The recession may be costing some Americans their dental coverage–and reminding them how important having dental benefits can be.

A few years ago, “dental was a tag-along product,” says Dr. Alan Vogel, national dental director at MetLife Inc., New York. “Everyone’s focus was on medical.”

Now, researchers are publishing more studies on the connections between oral health and general physical health, benefits budgets are shrinking, and dental insurance premiums are rising.

Due in part to the increase in the cost of dental insurance, “people are paying attention to it,” Vogel reports.

When the National Association of Dental Plans, Dallas, commissioned a survey of 1900 U.S. employers in July 2008, it found that 62% now regard dental coverage as an essential benefit, up from 53% in 2005.

LIMRA International, Windsor, Conn., polled 1000 U.S. employers of all sizes in December 2008 and January 2009. Most of the employers in the survey said they intend to continue to offer all the benefits they now offer, including dental. Some employers still hope to add dental benefits this year.

Few workers are experts on dental care.

Vogel said dentists and public health educators have their hands full with simply trying to teach patients the basics, such as the concept that gums should not bleed when they are brushed.

But consumers who need dental care are keenly aware of the effects of the economy on their ability to afford that care: Many are asking dentists for thorough diagnoses, then saving out-of-pocket payments by postponing whatever procedures can be postponed, Vogel says.

American Dental Partners Inc., Wakefield, Mass., a publicly traded company that sells services to dental practices, is seeing a similar trend.

“Our affiliated practices have observed patients either delaying care or, for those patients with dental insurance, opting for dental procedures that are largely covered by insurance,” American Dental says in a report filed with the U.S. Securities and Exchange Commission in March. “As a result, revenue growth rates of the affiliated practices have decreased and revenue mix has shifted towards lower-cost and lower-profitability dental procedures.”

Although dental insurance appears to be relatively inexpensive, Vogel says that is partly because the product covers only a small percentage of the problems that can affect the human body. In the United States, he says, people spend about as much each year on handling dental problems as they do on treating heart disease.

“Dental isn’t as cheap as you think it is,” Vogel says. “It’s not a low-cost item”

Although the Consolidated Omnibus Budget Reconciliation Act health benefits continuation rules require employers to offer departing workers a chance to continue their dental benefits, few departing workers do so, and layoffs appear to be costing some former group dental plan members their coverage, experts report.

Dental coverage cutbacks are particularly disturbing in light of recent research suggesting that good oral health can help improve many chronic conditions, such as heart disease, Vogel says.

Dental plans are trying to do more to tell policymakers and the general public why they think they matter.

The Delta Dental Plans Association, Oak Brook, Ill., a group that represents 39 dental plans, has started promoting its own reform proposal. DDPA says dental plans need to continue to be free to innovate, especially when developing dentist fee arrangements.

The American Dental Association, Chicago, recently attracted policymaker attention by organizing a conference on expanding access to dental care.

ADA also has started a pilot program that will create a network of community dental health coordinators, who will help connect patients with programs such as Medicaid and SCHIP.

In some cases, tight benefits budgets may have increased general consumer interest in dental insurance, by causing more employers to shift to employee-paid, or partially employee-paid, dental plans, and away from traditional group dental plans, Vogel says. Insurers have updated and expanded benefits to increase the plans’ appeal to consumers, he adds.

Vogel cites coverage of crown replacements as one example. Because crowns tend to be more durable than once expected, dental insurers can save money by cutting crown replacement benefits, then reallocating the money saved to support benefits consumers clearly value, he says.