Greater Care through Collaboration

Oral health has been largely neglected and siloed from the rest of the health care system, yet studies show more than 90% of all systemic diseases have oral manifestations. The cost to care for these chronic diseases contributes to growing national health expenditures – above and beyond the $520 million Medicare spends annually on dental emergency room visits or the $6 billion lost in economic productivity from dental-related work absences.

Medical-dental integration is an approach to care that integrates and coordinates dental medicine with primary care and behavioral health to support person and population health. This approach, also referred to as interprofessional practice or IPP, has demonstrated early promise, with positive patient outcomes and reductions in total cost of care.

Given the mouth-body connection, there is an increasing need to break down that silo and advance integration between primary care and dental providers.

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The national conversation on oral health is changing and the focus on whole person care has grown.

In fact, the federal Health Resources and Services Administration (HRSA) in 2014 provided recommendations and guidance on the integration of oral health into primary care and stated its importance with overall health. In academic year 2017-2018, HRSA Oral Health Training programs trained over 9,500 oral health students and nearly 500 primary care dental residents. And in 2019, HRSA co-sponsored the National Academies of Sciences, Engineering, and Medicine Workshop - Integrating Oral and General Health through Health Literacy Practices. All of this indicates the growing focus on medical-dental integration at the national level.

On the ground, Stakeholders agree that greater collaboration between dental and medical providers will improve patient outcomes. In a recent study, Reversible Decay: Oral Health is a Public Health Problem We Can Solve, 55% percent of pediatric physicians and 50% percent of family physicians reported that in the last 12 months they had provided oral health screenings as part of the general medical exam in the last 12 months.

The study demonstrates overwhelming agreement among patients, dentists, employers and physicians that a more comprehensive approach can improve health outcomes. Collaborative approaches range from providing reciprocal referrals and sharing data to providing oral health screenings as part of the general medical exam — and in some cases administering preventaive services like fluoride varnish.

Percent Who Agree Greater Collaboration across
Medical and Dental Providers Would Improve Patient Care:

Dentists
Physicians
Employers
Medical Dental Administrators

Integration is also growing at the local level with initiatives like MORE Care.

Through the Medical Oral Expanded Care (MORE Care) initiative, the DentaQuest Partnership for Oral Health Advancement has been working with primary care practices across the country to integrate oral health competencies and capabilities into primary care offices while building patient-centered referral networks with local dental providers. In the program’s first several years, rural areas in Pennsylvania, Colorado and South Carolina invested in integration changes as part of long-term pilot programs. More recently, MORE Care is working with urban and suburban communities to achieve the same goals.

As we move into a new era of health care, MORE Care provides the framework to help providers achieve a more comprehensive approach to health care.

Community safety nets are also investing in medical-dental integration.

For nearly a decade, DentaQuest has supported community health centers and other safety net clinics through various initiatives, including the National Oral Health Innovation and Integration Network (NOHIIN).

NOHIIN is leading a national movement to unify and empower Primary Care Associations (PCAs) and safety net providers to be champions of oral health as an essential component of overall health. Since 2015, the number of patients receiving dental services in a federally-qualified health center (FQHC) has grown by 18%. Although the majority of patients accessing care at FQHCs are receiving medical services, dental patients now make up nearly 23% of the FQHC patient population, compared to just 10% in 2007.

Through participation in NOHIIN, PCAs across the country are collaborating to share lessons learned, best practices, and leverage resources surrounding the integration of oral health.

Medical-dental integration also leads to improvements in health literacy and population health outcomes.

Overall, this type of collaborative approach creates a scenario that enables patients to realize the connection with oral health and overall wellbeing, encourages healthy behavioral change, and promotes the practice of prevention strategies.