2005
Primary Health Care Policy Fellowship

Improving Oral Health Integration within Primary Health Care

Homa Amini, D.D.S., M.S., M.P.H.
American Academy of Pediatric Dentistry

Carolyn Dolan, M.S., R.N., C.S.
American Nurses Association

Francisco J. Ramos-Gomez, D.D.S., M.S., M.P.H.
Hispanic Dental Association

Nicholas G. Mosca, D.D.S.
Association of State and Territorial Dental Directors

Health Issue – Dental caries is the most common chronic infectious, transmissible disease; yet dental caries can be easily prevented with an integrated primary health care model.

Problem:         An alarming lack of integration of oral health with general health and a widespread perception that oral health is “secondary to and separate from health”, when it should be “interdependent”.[i]The health care system is fragmented; there is little to no coordination of oral health services with primary health care services. Oral disease complicates medical conditions like diabetes and heart disease and is associated with pre-term low-birth weight babies.[ii] 

Ø      There is a lack of awareness about the oral complications of many systemic diseases among dentists, nurses and physicians due to the poor dissemination of the latest evidence-based research into education and practice.

Ø      Comprehensive dental care is not readily available for low income, uninsured or underinsured, Medicaid beneficiaries, infants and toddlers (0 to 5 years of age), the elderly, and those with special health needs (i.e. mentally challenged, HIV/AIDS, etc.).[iii]

Ø      Minority and low-income populations bear a disproportionate burden of oral disease in the U.S.[iv]

Ø      Poor integration of oral health education and training in the medical, nursing, and allied health education curriculum contributes to poor health outcomes.[v]

Ø      Severe fragmentation between local, state, federal, academic, private practice and professional entities is a barrier to a sustainable and integrated system for the prevention and control of oral disease.

Solution:         We recommend that DHHS convene a National Steering Committee to develop a department-wide oral health communications plan. The goal of this plan is to achieve a sustainable integration of local, state, federal, academic, private practice and professional partners that will maximize available resources. This National Steering Committee will make recommendations to reduce fragmentation of services and achieve a sustainable coordination and integration of medical and dental primary health care services.

We suggest that DHHS invite the existing primary health care and dental leadership within HRSA, NIH, CDC, CMS and other agencies to serve on this National Steering Committee with a mix of multi-disciplinary experts that includes clinicians, educators, state dental directors, purchasers / payors of care, and policy makers to provide guidance and expertise.

This promotes and supports the current strategic planning for the department while increasing interagency connectivity, catalyzing coalitions of people in the regions and states, and maximizing oral health information sharing.  An oral health communications plan developed by the National Steering Committee will provide direction to:

Ø      Assist the integration of recommendations to reduce oral disease for all DHHS primary health care programs.

Ø      Develop key regional (multi-state) federal oral heath leaders to support partnerships for the integration of oral health within primary health care.

Ø      Create and reinforce linkages among clinicians, health educators, state and territorial dental directors and health policy makers to assure integration of oral health within primary health care.

Ø      Formulate and legitimize health benefit models and prospective payment methods to integrate oral health and improve access to dental care.

Ø      Develop and implement a national surveillance measure to monitor and assess the integration of oral health within primary health care.

Conclusion:     A fragmented and poorly integrated oral health care delivery system is compromising the health of the Nation by compartmentalizing health information and services within specialized “silos”. Dr. Elizabeth Duke’s current strategic plan is directed to focus resources and services on diseases and conditions with the greatest health disparities, such as dental caries, the most common chronic and transmissible disease of children.[vi] A department-wide oral health communications plan created by expansion of HRSA’s current activities will help to reduce the burden of dental caries through primary health care interventions, thus avoiding the costs associated with specialty care. A National Oral Health Steering Committee will work to integrate oral health in health education and primary care services by building collaborative partnerships among dental, medical and public health communities.

References:

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