Articles
New Oral Cancer Early Detection Tool Now Offered as Delta Dental Benefit
2004 Cost Containment Report Released
PANDA Program Helps Dentists, Others Fight Child Abuse
UMDNJ Establishes Dental Education Center with $2 Million Award from Delta Dental
Staff Spotlight: E.J. Sebelle
Eat Right, Exercise and... Floss?
Just Two Months until Golf Outing
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New Oral Cancer Early Detection Tool Now Offered as Delta Dental Benefit

Delta Dental of New Jersey is pleased to announce a new benefit that could have lifesaving consequences for subscribers and their families. 

The brush biopsy is a newly developed procedure that enables dentists to more easily test patients with unexplained red and white oral lesions, which may potentially be an early sign of oral cancer or pre-cancer.

Oral cancer is a life-threatening disease. Only about half those diagnosed with advanced cases survive more than five years. Early detection, however, significantly improves the outlook for long-term survival. 

The brush biopsy may assist early detection. This simple procedure can be done during the course of a regular exam, and involves little or no discomfort.

In 10% of patients, a dentist may notice an unexplained red or white spot in the patient’s mouth. Usually, these spots are harmless, but they can be warning signs of oral cancer. Until recently, methods for dentists to tell if a spot had the potential to turn into cancer were limited. 

With the brush biopsy, the dentist uses a small brush to collect tissue and send it to a laboratory for testing. Delta Dental of New Jersey covers the brush biopsy procedure itself upon confirmation of the laboratory analysis of the specimen. In most cases, the patient’s medical plan reimburses for laboratory analysis. 

The new technology makes it easier for dentists to detect oral cancer and pre-cancerous cells. If the test indicates potential atypical or pre-cancerous cells, the patient is referred for definitive diagnosis through a scalpel biopsy.

The brush biopsy is now being taught as standard practice in many dental schools in the United States. Delta Dental is developing a continuing education program for dental professionals on brush biopsy. The American Dental Association gave brush biopsy its Seal of Acceptance. 

“Oral cancer is a devastating disease,” says Dr. Scott Navarro, dental director, Delta Dental of New Jersey. “It can destroy your ability to communicate and obtain nourishment, as well as destroy your appearance, and ultimately may take your life. In spite of advances in cancer treatment, the survival rate of oral cancer has not risen significantly in the last 40 years. Early detection is the key to improving not only the survival rate but also the quality of life for those victims of oral cancer. Delta Dental of New Jersey is pleased to do its part in not only providing benefits for this early detection procedure but also in educating the public and profession regarding this valuable new tool in the fight against oral cancer.”

Delta Dental will also continue to cover traditional scalpel biopsies for oral cancer. 


Oral Cancer Facts

• 8,000 people in the U.S. each year die from oral cancer.
• 30,000 new cases of oral cancer are diagnosed each year.
• Oral cancer kills as many Americans yearly as melanoma, and almost twice as many Americans as cervical cancer.
• The five-year survival rate for those with advanced forms of oral cancer is just 57%; it has not improved in the last 40 years.
• When detected early, oral cancer survival rates increase dramatically (to 81% or more).
• The average cost of treating an advanced case of oral cancer is $200,000. Treatment costs for cancers detected earlier, especially in pre-cancerous stages, are significantly less.

Who Is At Risk for Oral Cancer?
Oral cancer can strike anyone. At particular risk are:

• Smokers;
• African Americans;
• Users of smokeless tobacco;
• Those who excessively consume alcohol.

However, 25% of those diagnosed have no risk factors at all!

• The incidence of the disease is on the rise among women under 40 and nonsmokers.

More information about oral cancer can be found at www.deltadentalnj.com; click on “Brokers,” then on the “Brush Biopsy Brochure” link.

2004 Cost Containment Report Released

Delta Dental’s cost containment programs saved groups more than $170.6 million in 2004. We also paid a record $409.1 million in claims in 2004.

These are among the findings of our 2004 Cost Containment Report. 

Delta Dental of New Jersey reports cost containment savings in eight key areas:

1. In-Network Savings - Reduction of billed charges to reflect the participating dentist's filed fee with Delta Dental, the maximum fee level approved for a DeltaPremier dentist, or the maximum charge approved under a PPO program. Represents savings from utilization of network dentists.
2. Contractual Limitations - Procedures denied due to generally accepted dental practice or specific contract limitations such as performance of a procedure in excess of a frequency limitation. Also includes reduction to payments due to Table of Allowance, reduction to the levels upon which payments of non-par dentists are based, and PPO tables (when non-PPO dentists are utilized).
3. Eligibility Verification - Benefit denials for procedures rendered during a period of patient ineligibility under the plan.
4. Non-Covered Services - Benefit denials for procedures excluded from coverage under the group program.
5. Dentist Consultant Review - Procedures which are not supported by diagnostic records or within generally accepted standards of dental care based on direct review or payment policy established by Delta Dental's dental consultants. This includes procedures for which Delta Dental will provide a benefit allowance for an alternative procedure that is within the generally accepted standard of care given the diagnosis or treatment plan.
6. Optional Services - Benefit denials or alternate benefit allowances for dental procedures that are considered optional and may be performed at the expense of the patient.
7. Non-Billable Services - Procedures that are not chargeable to Delta Dental or billable to the patient. Such charges may include component costs of a more comprehensive procedure which do not warrant a separate charge, and services denied as duplicate submissions.
8. COB Savings - Claim dollars saved through the application of coordination of benefit policies in accordance with the group contract, including non-duplication COB reductions (where applicable) and an enforcement of order of benefit determination rules.

To view the entire 2004 Cost Containment Report, visit our Web site at www.deltadentalnj.com, click “Brokers” and “Cost Containment.”

PANDA Program Helps Dentists, Others Fight Child Abuse 

Each year 40,000 cases of abuse and neglect are reported to the New Jersey Division of Youth and Family Services. Every 11 minutes a child is reported abused or neglected in the United States. More than three children die each day from abuse or neglect.
Would you be able to recognize an abused child?

The signs of abuse aren't always obvious. That's why the Delta Dental Foundation offers its PANDA (Prevent Abuse and Neglect through Dental Awareness) educational program to those who are in regular contact with children. 

PANDA was originally created for dentists, who are well positioned to detect child abuse. Two out of every three injuries occur to the head, face, and neck areas, which are readily visible during a dental exam. 

In recent years, the PANDA program expanded to include medical professionals, teachers, school nurses, youth group leaders, and other community group leaders who can assist in the fight to combat devastating patterns of abusive behavior.

PANDA presentations provide detailed information on physical and behavioral indicators of child abuse and neglect. They also teach how to report, whom to contact, and how to deal with the sensitive issues involved in filing a report of suspected abuse. 

The PANDA presentation is a one- to three-hour slide program and workshop conducted by trained professionals. The PANDA Coalition has members who are willing to present the program free of charge to dental or other interested groups with 10 or more members. For more information or to schedule a presentation in New Jersey, please call Delta Dental at (973) 944-4555. In Connecticut call the Connecticut State Dental Association at (860) 278-5550.

Sidebar: Delta Dental Supports Blue Ribbon Campaign Against Child Abuse 

Delta Dental is an annual sponsor of the Prevent Child Abuse-New Jersey (PCA-NJ) Blue Ribbon Campaign, which takes place each April during National Child Abuse Prevention Month.

PCA-NJ, with the help of hundreds of volunteers, distributes more than 250,000 blue ribbons throughout New Jersey. The ribbons remind people of the tragedy of child abuse and what they can do to help prevent it. 

For more information on PCA-NJ or to learn about becoming a volunteer for the Blue Ribbon Campaign, please call (732) 246-8060 or visit PCA-NJ's Web site at www.preventchildabusenj.org.

For information about other programs to prevent child abuse, visit the U.S. Department of Health and Human Services' National Clearinghouse on Child Abuse and Neglect Information at http://nccanch.acf.hhs.gov/.

UMDNJ Establishes Dental Education Center with $2 Million Award from Delta Dental

Delta Dental of New Jersey, Inc., has awarded $2 million to the University of Medicine and Dentistry of New Jersey (UMDNJ) to establish the Delta Dental Educational Conference Center in a new Oral Health Pavilion at the UMDNJ-New Jersey Dental School.

The award will be used to construct three state-of-the-art lecture halls that can also be combined into one conference center with a capacity of more than 400. The Delta Dental Educational Conference Center will include three conference rooms, a school lounge and a gallery that serves as a site for events. These areas of the conference center will comprise nearly 20,000 square feet within the Oral Health Pavilion, a three-story, 78,000-square-foot facility.

The conference center is part of a $45 million capital campaign for construction of the new Oral Health Pavilion and the renovation of the dental school. 

Dr. Gerald Sydell, chairman of the board of Delta Dental of New Jersey, said, "We are proud to have the opportunity to positively impact dental education and patient care at the UMDNJ-New Jersey Dental School. This school is poised to be a leader in dental education nationally. We believe that the funding will benefit the public in several important respects, including advancing dental education and providing care to the underserved in this state. The educational conference center will be an integral part of the growth and development of this fine institution."

Walter J. VanBrunt, president and chief executive officer of Delta Dental of New Jersey, said, "Delta Dental is proud to support the UMDNJ-New Jersey Dental School capital campaign in a manner that will positively impact the educational setting, foster their learning environment, and help the university fulfill its mission to the community."

Dr. Cecile Feldman, dean of the UMDNJ-New Jersey Dental School, said, "Our capital campaign and the development of the Delta Dental Educational Conference Center allow us to expand our reach and focus on our mission of educating students, conducting research and providing high-quality oral health care to our patients. This conference center will create an educational setting that gives our students an opportunity to hone their professional skills in a modern learning environment."

Each lecture hall has executive-style seating and state-of-the-art audio, video and computer equipment. Individual learning stations in each lecture hall will have Internet access for laptop computers. The Delta Dental Educational Conference Center will be housed in the Oral Health Pavilion, which is a new building adjacent to the dental school. The Oral Health Pavilion includes pre-doctoral clinics for students, patient waiting areas, administrative offices and a 3,000-square-foot school lounge.

UMDNJ comprises New Jersey's only three medical schools, the state's only dental school, the school of health-related professions, the school of nursing, the school of public health and the school of biomedical sciences on campuses in Newark, Piscataway/New Brunswick, Stratford, Camden and Scotch Plains. UMDNJ also operates University Behavioral HealthCare in Newark and Piscataway. It is affiliated with more than 200 healthcare and educational institutions throughout the state.

Staff Spotlight: E.J. Sebelle

E.J. Sebelle was still in college when he started working part-time at Delta Dental. After graduating from Montclair State University in 1999, E.J. became our marketing coordinator.

Shortly after starting full-time, E.J. was profiled in Staff Spotlight. Back then, he called Delta Dental “a great place to start my career.” He looked forward to “becoming a jack of all trades, and eventually, I hope a master of some.”

How has his vision panned out?

“It’s still a great place to work, and I still handle many different functions,” E.J. says. He’s also developed expertise in several areas. 

E.J. handles quote requests for voluntary DeltaCare plans. DeltaCare is our dental HMO product, offered through Delta Dental’s Flagship subsidiary. Voluntary plans are those in which employees choose to participate and pay the cost themselves.

E.J. also handles provider analysis when requests for proposals (RFPs) come in. This involves comparing Delta Dental’s dental network to our competitors. “That’s always a good selling piece because our network is so large,” says E.J. 

He takes pride in the service that he and Delta Dental deliver to clients. “Our service is second to none,” E.J. says. “We’re always willing to go out to see clients, to check in, say hello, and let them know their business is valued by us.”

Eat Right, Exercise and... Floss?

You know that white substance that builds up between teeth and gums? It is loaded with bacteria, many of which seem to be perfectly content to stay in their neighborhoods and eat away at local surroundings such as gums and jawbones. But some of these bacteria are more adventurous; they can get into the bloodstream and end up in exotic locales like lungs and arteries. 

A growing body of scientific evidence indicates that the bacteria responsible for gum disease can precipitate or aggravate a number of systemic illnesses, among them cardiovascular disease, diabetes, respiratory illness, and pre-term labor in pregnant women.

If that isn’t enough to make you want to keep a regular date with your dentist, consider this: Many of these and other diseases also have symptoms that initially show up in the mouth, offering early warning signs of sometimes serious medical conditions. In fact, more than 120 disease signs and symptoms can be detected through a routine oral exam. Dentists are often the first to detect cancerous or pre-cancerous lesions in the mouth. They can often spot other diseases as well, including anorexia and bulimia, hepatitis, anemia and, in some cases, the presence of AIDS by detecting oral infections that come from a compromised immune system. 

On its own, poor oral health can impact time away from school and jobs. The Surgeon General reports 51 million school hours are missed each year due to dental-related illnesses. For adults, more than 164 million work hours are lost each year due to dental problems. 

According to the Surgeon General, “Oral health is integral to general health. You cannot be healthy without oral health.” Illustrating the point are statistics showing the prevalence of specific diseases and ailments and their relations to oral health:

• More than one in three people age 30 and older have periodontal disease.
• Severe periodontal disease affects about 14% of adults aged 45 to 54.
• Pregnant women with periodontal disease are seven times more likely to give birth to a low-weight or pre-term baby. Almost 20% of pre-term and low-weight births can be linked to periodontal disease.
• Oral and pharyngeal cancers are diagnosed in about 30,000 Americans annually; 8,000 die from these diseases each year.
• In a recent study, people with rheumatoid arthritis (RA) were more than twice as likely to have periodontal disease with moderate to severe jawbone loss than those without RA. RA patients also averaged 11.6 missing teeth, compared to 6.7 in the control group.

Doctors conclude that there is still much to learn. But the findings so far underscore the importance of regular, preventive dental care, and they emphasize the key role that dental health plays in overall health.

Just Two Months until Golf Outing

The 15th Annual Delta Dental Golf Classic takes place June 22 at the Fiddler’s Elbow Country Club in Bedminster, New Jersey. The annual event benefits Special Olympics New Jersey (SONJ). SONJ is a non-profit organization that provides athletic training and competition for children and adults with developmental disabilities. 

Registration and sponsorship materials are available. For more information, please call Jennifer Appaluccio at (973) 285-4059.

Stay Current with News from Delta Dental - Subscribe to Consultant News

Delta Dental now offers two publications for brokers and consultants. The print newsletter Broker News is mailed to brokers twice a year. The online newsletter Consultant News is delivered every other month by e-mail to brokers who subscribe. 

Both publications are free.

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