Q. My dental bills related to Sjögren’s syndrome are exorbitant. Why can’t dental work be considered a necessary part of major medical insurance?
A. Your experience is a common problem, and I wish we could offer you an easy solution. We face a tradition in which dentistry and major medicine have been treated separately for a long time by insurance companies and even many medical professionals and educators. This is unfortunate, because the mouth often mirrors the body – in other words, oral health is an integral part of systemic health, and major medical problems often are reflected in the mouth.
What can you do? The best tool is education. Have your doctor explain to your insurance company that Sjögren’s syndrome is a chronic and systemic illness that involves serious oral health complications and treatment. Preventive care and care when problems first arise are critical so that more major problems don’t develop in the mouth and affect the rest of the body. For example, infection in the mouth can spread in the body, and loss of teeth due to dry mouth can impact nutrition. Sjögren’s patients are susceptible to developing non-Hodgkin’s lymphoma, and this complication most frequently is manifested first in the salivary gland. Share the information on our Foundation’s Web site at www.sjogrens.org and a copy of the Foundation brochures on Dry Mouth and on Sjögren’s. We need to ensure that our insurance providers and our doctors understand the close connection between the mouth and the rest of the body.
The National Institutes of Health Sjögren’s Syndrome Clinic worked with the Foundation to draft a sample letter that patients can give to their oral care physicians to send to their providers. That letter is reprinted below and can be downloaded on our website at:
Please feel free to give this to your doctor to submit to your insurance company.
You also can contact your U.S. Senators and Representative. Tell your Congressional members your story and ask for their help. Don’t forget to share information about your contacts and their responses with the SSF, so we can follow up on behalf of all Sjögren’s syndrome patients.
The Sjögren’s Syndrome Foundation is working hard to increase awareness and education about Sjögren’s syndrome so that patients can obtain better insurance coverage. We encourage you and others to share your stories so the Foundation can use those stories as it strives to help improve the lives of those with Sjögren’s syndrome.
To Whom It May Concern:
This letter is intended to give you a brief summary of Sjögren’s syndrome, associated oral manifestations and justification of the need for expanded dental care to be covered by your plan for our patient, [insert name].
Sjögren’s syndrome is a systemic immune mediated disease of exocrine tissues, such as salivary and lacrimal glands resulting in oral and ocular dryness. The oral manifestations of Sjögren’s syndrome include reduced quantity and quality of saliva, increased incidence of caries, dental decay and loss of teeth, mucosal atrophy, salivary gland enlargement, recurrent parotitis, and greater frequency of candidiasis and other infections.
Even though some medications stimulate saliva secretion, such as cevimeline (Evoxac™) and pilocarpine (Salagen™) the mainstay in the treatment of patients with Sjögren’s syndrome is regular dental care. Unfortunately, many of a patient’s dental issues are caused by the lack of saliva being produced by their salivary glands due to Sjögren’s syndrome.
Patients suffering from Sjögren’s syndrome require meticulous dentist-guided care, such as frequent visits to a dentist and prescription strength fluoride, to prevent and treat any complications associated with the disease as well as expanded services such as dental caps and implants. This progressive dental decay is caused by their disease and that is why we hope you will consider covering their dental visits under their health insurance plan versus dental insurance.
The complexity of the Sjögren’s syndrome requires multidisciplinary care with regular visits to a dentist, ophthalmologist, rheumatologist and their primary care provider.
We thank you for reiviewing this case and would be happy to discuss any questions you might have regarding Sjögren’s syndrome.
[your dentist or physician]