Leading Indicators: Using Oral Health to Assess Life and Disability Risks

Underwriters can benefit from a deeper understanding of the link between oral health and overall health. Dental claims are valuable for assessing life and disability risks, making dental records an essential source of information underutilized by traditional underwriting methods. Poor oral health can lead to many adverse outcomes contributing to mental and physical instability. Data regarding tooth loss, dental visits, and periodontal diseases can indicate risks for mortality, disabilities, and other health conditions. Therefore, it is crucial to recognize the impact of oral health on life and disability claims and find ways to incorporate such information in the underwriting process for insurance.

Many published papers discuss an association between oral health and mortality, often looking at tooth loss. Padilha et al. (2008) and Hayasaka et al. (2013) conducted studies in the United States and Japan, respectively, and noted a significantly higher hazard of death for those with fewer teeth compared to those with 20 or more teeth. Atanda et al. (2021) performed a meta-analysis and highlighted the importance of tooth retention, as adults that had less than 20 teeth had an increased likelihood of functional dependence, disability, and lower overall quality of life.?

Several studies have established a link between oral health and disability among older adults. Kotronia et al. (2019) analyzed over 6,000 older adults in the United Kingdom and the United States. They found that decreased oral health was correlated with a higher risk of disability and physical function impairment. Specifically, the study saw that tooth loss was associated with limitations in activities of daily living (ADL) after adjusting for other factors such as age, social class, smoking, physical activity, history of cardiovascular disease (CVD), and diabetes. Participants who rated their oral health as fair or poor, reported having three or more dry mouth symptoms, or stated they had two or more oral health problems were more likely to have limitations in mobility, ADL, and instrumental activities of daily living (IADL).

Another study by Wu et al. (2007) also investigated the relationship between dental care utilization and overall health in older adults. According to the study, individuals with better self-reported general oral health had a higher probability of having had a more recent dental visit. A bivariate analysis showed a positive correlation between an increased level of cognitive function and individuals who had more recent dental visits and more frequent dental checkups.

In addition to the impact on disability risk, poor oral health has been connected to other health conditions, such as cardiovascular disease, diabetes, pneumonia, and brain atrophy. The U.S. Department of Health and Human Services Oral Health in America report highlights the strong connection between oral health and overall health, including linking periodontal disease to diabetes, cardiovascular disease, and stroke. Scannapieco et al. (1998) found that poor oral hygiene was associated with a higher risk of developing pneumonia in hospitalized patients, with the possible explanation that the aspiration of oral bacteria into the lower respiratory tract is a potential mechanism leading to pneumonia. Dyer (2023) discussed a Japanese study that explored the relationship between oral health and cerebral function. Tooth loss with mild gum disease and the retention of teeth with severe gum disease were both related to a shrinking hippocampus, similar to what is commonly seen in the early stages of Alzheimer’s disease, which causes memory loss and cognitive impairment.

Gathering oral health data is also an important part of the process of improving the assessment of risk in life and disability insurance underwriting.

Dental care providers can contribute information since they are responsible for keeping dental records such as frequency of dentist visits, tooth retention, and history of periodontal disease. Sharing this oral health data with life and disability underwriters lets them create better risk prediction models, allowing insurers to calculate morbidity and mortality risk more accurately. Claim records from dental insurance companies contain similar details and thus lend value as well.

Other private companies also collect oral health information. SIKKA does back-office administration for dental offices with over a hundred million patients in the United States and Canada and has developed a Life Expectancy at Current Age (LECA) Risk Score and a Periodontal Disease to Mortality Score.

SIKKA commissioned a study of their data and found a notable positive correlation between the presence of oral health red flags and tobacco usage, diabetes, and hypertension. Furthermore, factoring in oral health data led to being 2-5 times more likely to correctly confirm each of the four conditions, which without including it would have let the risks go unnoticed. It was also reported that roughly 50% of tobacco users were only identifiable through oral healthcare information.

Knowledge of dental history can enhance underwriters’ ability to correctly assess a person’s overall risk of death and disability. Incorporating oral health data, such as periodontal disease, oral conditions, and tooth loss, in modeling helps foster an in-depth understanding of which individuals are at an increased risk of developing diseases related to life and disability insurance before medical data shows signs of these conditions. Adding covariates proven to be statistically significant leads to the construction of more accurate models. Additionally, the ability to verify patient-reported responses (or prove the inaccuracy of it) allows underwriters to fine-tune their risk predictions.

Poor oral health adversely impacts an individual’s ability to function and overall quality of life, particularly among older adults. Thus, including data contained in dental claims in the underwriting process for life and disability insurance can give insurers a competitive advantage. Leveraging sources that provide this information promotes better modeling and beneficial long-term effects from more accurate forecasting.

#underwriting #disabilityinsurance #datasources

Atanda, Adejare (Jay), et al. “The Impact of Tooth Retention on Health and Quality of Life in Older Adults.” Innovation in Aging, vol. 5, no. Supplement_1, 17 Dec. 2021, pp. 609–610, https://doi.org/10.1093/geroni/igab046.2334.

Dyer, Rebecca. “Disturbing New Finding Links Cognitive Decline to Dental Hygiene.” ScienceAlert, 9 July 2023, www.sciencealert.com/disturbing-new-finding-links-cognitive-decline-to-dental-hygiene.

ExamOne. Oral Healthcare Indicators, May 2023, www.examone.com/wp-content/uploads/2023/06/ExamOne-Oral-Healthcare-Indicators-Confirmations-and-Lift.pdf.

Hayasaka, Kazuki, et al. “Tooth Loss and Mortality in Elderly Japanese Adults: Effect of Oral Care.” Journal of the American Geriatrics Society, vol. 61, no. 5, 16 Apr. 2013, pp. 815–820, https://doi.org/10.1111/jgs.12225.

Kotronia, Eftychia, et al. “Oral Health, Disability and Physical Function: Results from Studies of Older People in the United Kingdom and United States of America.” Journal of the American Medical Directors Association, vol. 20, no. 12, Dec. 2019, https://doi.org/10.1016/j.jamda.2019.06.010.

National Institutes of Health. National Institute of Dental and Craniofacial Research, 2021, Oral Health in America: Advances and Challenges, https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf.

Padilha, Dalva M., et al. “Number of Teeth and Mortality Risk in the Baltimore Longitudinal Study of Aging.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, vol. 63, no. 7, 2008, pp. 739–744, https://doi.org/10.1093/gerona/63.7.739.

Scannapieco, F.A., et al. “Associations between Oral Conditions and Respiratory Disease in a National Sample Survey Population.” Annals of Periodontology, vol. 3, no. 1, July 1998, pp. 251–256, https://doi.org/10.1902/annals.1998.3.1.251.

Wu, Bei, et al. “Cognitive Function and Dental Care Utilization among Community-Dwelling Older Adults.” American Journal of Public Health, vol. 97, no. 12, Dec. 2007, pp. 2216–2221, https://doi.org/10.2105/ajph.2007.109934.