How technology is changing dental appointments for patients with intellectual disabilities [PODCAST]

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We explore the unique challenges faced by patients with intellectual and developmental disabilities (IDD) during dental appointments. Our guests, Brian Jones, a health care executive, and Tina Saw, a dentist and health care leader, share insights on how sensory sensitivities, higher oral care needs, and barriers to care impact these patients. They’ll discuss innovative approaches like chair-side salivary testing and the critical role of medical-dental integration in improving health outcomes.

Brian Jones is a health care executive. Tina Saw is a dentist and health care executive.

They discuss the KevinMD article, “Is saliva the key to early disease detection and better oral health outcomes for patients with intellectual and developmental disabilities?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Brian Jones and Tina Saw. They are both health care executives; Tina is a dentist. They’re going to talk about the KevinMD article “Is saliva the key to early disease detection and better oral health outcomes for patients with intellectual and developmental disabilities?” Brian and Tina, welcome to the show.

Brian Jones: Thanks for having us.

Tina Saw: Thank you so much.

Kevin Pho: So I’m going to ask each of you just to briefly share your story and journey. Tina, why don’t you go first?

Tina Saw: Yeah, so my name is Tina. I’m a dentist based out in San Diego, California, and I’ve had a private practice for a really long time. Really, my story is: How can I help patients more? I do have a child with a disability, and so it’s really been a passion for me to try to help solve these problems, as I see the challenges in health care for people with autism and disabilities. So that’s just a little brief about me.

Kevin Pho: Perfect. Then, Brian, tell us a little bit about yourself.

Brian Jones: Sure. Brian Jones, based out of the Washington, D.C., area. I got into the health care space by realizing there were some significant issues that came out of my dad passing away from a long fight with cancer, and understanding what it was like, not only for him to go through that journey, but the journey afterwards as well, and how hard that system is to navigate. I found my way now to the oral health space, looking deeper into how we can find new and innovative ways, not only to serve our members, but also to integrate the provider into more personalized care with our members as well.

Kevin Pho: And Brian, how did you and Tina connect?

Brian Jones: So Tina and I connected initially through a mutual friend, who also happens to be my best friend and has a son on the spectrum as well, with a new and innovative way to say, “How do we approach patients with special health care needs, especially in the oral health space?” And he connected up Tina and I. I have an avenue where we’re directly serving members as a managed care organization, specifically within the Medicaid space, and again finding new ways to kind of bend that cost curve and create better outcomes for members with special needs.

Kevin Pho: All right, let’s talk about this KevinMD article. It is titled “Is saliva the key to early disease detection and better oral health outcomes for patients with intellectual and developmental disabilities?” Tina, before we talk about the article, what led you to write this article in the first place? And then you could talk about the article itself for those of you who get a chance to read it.

Tina Saw: Yeah, so I think one of the things for me, especially with a child on the spectrum: My child’s very lucky, where he had me, so I could go and see him at any time. But when I brought him to other health care providers, I noticed there were a lot of challenges. I spent a lot of time also in all these forums, connecting with other parents who have a child with special needs, and a lot of this is that we struggle as parents to bring our children to the dentist because they have so many sensory problems. Really, the sound of the drill, or what we call the handpiece in dentistry, or even the suction. There are a lot of techniques that a child with a disability really needs to go through and feel touched, and a lot of times it’s just very, very difficult to find a provider who understands all of that.

And so as parents, what we try to do is focus a lot on prevention, early detection, all those things, but there really hasn’t been a really good mechanism to do that with children who have special needs. Another thing, too, is that the taste of even toothpaste or anything can really trigger a child. So I think the bottom line was, I got to this point where it’s like, “How can we develop something to help these patients, so that they ultimately don’t have to go through sedation or anything to fix all these dental problems?”

Kevin Pho: OK. And what were some of the innovations that we’re talking about?

Tina Saw: Yeah, so saliva testing is one of those. I think one of the things with saliva is that you can tell a lot really early on just through spit. You can look at people’s pH. You can look at their cavity risk through how their saliva coats, everything like that, and you can look at their gingivitis. But one of the things, too, is that we need to do it very quickly. I think the challenging thing with people who have IDD, or intellectual and developmental disabilities, is: How do we get them to cooperate, or how do you make the process really, really easy?

So with my child, I think one of the things was, when there was COVID testing, that spit thing, I could barely get him to spit in that vial so that we could even send it out to get the COVID test. So we’ve made it really easy, actually through my company, Oral Genome, where they spit in this device that has something that just triggers that saliva to flow out. And then we’re able to just accurately get it on a test card and be able to measure their dental health, to understand it and kind of change their trajectory, so they have better outcomes, better prevention, and the parents know what to do.

Kevin Pho: So, Tina, just a follow-up on that. So they would spit on the card, and then what kind of information, as a dentist, would that give you? And give us maybe a case study or story about how you said it would change that trajectory of care.

Tina Saw: Yeah, for example. I mean, cavities are one of the number one chronic childhood diseases. And so when we measure things to do with cavities, pH is one of the big ones, where you’re looking at how acidic that saliva is. Everybody is just slightly different, and that’s something that you can change over time based on how they eat, different dietary recommendations, lifestyle recommendations, how they brush, and what products they utilize.

Buffering capacity is another thing that we measure, which is how the saliva coats and protects; that natural protection that occurs after you’re eating. So it’s like, how do you counter that acid breakdown? But there are ways to rebalance. So if we’re changing some of our food and our products and things like that, we can actually almost remineralize and kind of change that trajectory of how that acid attack happens and how that protection happens.

Kevin Pho: So, Brian, when you heard Tina’s story, tell us about how this technology resonated with you.

Brian Jones: Sure. So, you know, when we look at how we deliver the optimal care to a member that we are stewarding through our process, we have to find new and innovative ways to make it minimally invasive on them, and also give them a direction, because you’re only going to see your dentist twice a year, optimally. So what can we do in between that period of time to help them understand how they can change their lifestyle or the habits that they have to enhance their oral health? And by the way, we’re also finding additional ways to enhance their overall health as well.

And so Tina had mentioned the salivary collection device. Well, working within the special needs populations, sometimes you have caregivers that are trying to take this, and sometimes you have the member themselves. Having an easy way that does not require anything other than placing the cup up to your lips, essentially, to collect that is crucial to make sure you get the right sample with how that’s being done.

And then there are the recommendations that come from that, whether that is using a different toothpaste or mouth rinse based on the pH of your mouth, because maybe your diet is very basic, and fluoride doesn’t do the same things in your mouth that maybe an arginine toothpaste and a mouth rinse might do. Those are interventions that can happen in between visits to increase your overall health, to make sure that the bad bacteria is being driven out of their mouth, and really allowing us to have an ongoing intervention versus a twice-a-year intervention, where usually it’s based on some restorative components as well. So how do we really drive them to a prevention-based lifestyle versus prevention every six months, from that perspective?

Kevin Pho: So, Brian, you mentioned that you want to expand this technology, certainly, to different practices, different groups with IDD, intellectual and developmental disabilities. Give us a case study or story where, by implementing this technology, it’s made an appreciable difference in their care.

Brian Jones: Sure. So right now, with Tina and her team, we’re implementing four pilots across the country, in Pennsylvania, West Virginia, California, and Florida. We’re looking at various populations within those areas, primarily focused on kids and adults with intellectual and developmental disabilities, but also expanding that to say, “What’s the difference between rural, suburban, and urban populations as well?” As we know, access to various different elements within that can change based on that population.

Our early results are from the pilot that we have ongoing in West Virginia, which is our longest pilot so far, in a rural population. Of about our first one hundred members that we saw there, we saw about a 5 to 7 percent diagnosis of undiagnosed diabetes through our saliva testing. Their salivary glucose levels were high, as an early indicator that they might be prediabetic or diabetic, and these are all folks that had no idea they were. So through care coordination and others, we were able to get them in for an A1C test, so it was verified with a blood test, and we found that all of these folks had undiagnosed diabetes at some level of diagnosis.

And so when you think about catching it early, and all of the things that you can put in place within that process, from better diet to better lifestyle habits to avoiding end-stage renal disease and dialysis down the road, we can start taking a look at the overall savings that you can offer the health care system, but the quality of life that you can offer that individual by identifying it early. Because maybe they only go to the doctor when they’re hurt, or they don’t have regular checkups, or they’re not at the age yet where it’s recommended that you have a regular annual checkup.

And so we were able to identify those, but also look at the persistence of periodontal disease within that, and help them with interventions through the dental office, with other habits that they can put in place to be able to do that, whether it’s another technology, a different toothbrush, or just different hygiene habits that they can implement. Not only to make their oral health journey that much more productive, but also to help them now on their new diabetic journey, from that perspective, and how they can use oral health to make themselves healthier there.

Kevin Pho: Yeah, Tina, talk more about that. As you know, I’m an internal medicine physician, so there is a strong connection between oral health and a variety of systemic diseases: diabetes, cardiovascular conditions, and whatnot. So tell us more about that connection and how important it is to have good oral hygiene to prevent some of these more systemic complications.

Tina Saw: Yeah, I mean, you’re absolutely right. Everything starts in the mouth. What we do is we’re measuring these biomarkers that we’re finding, actually through literature, are related to cardiovascular disease. Brian mentioned diabetes. We’re looking at Alzheimer’s. These are the things that, more and more, everyone talks about: the oral systemic connections. And so with our results and what we’re doing, not only are we measuring that biomarker, but we’re also saying, “Hey, you need to check out these medical conditions that are probably going to be associated.” And then we go and do these referrals and catch these diseases early on.

One of the other things that we’re doing also at Oral Genome is a lot of oral systemic research. We do it at the universities. We’re working with neurologists. We’re working with people looking at their cognitive behavior. Because ultimately, what we’re trying to do is bring people, starting in dental, in the mouth, with saliva testing, to go look at more long-term conditions, catch things early, and even save the health care system money just by doing an early intervention.

Kevin Pho: And Tina, what exact biomarkers are currently being tested whenever you do the saliva test? You mentioned pH. What are some specific things that you’re also measuring?

Tina Saw: Yeah, pH, buffering capacity. We look at your protein levels. We look at glucose. We look at MMP-8. And then we look at Porphyromonas gingivalis, commonly known as P. gingivalis, and nitric oxide.

Kevin Pho: And in terms of the cost for these tests, is this typically covered by dental insurance? How much does it cost to implement one of these tests?

Tina Saw: Yeah, so for providers, we do charge providers about $55 to $65, and then we will go look for, you know, a lot of providers may bill their insurance. But we do partner with some, like Avesis, that will help bring this to their members in different pilots.

Kevin Pho: And Brian, in terms of future directions, do you see this expanding to a population outside of those with intellectual and developmental disabilities? Talk about some of the other applications that can potentially come down the road.

Brian Jones: Oh, most definitely. I mean, we’re using this device as a central point to a prevention-based, value-based care program. One of the key components of our pilot is: How do we factor this into a normal dental visit without adding time? And we’re actually finding it’s fitting in, or even reducing the amount of time that a dental visit can take, because we’re able to pinpoint additional points of care.

But from our perspective, we need to make this cost-effective for the Medicaid populations. Typically, when you’re looking at what’s reimbursed within Medicaid, either the reimbursements are very low or not there at all for new, innovative technology. And so we’re helping the providers by doing bundled approaches to preventive care, where we’re bundling things together that allow them to not only bill for additional services that these tests allow them to do, like nutritional counseling, tobacco cessation counseling, things like that that could be done within the provider’s office, but now we’re giving them much more meaningful things to use. One of the great things about the app and the AI that comes out of this is there are tangible recommendations for what they should be doing, and so we’re helping the dentist bridge that gap as well in some of those areas.

And, you know, we would like to install this everywhere we work, to understand how we can risk-stratify the population, understand where the real critical points of care are, and then potentially make recommendations from a policy perspective based on the oral health of that population, to say, “Maybe we need to do something different here than maybe we’re doing over here,” instead of what’s traditionally been a peanut butter spread approach to oral health care. So that’s really where we’re headed and focused there.

Kevin Pho: We’re talking to Brian Jones and Tina Saw. They’re both health care executives; Tina’s a dentist. Their KevinMD article is titled “Is saliva the key to early disease detection and better oral health outcomes for patients with intellectual and developmental disabilities?” Now I’ll ask each of you just to share some take-home messages with my clinician audience. Tina, why don’t you go first?

Tina Saw: Some take-home messages: You know, I really believe, as a dentist, that there is so much about the oral systemic connection. But here’s the thing: It’s our job to implement new technologies to better help our patients. So implement new technologies to better help our patients.

Kevin Pho: Hey, Brian, why do we end with you?

Brian Jones: So, you know, working and coming from the managed care side, talking to the clinicians out there: There is an organization out here that is trying and really putting an emphasis on how we enhance the experience, not only for the member, but how we’re doing that through the provider. A lot of times we’re seen as adversaries instead of partners in these communities. And we can really bridge the gap and do what all of us are trying to do, which is make that member population that much healthier by collaborating on these types of things. And that’s really how Tina and I came together, to solve a major problem within the oral space.

Kevin Pho: Brian, Tina, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Brian Jones: Great, thank you.

Tina Saw: Thank you.

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