Chad Meyerhoefer on Oral Health and Heart Disease

Image by iStock/VectorCookies

In this episode of Lehigh University’s College of Business ilLUminate podcast, host Stephanie Veto talks with Chad Meyerhoefer about his research on the causal effects of poor oral health on heart disease. Meyerhoefer holds the Arthur F. Searing Professorship and is the chair of the department of economics. His research focuses on the economics of health and nutrition and involves using microeconometric methods to evaluate and inform public policy. 

Listen to the podcast here and subscribe and download Lehigh Business on Apple Podcasts or wherever you get your podcasts.

Below is an edited excerpt from the conversation. Read the complete podcast transcript [PDF]. 

Veto: You're working on a research initiative about causal effects of poor oral health on heart disease. What drew you to this topic? 

Meyerhoefer: About 20 years ago, I worked at the U.S. Agency for Healthcare Research and Quality. I met a dentist named Richard Manski. He’s the chair of Dental Public Health at University of Maryland. We started talking about the dental care markets and how incentives provided by dental insurance are different from medical insurance and what that means for people's demand for medical care. 

Along with some other co-authors, we started working on how prices for dental services and insurance really affected whether people got preventive dental care and whether they got more expensive restorative care. We transition that work into focusing on the elderly and the situations that underlie access to dental care among the elderly. That population is really the only population in the U.S. that has a very difficult ability to access dental insurance, because dental insurance is not part of the Medicare program. 

It is incorporated indirectly in some people's Medicare plans if they have Medicare Part C, also known as Medicare Advantage. But it's not part of traditional Medicare like prescription drugs are now, or inpatient or outpatient services. So, we wanted to really determine what would change, how much people's health would improve if there was a Medicare dental benefit, and how it would also change demand patterns. 

That got us interested in the relationship between oral health and physical or non-oral health. Because, if it turns out that better access to oral hygiene and oral health actually has an indirect effect on chronic disease, then adding a dental benefit to Medicare may be less expensive than people think. It could offset the costs that are spent on the treatment of other chronic diseases like diabetes, heart disease, stroke and cancer. 

Veto: Give us an overview of the study and what you set out to examine. 

Meyerhoefer: This study is funded by the National Institutes of Health, and it focuses on identifying the strength and importance of the link between oral health and cardiovascular disease. Cardiovascular disease is not the only chronic condition that's affected by poor oral health, but it's the most expensive condition that Medicare pays to treat. It's very important in a person's likelihood of mortality and it's very common. So, we thought it would be best to start out looking at the link between oral health and cardiovascular disease. 

There are biological models that tell us how those things are related. And to briefly summarize, the link comes through periodontitis. People with poor oral hygiene can develop gum infections. Those infections lead to bacteria around your tooth and your gum tissue. Because there's blood flow through that part of your mouth and your gums, that bacteria can get into your bloodstream and then cause an inflammatory reaction in other parts of your body, which can lead to heart disease and heart attacks. 

People don't realize that when they practice good oral hygiene–brush their teeth, treat infections, things like that– they're reducing the likelihood of having a heart attack. So, we know that link exists conceptually, but we don't really know how strong it is or how important it is. What this study does is it tries to measure how much more likely a person is to have a heart attack or to have congestive heart failure, angina, or any other cardiovascular condition when they have a very strong form of poor oral health, which is edentulism. 

Veto: I'm just thinking about how much you had to really dive deep into dental knowledge and oral health beyond health economics itself. You're talking about things like you’re a dentist. 

Meyerhoefer: That's one of the interesting things about my job that I like. I have to learn about information from other fields to work in health. That's one of the unique aspects of health economics. I, of course, learned a lot from my co-authors, who are trained and have formal training in this area. But in some sense, this study, the economic part of it, is at the very end of the study that we haven't even gotten to yet, which is concerning how much cost offset there is in reduction in treatment of chronic disease from covering oral health. 

Economists spend a lot of time, especially applied economists like myself, studying statistical and econometric methods. This study is really about the application of those methods that have been developed in economics and in epidemiology to this problem. People haven't really investigated this problem using the techniques we use. 

Veto: What do you think the most important takeaways are from this research? 

Meyerhoefer: I think one important takeaway is that we know better now which conditions are most affected by poor oral health. We know that it's really increasing the likelihood of heart attacks. If you have a patient that has poor oral hygiene, has problems with their teeth, and then is also, by other measures, at risk for a heart attack, then that's important to know. It means that one of the things you can do for that patient is you can really emphasize the importance of better oral hygiene, or going to a dentist, or trying to find that patient a pathway to access dental care. For a patient that's already at risk of a heart attack, that's going to be more important. We find it's a large effect. It's larger than probably a lot of clinicians believe. 

Then for a patient who has something like angina, it's not that it's not important - good oral health is always important - but it's not going to be an acute risk factor like it will be for somebody at risk of a heart attack. I feel like there is going to be a contribution to downstream work that's really focused on the costs and benefits of incorporating a dental care benefit into Medicare, which is something that is relevant in healthcare policy right now. 

There's a group of policymakers that is really pushing to do this, but there's concern over the costs and changing a large program. A large entitlement program like Medicare, is difficult and complicated. So, it's not something that will come easily, but it's something that, to kind of have a path forward, we do have to know more about these linkages between chronic conditions and oral health.