A 2014 study in the American Journal of Preventive Medicine examined the dental and medical claims of more than 330,000 insured members and found that treating gum disease was associated with about 40% lower annual medical costs for members with diabetes, with similar reductions for stroke and pregnancy.1 It is a retrospective claims association, not proven savings, and it concerns professional periodontal treatment rather than home flossing.
What did the Jeffcoat study find?
Among insured members who had gum disease and a serious medical condition, receiving professional periodontal treatment was associated with substantially lower medical costs. That finding comes from a 2014 study led by Marjorie Jeffcoat, published in the American Journal of Preventive Medicine, which examined the combined dental and medical insurance claims of more than 330,000 insured members.
The pattern was consistent. For members with diabetes, treating gum disease was associated with about 40% lower annual medical costs. And the pattern wasn't unique to diabetes: the study found similar cost reductions for members with a history of stroke, and for pregnant members.1
Over 330,000 insured members. Treated gum disease associated with roughly 40% lower annual medical costs for members with diabetes, with similar reductions for stroke and pregnancy.
Numbers like these are why oral health keeps forcing its way onto the agendas of medical insurers and employers. Whole carrier programs exist because of data in this family, a story we tell in why insurers built whole programs around gums.
Does treating gum disease cause the savings?
No. The study establishes an association, not causation, and two caveats matter. An evidence-first library has to be precise here, because this finding is easy to overstate.
First: it's an association, not a proven cause. This was a retrospective analysis of claims data: researchers looking backward at what happened, not a randomized controlled trial assigning people to treatment. People who get their gum disease treated may differ from people who don't in ways that also affect their medical costs: they may be more engaged with their health generally, more likely to fill prescriptions, more likely to show up to appointments. The study can't fully untangle that. The honest reading is that treated gum disease and lower medical costs travel together in the data, strongly and repeatedly, not that treating gums has been proven to cause the savings.
Second: it's about professional treatment, not home flossing. The members in this study received periodontal treatment: professional care for diagnosed gum disease. Nobody should read this study and conclude that a flossing habit is worth 40% of their medical bills. That claim doesn't exist in the literature, and we won't pretend it does.
What does Cigna's own data show?
Cigna reports the same direction from its own books, and the Jeffcoat study isn't alone. Cigna's own three-year claims study found medical costs about 23% lower (roughly $2,500 a year) for diabetics whose gum disease was treated.2 That figure comes from Cigna's internal analysis rather than peer review, so we attribute it to Cigna and hold it more loosely, but it points the same direction as the academic data: in claims databases, treated gums and lower medical spending keep showing up together.
Where does daily home care fit in?
Daily home care sits upstream of the cost evidence, connected to it by a chain in which each link has its own evidence: no link borrowed from another.
Link one: daily interdental cleaning is tied to less gum inflammation and less gum disease. Cochrane (the most rigorous reviewer of clinical trials in medicine) finds that cleaning between the teeth, on top of brushing, reduces gum inflammation, the earliest stage of gum disease; the certainty is modest, but the direction is consistent.3 And in large national CDC survey data, adults who cleaned between their teeth regularly had measurably less gum disease, with the most frequent cleaners showing the least severe disease.4 Both findings carry caveats (trial certainty is modest, the survey data is observational), and we walk through them fully in what Cochrane actually says.
Link two: less gum disease means less gum disease to treat. This one is close to arithmetic. The Jeffcoat cost data lives at the destination: people whose periodontal disease was professionally managed. Prevention's job is to keep people from needing the trip.
Walked in order, the chain reads: daily care between the teeth is associated with less gum inflammation and disease → less disease means fewer people progressing to the serious periodontal cases → and treated or avoided periodontal disease is where the medical-cost data lives. No single study covers the whole chain, and we won't pretend one does. But every link is individually sourced, and they point the same way.
Why this finding earns its place
Most oral-health evidence measures teeth: plaque scores, bleeding sites, pockets. The Jeffcoat study measured something the rest of the healthcare system actually budgets around (total medical spending) and found gum treatment associated with double-digit reductions in it, across three very different conditions. Even stated with every caveat intact, that's the strongest signal we have that the mouth's connection to the body shows up not just in biology, but on the bill.
Common questions
Does flossing save 40% on medical bills?
No, and nobody should read the study that way. The members in it received periodontal treatment (professional care for diagnosed gum disease), not a home care routine.1 The claim that a flossing habit is worth 40% of a person's medical bills does not exist in the literature, and we won't pretend it does.
Is this proof that treating gum disease saves money?
No. It was a retrospective analysis of claims data, not a randomized controlled trial.1 People who get their gum disease treated may differ from people who don't in ways that also affect their medical costs: more engaged with their health generally, more likely to fill prescriptions, more likely to show up to appointments. The honest reading is that treated gum disease and lower medical costs travel together in the data, strongly and repeatedly.
Does the finding apply to people without diabetes?
The pattern was not unique to diabetes. The same study found similar cost reductions for members with a history of stroke and for pregnant members1. The pregnancy thread is covered in oral health during pregnancy. It is a study of people who had gum disease alongside a serious medical condition, so it says nothing about members without either.
Why do insurers act on this if causation isn't proven?
Because carriers make coverage decisions on their own claims experience rather than on proof of causation. Several large ones have built programs that pay for extra gum care for members with conditions like diabetes and heart disease: the story in why insurers built whole programs around gums. The programs are documented fact; the savings figures those companies publish come from their own internal analyses rather than peer review.
- Jeffcoat MK, et al. Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. American Journal of Preventive Medicine, 2014. AJPM (PMID 24953519). Retrospective claims association across 330,000+ insured members; not a randomized trial; concerns professional periodontal treatment.
- Cigna three-year claims analysis of members with diabetes and treated gum disease. Insurer's own analysis, not peer-reviewed; figures attributed to Cigna.
- Worthington HV, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database of Systematic Reviews, CD012018, 2019. Modest-certainty evidence of reduced gingival inflammation.
- Marchesan JT, et al. Interdental cleaning is associated with decreased oral disease prevalence. Journal of Dental Research, 2018. PMC6728587. Observational NHANES analysis; association, not proven causation.