What if the most expensive healthcare problem in your company is not what you think it is? For employers paying medical insurance premiums, untreated dental disease is silently inflating costs in ways that never appear on a dental benefits report. The connection between oral health and systemic disease is not a hypothesis. It is peer-reviewed, published, and quantified. And the numbers are staggering.
Most benefits leaders evaluate dental insurance as a standalone line item: a fixed premium, a predictable annual maximum, a utilization rate. But dental health does not exist in isolation. The mouth is not separate from the body, and the financial consequences of untreated oral disease extend far beyond the dentist's chair. They show up in emergency room visits, chronic disease management, adverse pregnancy outcomes, and rising medical claims.
The Medical-Dental Connection Is Not Fringe Science
Periodontal disease, the chronic infection that destroys gum tissue and bone around teeth, is one of the most prevalent chronic diseases in the United States. It is also one of the most consequential for overall health. The scientific literature is unequivocal: periodontal disease is associated with significantly increased risk of cardiovascular disease, poorly controlled diabetes, adverse pregnancy outcomes including preterm birth and low birth weight, respiratory infections, and chronic kidney disease.1
This is not alternative medicine. The evidence has been published in the Journal of the American Dental Association, the Journal of Periodontology, the American Journal of Cardiology, and dozens of other peer-reviewed publications. The American Academy of Periodontology and the American Heart Association have both issued formal statements acknowledging the association between periodontal disease and cardiovascular risk.2
The mechanism is straightforward. Chronic periodontal infection introduces bacteria and inflammatory mediators into the bloodstream. This systemic inflammatory burden exacerbates existing chronic conditions and increases the likelihood of new ones. For diabetics, the relationship is bidirectional: uncontrolled diabetes worsens periodontal disease, and untreated periodontal disease makes glycemic control harder to achieve.
The Numbers Employers Cannot Afford to Ignore
When researchers have quantified the cost impact of untreated periodontal disease, the findings are consistent and substantial. A 2023 study published in JADA in collaboration with the CareQuest Institute found that diabetics who received periodontal treatment had 12% lower total healthcare costs on commercial insurance plans and 14% lower costs on Medicaid, compared to diabetics who did not receive periodontal care.3
Earlier research reinforces these numbers. A 2016 analysis using the Truven Health MarketScan database found that periodontal treatment for diabetics resulted in $1,799 per patient per year in reduced medical expenditures.4 A 2011 study by Jeffcoat and colleagues at the University of Pennsylvania found even higher savings: $2,483 per patient per year in reduced medical costs for diabetics who received periodontal treatment.5 Looking at the long view, data from the Harvard Center for Health Decision Science estimates that addressing periodontal disease results in lifetime healthcare savings of $5,904 per person.6
These are not theoretical projections. They are observed differences in actual claims data, controlled for demographics, comorbidities, and other variables. The message is consistent across every study: untreated periodontal disease costs more on the medical side than treating it costs on the dental side.
Why This Is an Employer Problem
If you are a self-insured employer, or if you are paying medical insurance premiums for your workforce, untreated dental disease is costing you money on the medical side of the ledger. The dental benefit you offer may look affordable on paper, but if it is not being used, or if it is insufficient to cover the care employees actually need, the cost does not disappear. It migrates to medical claims, emergency room visits, lost productivity, and absenteeism.
"The ROI of dental benefits is not about teeth. It is about total healthcare cost."
Consider this: a typical dental insurance plan has an annual maximum of $1,500, a figure that has not changed since 1973.7 Adjusted for inflation, that $1,500 from 1973 would be over $11,000 today. Meanwhile, the cost of a single dental crown ranges from $750 to $2,000. A single root canal and crown can exhaust an employee's entire annual benefit before they have addressed any other dental needs. The benefit is structurally insufficient, and employees know it. So they defer care, the disease progresses, and the costs shift to medical.
The Access Problem
Even when dental benefits exist, they are not being used at the rates they should be. The data on this is sobering.
According to the American Dental Association, 46% of Americans report skipping dental care because of cost.8 CDC data from the National Health Interview Survey shows that 37% of adults do not see a dentist regularly, and only 64% of adults aged 18 to 64 had a dental visit in the past year.9 Perhaps most telling, NCHS Data Brief 336 found that 22.1% of adults who have dental coverage still do not use it.10
The benefit exists, but the barriers prevent utilization. Those barriers include cost-sharing and copays, network restrictions that limit provider choice, annual maximums that make comprehensive care impossible, and the administrative burden of claims, pre-authorizations, and appeals. When the system is designed to limit access, it should not be surprising that access is limited.
Remove Barriers. Fund the Care.
The solution is not to spend more money on the same broken model. It is to change the model. Instead of paying insurance premiums for a product that restricts access and caps coverage at an amount that has not changed in half a century, employers can fund dental care directly.
A dental wallet, backed by a 213(d) Health Reimbursement Arrangement, puts employer dollars directly into an account the employee controls. No network restrictions. No annual maximums in the traditional sense. No claims, no pre-authorizations, no denials. The employee visits any licensed dentist, pays at the chair, and the eligible expense is covered from their wallet balance.
When you remove the barriers, utilization goes up. When utilization goes up, preventive care happens. When preventive care happens, periodontal disease is caught early and treated. When periodontal disease is treated, medical costs go down. The evidence is clear, the mechanism is understood, and the infrastructure to deliver it exists today.
For employers who are serious about controlling healthcare costs, dental health is not a side issue. It is a medical cost driver hiding in plain sight. The question is not whether you can afford to invest in better dental benefits. The question is whether you can afford not to.
Learn more about how Toothsome helps employers deliver dental benefits that actually reduce total healthcare cost on our employers page.