Full arch dental implant treatment is a transformative procedure for many patients who suffer from severe dental issues. Many of these patients have been suffering for decades with dental pain, infections, embarrassment, and countless missed social occasions due to their smile. Yet, this transformational treatment remains largely uncovered by medical insurance, placing a significant financial burden on those in need. This article explores the reasons why medical insurance companies are actually incentivized to provide coverage for full arch dental implant treatment, highlighting its benefits for both patients and insurance companies.
The "Dental Insurance Paradox" refers to the inherent contradiction in how dental insurance is structured compared to medical insurance. When only a few dental problems are encountered, it makes sense to repair the problem in a “tooth by tooth” fashion. The current dental insurance benefit system is set up to work this way, with low annual maximum benefits covering a a select few treatments. Once that annual maximum is met, you’re on your own.
When a patient requires extensive dental work, such as those with terminal dentition, requiring the replacement of many teeth, it is often recommended to remove the remaining teeth and perform full arch implant rehabilitation. This approach is typically less time-consuming, less expensive, and more predictable than attempting to save each individual tooth (which may require years of treatment, costly surgeries, and questionable predictability.) Yet, with full arch implant rehabilitation, both medical and dental insurance covers little to none of this treatment.
The current dental benefits system is designed for patients who need minimal dental care and have regularly visited the dentist their entire lives. The reality in the US is that many Americans have experienced hardship, whether it be financial, social, personal, or simply a fear of dentists. Many of these patients have not seen a dentist in years, potentially even decades. These patients who have steered away from dentists their whole lives, are the ones who need care the most. Oftentimes, in the case of terminal dentition, full arch implant rehabilitation is a predictable, fast, and single treatment that can address their needs. However, the system is not set up to cover extensive treatments, including full arch implant rehabilitation.
Medical insurance often has patients pay a deductible up to a certain amount of care needed, and then extensive work beyond that amount is covered by the insurance company. This means extensive work is covered, while minor issues may not be. This is the dental insurance paradox1.
With a current dental utilization rate of only 43%, a significant portion of the population does not regularly see a dentist2. This massive category of patients contain the individuals most likely to benefit from full arch implant rehabilitation rather than incremental tooth-by-tooth treatments, making it a more effective and financially sensible option.
A healthy oral cavity has far-reaching implications for overall health. Untreated oral disease can worsen cardiovascular disease, risk of stroke, and diabetes3. Poor oral health due to reduced chewing capacity is even associated with cardiovascular and cancer related mortality4. One study even found an association of tooth loss with high risk of hip fracture5. The morbidity and mortality of such injuries are significant, carrying a 25% 1 year mortality, rate with permanent disability ranging from 30-80% of patients. The lifetime costs of treatment associated with a hip fracture is $81,3006.
By optimizing oral health overall, whether through full arch implant treatment or other means, we can remove disease, reduce oral inflammation, improve masticatory function, and contribute to a healthier overall lifespan. Aside from the health benefits, the economic impact can reduce said health conditions, and ultimately actually likely save health insurance companies money in the long run, in this example, potentially ~$30,000 per patient.
At this point in time, the dental industry is only at the beginning of exploring these oral-systemic connections, and will likely discover more.
Optimal oral health not only improves physical health but also has a profound impact on mental health and psychological wellbeing. The ability to smile confidently is known to improve mood, reduce stress, and foster stronger interpersonal relationships7,8. Conversely, being embarrassed about one's smile and experiencing low self-esteem due to terminal dentition can negatively affect mental health.
Poor mental health ultimately leads to higher healthcare expenses. In the US alone, mental health treatment costs the US economy $1 trillion each year9.
By medical insurance covering full arch implant treatment, health insurance companies can help actually reduce health care costs by improving patient’s mental health and overall well-being.
The demand for dental implants has increased significantly due to improvements in dental implant awareness, an aging population, and a preference for implants over other dental prosthetics due to esthetics and the ability to preserve natural bone10. Tooth loss affects 52% of adults in the US. In fact, by 2026, nearly 1 in 5 Americans are expected to have at least one dental implant11. However, only 10% of general dentists in North America surgically place implants according to one source12. When adding in the dental specialists who also place implants (periodontists, oral surgeons, and prosthodontists13), the combined figure results in only ~40,000 dentists who place implants, needing to serve nearly 134 million Americans with missing teeth14. This supply and demand mismatch creates an astounding access to care problem, making it difficult for patients to find appropriate providers.
Full arch implant treatment is prohibitively expensive for the majority of Americans. A Texas survey demonstrated prices average to be $26,350 per arch15. Given that the cost is nearly entirely out of pocket, the high price point cost drives many patients to seek care abroad, where standards may not be as stringent as in the US, potentially lacking accreditation standards . The CDC reports the most common complication amongst medical tourists are infection related, which may pose challenges for follow-up care when patients return to the US16.
When patients who have received treatment abroad experience complications, US dentists may be unable to treat them due to unfamiliar parts, lack of compatible equipment, or discomfort with the techniques used by foreign providers. This can lead to further risk of complications, limited postoperative care, lack of legal recourse, and ultimately increased costs17.
A streamlined, technology-enabled platform like Toothsome can significantly improve the discoverability and accessibility of this specialized treatment for millions of Americans. By using AI to connect patients with highly qualified implant dentists, we can bridge the gap between demand and supply, ensuring that patients receive the care they need. Search today if you are at the beginning of your implant journey.
Covering full arch dental implant treatment through medical insurance is not only beneficial for patients but also for insurance companies. By addressing the dental insurance paradox, improving overall health, and reducing the need for medical tourism, insurance companies can save money in the long term. Additionally, platforms like Toothsome can help bridge the gap between patients and providers, ensuring that everyone has access to the care they need.
It’s time for a paradigm shift in how dental and medical insurance companies view full arch implant rehabilitation. Let’s push for policies that support comprehensive coverage for these life-changing treatments, ultimately leading to improved health outcomes for millions of Americans.
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