Collaboration Between Medical Providers and Dental Hygienists in Pediatric Health Care
Dental caries remains the most common chronic health condition in children. In the NHANES II and III surveys, it was determined that 40% of children aged 2-11 had caries. What is worse is the disparities found in the survey, 90% of preschool Native Americans have severe early childhood caries. Access to care is a large part of the problem. An article published in June 2016 in the Journal of Evidence-Based Dental Practice explored 4 innovative care models aimed to improve access to dental care for low-income families that are at greatest risk for early childhood dental caries.1
In the four models that will be described in this article, the authors leveraged the medical home to expand access to preventive oral health care for children.
The first model explored is expanded coordinated care. It is described as “Coordination where enhanced care by the medical provider includes basic preventative oral health services at the medical visit with a coordinated referral to an outside dentist.” In many states, medical professionals can contribute to early childhood oral care. Children often see their medical provider up to 12 times from birth to 3 years of age. In medical settings, some medical providers are offering oral health risk assessments, oral health anticipatory guidance, fluoride varnish applications, dental referrals, and prescribing fluoride supplements. Multiple barriers were described associated with this model including lack of time to provide care, lack of adequate reimbursement, conflicting priorities, and lack of dentists to whom patients can be referred.
The second model explored is colocation care. This model is described as the “colocation of dental hygiene services in the medical practice.” This model was tested in Colorado where dental hygienists are authorized to practice independently. This model included dual-function examination rooms which accommodated for medical care or dental care. It was determined by the authors collocating dental hygienists into a primary care setting is feasible. Some of the limitations include the lack of states with the option for dental hygienists to practice independently.
The third model is integrated care. This model is described as the “integration of dental hygienists within the medical care team with case coordination to a dentist for restorative needs.” Dental hygiene services are integrated into the medical home creating an all-encompassing “health home”, a one-stop-shop for medical treatment and preventive dental care. Dental hygienists collaborated with 1 or more dentists in their community to create a relationship in which they can refer patients in need of restorative care. There are multiple benefits to this model including face-to-face communication between the dental hygienist and the medical team, shared triage and care plans, commonly supported schedules and billing, and medical and dental records that share patient information. This model also reinforces the importance of optimal oral care.
The fourth model is a virtual dental home. This model is described as “telehealth supported dental hygiene services provided in the community.” The dental hygienist would use telehealth to connect dental teams, they would work in communities, providing case management, triage, preventative care, and interim therapeutic restorations. In the event more complex treatment is required the dental hygienist would connect the patient with a dentist. Community dental hygienists would be equipped with portable imaging equipment and software, an electronic dental record system, this will enable the dental hygienist to take medical/dental histories, x-rays, and oral digital photographs to upload to a secure system where the dentist can review the patient’s information. The community dental hygienist can then develop a treatment plan and help manage the patient’s cases.
The authors note that all the models are relatively unstudied, however, it is an attempt to solve the problem of lack of access to care. Further studies are needed to better understand the impacts of these various models.
The authors conclude by stating “Dental disease especially caries, is the most common disease of children. Low-income children carry the burden of disease yet are often challenged in finding a dental provider who will treat them. Alternatively, children (including low-income children) successfully access medical care at an early age and access it often. Taking advantage of the many opportunities medical providers have to provide preventive services to children and incorporating basic preventive oral health services into medical visits is a strategy now being implemented across the US models that coordinate, colocate, and integrate medical and dental care hold promise to reducing the burden of dental disease carried by patients most at risk.”
Do you see a need for better access to care for low-income children? Would you be interested in working in a capacity described by any of these models? Do you think allowing hygienists to work independently could improve access to care? Do you think providing a mid-level provider, such as a dental therapist would be a good strategy to improve access to care?
- Braun PA, Cusick A. Collaboration Between Medical Providers and Dental Hygienists in Pediatric Health Care. J Evid Based Dent Pract. 2016 Jun;16 Suppl:59-67. doi: 10.1016/j.jebdp.2016.01.017. PMID: 27236997.
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