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Letters: Genetic testing

June 05, 2017 I read with interest the April 21 article "ADA Puts Genetic Testing, Oral Health in Context for Dentists." Specifically, I found it profound that the Oral Health Topic published by the ADA concluded, "no predictive (genetic) test for periodontal disease currently exists." This is consistent with dental clinical policy of the benefit administrator United Healthcare, which states, "the clinical utility of genetic testing for susceptibility to periodontal disease has not been established. Additionally, there is a lack of objective, high quality clinical evidence to support these tests."

In the March 3, 2014, article "Delta Dental Plan for Employees Limits Cleanings for Health Adults to One Per Year," the ADA News reported on Delta Dental's plan for its employees in Michigan, Indiana and Ohio to implement a risk-based dental benefit plan called RightSize that uses a genetic test to assess patients' risk for developing periodontitis. The plan provides benefit coverage for one cleaning annually for patients who are determined not to be at risk. Patients who test positive for specific genetic markers are eligible for an additional cleaning, according to Delta. Stratifying patients by risk factors to limit benefits for dental cleanings was shown in a study using Delta Dental claims data to reduce plan costs by $37 per patient. Given the conclusions published by the ADA, it is troubling that this genetic test continues to be used by Delta Dental to determine a patient's risk for periodontitis and as a means to ration access to benefits.

Compounding the issue, some companies have instituted wellness plans that encourage employees to take this genetic test to receive additional dental cleanings. Interestingly, one major employer promoting this test is Amway Corporation. Both Delta of Michigan and Amway Corporation are investors in the company producing the genetic test.

Rightfully, risk-based plans are growing in popularity with employers and plan purchasers as they can better direct limited resources into care for those who need it most. As a profession, we welcome evolving science that can result in better health outcomes however, to assure patient health, any assessment of risk for the purpose of determining eligibility for benefit coverage should be grounded in recognized evidence and best practices. It is my hope that the ADA will partner with benefit industry representatives and other stakeholders to set standards for risk assessment tools that impact coverage for patient care.

Christopher J. Smiley, D.D.S.
Rockford, Michigan