Aug 8, 2024
The dental-mental connection
Massachusetts’ top insurer expands preventive oral health benefits for people with depression and other conditions
For those grappling with a mental health condition, oral health can suffer as well, clinicians have found.
Massachusetts’ leading not-for-profit insurer is trying to change that with expanded dental benefits for any commercial member with a mental health condition, including additional preventive services such as more frequent dental cleanings and fluoride treatments, at no charge.
“There are many reasons why people with mental health conditions can benefit from additional support with their oral health,” said Dr. Gregory Harris, senior medical director for mental health at Blue Cross and a practicing psychiatrist. Harris noted a range of issues have been identified by the American Psychiatric Association.
“Some patients find it hard to do activities of daily living – including taking care of their oral health,” he said. “Some take medications, like certain antidepressants, that can cause dry mouth and increase the risk of tooth decay and cavities. And others may feel anxious about going to the dentist.”
The rates of patients struggling with anxiety and depression have risen nationwide for several years, and Blue Cross has seen claims double for mental health treatment since 2019, Harris noted, making the need for care more acute.
For some patients, dental care cost may also be a concern.
Our goal is to remove a financial barrier and help more of our members get the oral health care they need
said Blue Cross Executive Director of Professional Services Dr. Bob Lewando, a periodontist.
Because Blue Cross provides dental coverage to one-third of its 3 million medical members, Lewando said, “We have a unique opportunity to improve their overall health and significantly reduce their medical costs through enhanced oral health care.”
For instance, Lewando noted that improved oral health can lead to better management of several chronic health conditions, such as diabetes and heart disease, and can improve a member’s quality of life, self-esteem and social interactions.
Additional help for those with neurological disabilities
The health plan is providing the same expanded benefits for any member with an intellectual or developmental disability, such as autism or Down syndrome, a move clinicians say is welcome.
“Many individuals with neurodevelopmental diagnoses face significant challenges to getting needed dental care,” said Dr. Jessica Everett, a clinical director at Blue Cross and practicing psychologist. “Some may not understand why dental care is important, and some may have sensory issues that make it difficult for them to navigate a visit to the dentist.”
Everett noted patients with sensory sensitivity issues also may find it difficult to maintain good oral hygiene at home for an array of reasons, including disliking the taste of toothpaste or the way brushing or flossing their teeth feels.
This can lead to poorer oral health, including more cavities, tooth extractions and gum inflammation, than the general population, according to a study in the Journal of Intellectual & Developmental Disability.
“This program is beneficial because it allows our members to practice going to the dentist and gain more confidence with each visit,” Everett says. “It makes the experience more routine for them, while also improving their oral health and overall health.”
Blue Cross has made accessing the new benefits easy, Harris says. Members can enroll in the program with their doctor’s help.
The health plan also offers expanded dental benefits to members with diabetes, heart disease, stroke, oral cancer, Sjogren's Syndrome and women who are pregnant. These conditions can put patients at higher risk for developing oral health conditions, and these benefits can help members manage oral health complications related to their medical condition.
An integrated approach
The new program is a joint effort between Blue Cross’ dental and mental health teams, and Harris said the health plan’s 5,000 dental and 19,000 mental health clinicians have been notified so they can encourage their patients to take part.
Harris said the program was designed to provide a holistic experience.
“We’re one human being,” he said. “And we know that good oral health and good physical and mental health are all connected, so we want to make it as easy as possible for our members to get this kind of integrated care.”
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PHOTO OF DR. GREG HARRIS BY MIKE GRIMMETT