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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 and Tina Saw: Thanks for having us.
Kevin Pho: So I’m going to ask each of you 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. My story is really about figuring out how I can help patients more. I do have a child with a disability, 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. That’s just a little brief about me.
Kevin Pho: Then, Brian, tell us a little bit about yourself.
Brian Jones: Sure. Brian Jones, based out of the Washington, DC 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. I found my way now to the oral health space and 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: Tina and I connected initially through a mutual friend, who also happens to be my best friend, and who has a son on the spectrum. He was working with Tina on a new, innovative way to approach patients with special health care needs, especially in the oral health space. He connected Tina and me, and I have an avenue where we’re directly serving members as a managed care organization, specifically within the Medicaid space. Again, we’re 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 talking 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 that didn’t 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, is that my child is very lucky because I could see him anytime. But when I brought him to other health care providers, I noticed there were a lot of challenges. I also spend a lot of time in forums and connecting with other parents who have children with special needs. A lot of us struggle to bring our children to the dentist because they have so many sensory problems—the sound of the drill, or what we call the handpiece in dentistry, or even the suction. There’s a lot of techniques that a child with a disability really needs to go through, and sometimes it’s difficult to find a provider who understands all of that.
As parents, we try to focus a lot on prevention and early detection, but there really hasn’t been a good mechanism to do that. Also, with children who have special needs, even the taste of toothpaste or any dental products can really trigger them. So I thought, how can we develop something to help these patients so that they don’t ultimately have to go through sedation or any extensive procedures to fix these dental problems?
Kevin Pho: OK, and what are some of the innovations that you’re talking about?
Tina Saw: Saliva testing is one of them. You can tell a lot really early on just through spit. You can look at people’s pH levels, their cavity risk, and how their saliva coats everything. You can look at gingivitis and more. But we need to do it very quickly. The challenging thing with people who have IDD, or intellectual and developmental disabilities, is how to get them to cooperate and make the process really easy.
For my child, when it came to doing something as simple as a COVID test that required spitting in a vial, I could barely get him to do it. So we made it easier through my company, Oral Genome, by creating a device that helps trigger saliva flow. We can then accurately get it on a test card, measure it, and understand their dental health to change their trajectory for better outcomes, better prevention, and to help parents know what to do.
Kevin Pho: So Tina, just to follow up on that, they would spit on the card. What kind of information, as a dentist, would that give you? Could you give us a case study or a story about how it would change that trajectory of care?
Tina Saw: Yeah, for example, cavities are one of the number one chronic childhood diseases. When we measure things related to cavities, like pH, we look at how acidic the saliva is. Everyone is slightly different, and it’s something you can change over time based on diet, lifestyle recommendations, how they brush, and what products they use.
Buffering capacity is another thing we measure, which shows how the saliva naturally protects the teeth after eating. It’s about countering that acid breakdown. There are ways to rebalance. By changing food choices or products, we can almost remineralize the teeth and change the trajectory of how acid attacks and how protection happens.
Kevin Pho: So, Brian, when you heard Tina’s story, tell us about how this technology resonated with you.
Brian Jones: Sure. When we look at how we deliver optimal care to members, we have to find new and innovative ways to make it minimally invasive for them and give them direction on what to do between dental visits. 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 habits to enhance their oral health? In turn, we’re also finding ways to enhance their overall health.
Tina mentioned the saliva collection device. Working within special needs populations, sometimes you have caregivers who are trying to take samples or members themselves. Having an easy way that requires only placing the cup up to your lips to collect the sample is crucial. It ensures you get the right sample, and then the recommendations that come from that—whether using a different toothpaste or mouth rinse based on the pH of your mouth—can guide you in making positive changes in between visits.
For example, if a diet is very acidic or basic, fluoride might not be as effective as an arginine-based toothpaste and mouth rinse. These are interventions that can happen in between visits to improve overall health and keep bad bacteria out, offering an ongoing intervention rather than just relying on preventive measures every six months.
Kevin Pho: So, Brian, you mentioned wanting to expand this technology to different practices and groups with IDD. Give us a case study or story where implementing this technology made a significant difference in their care.
Brian Jones: Sure. Right now, 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 looking at differences between rural, suburban, and urban populations.
Our longest pilot is in West Virginia, where we’ve seen early results from our first 100 members. We saw a 5 to 7 percent diagnosis rate of undiagnosed diabetes through saliva testing. Their saliva glucose levels were high, indicating they might be pre-diabetic or diabetic, and they had no idea. Through care coordination, we got them in for an A1C test, and it confirmed the diagnosis.
By catching it early, we were able to set up interventions like dietary and lifestyle changes, avoiding downstream complications like renal disease and dialysis. We can look at the overall health care savings and quality of life improvements by identifying these issues early since these individuals might not regularly go to the doctor or have annual checkups.
We also looked at the persistence of periodontal disease and helped with interventions through the dental office. This way, we can make their oral health journey more productive while supporting their new diabetic management.
Kevin Pho: Tina, talk more about that. As you know, I’m an internal medicine physician, and there’s a strong connection between oral health and a variety of systemic diseases—diabetes, cardiovascular conditions, and whatnot. Tell us more about that connection and how important it is to have good oral hygiene to prevent some of these systemic complications.
Tina Saw: You’re absolutely right. Everything starts in the mouth. What we’re doing is measuring these biomarkers through saliva that are related to systemic diseases, like cardiovascular disease and diabetes. There’s also research linking it to Alzheimer’s disease. We’re measuring these biomarkers and recommending medical evaluations for conditions likely to be associated with these markers, catching diseases early, and saving the health care system money by doing early interventions.
At Oral Genome, we’re also doing a lot of oral systemic research with universities and collaborating with neurologists to look at cognitive behavior. We aim to bring people from dental care and saliva testing to look at long-term conditions, catch things early, and improve overall health.
Kevin Pho: Tina, what exact biomarkers are you currently testing when you do saliva tests? You mentioned pH; what are some other specific things that you’re measuring?
Tina Saw: We measure pH, buffering capacity, protein levels, glucose, MMP-8, and 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: For providers, we charge about $55 to $65. Some providers may bill insurance, but we also partner with organizations to bring this to health care systems and their members through different pilots.
Kevin Pho: And Brian, in terms of future directions, do you see this expanding to populations outside of those with intellectual and developmental disabilities? What are some other potential applications that can come down the road?
Brian Jones: Most definitely. We’re using this device as a central point in a preventative-based, value-based care program. One key component of our pilot is incorporating it into a normal dental visit without adding time, and it’s fitting in or even reducing visit times because we can pinpoint additional points of care.
We need to make this cost-effective for Medicaid populations, where reimbursements are either very low or nonexistent for new technology. We’re helping providers by doing bundled approaches to preventive care, allowing them to bill for additional services like nutritional and tobacco cessation counseling based on the saliva test results. The AI recommendations provide tangible advice for what they should be doing.
We’d like to install this everywhere to understand the population’s health and make policy recommendations based on oral health. Instead of a “peanut butter spread” approach, we can stratify and identify critical care points for specific populations.
Kevin Pho: We’re talking to Brian Jones and Tina Saw, both health care executives. Tina is 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’m going to ask each of you to share some take-home messages with my clinician audience. Tina, why don’t you go first?
Tina Saw: I believe there’s 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. We need to be proactive in embracing technology to make a difference.
Kevin Pho: Hey, Brian, why don’t we end with you?
Brian Jones: Coming from the managed care side, I want clinicians to know that there are organizations out here putting emphasis on enhancing the experience, not only for members but for providers as well. We’re often seen as adversaries rather than partners, but we can bridge that gap and make the member population healthier by collaborating on these types of initiatives. That’s how Tina and I came together—to solve a major problem in the oral health space.
Kevin Pho: Brian and Tina, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Brian Jones and Tina Saw: Thank you.
