territorial Directors (ASTDD). Best Practice approaches for state and community oral health programs: Best practice approach report: Oral health in the older adult population (age 65 and older). March 2017. HYPERLINK "https://www.astdd.org/best-practices/" https://www.astdd.org/best-practices/. Accessed February 13, 2018.
Hajishengallis G. Periodontitis: From microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015; 15:30-34.
The Association of State and Territorial Directors (ASTDD). Best Practice approaches for state and community oral health programs: Best practice approach report: Oral health in the older adult population (age 65 and older). March 2017. HYPERLINK "https://www.astdd.org/best-practices/" https://www.astdd.org/best-practices/. Accessed February 13, 2018.
SEER stat fact sheets: Oral cavity and pharynx cancer. National Cancer Institute Web site. http://seer.cancer.gov/statfacts/html/oralcav.html. Accessed February 13, 2018.
Brocklehurst P, Kujan O, O'Malley LA, Ogden G, Shepherd S, Glenny A. Screening programmes for
the early detection and prevention of oral cancer. The Cochrane Library. 2013.
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