Oral Health Strategy in the Primary Care Setting

By Ashley Mills

In 2000, former Surgeon General David Satcher released a report on Oral Health in America, revealing how oral disease is a silent epidemic, especially in underserved populations. Three years later, former Surgeon General Richard H. Carmona built upon Satcher’s report and released a National Call to Action to Promote Oral Health. This Call to Action highlighted the many disparities related to oral health and charged individuals, whether as community leaders, volunteers, healthcare professionals, researchers, or policy makers, to collaborate and promote oral health and reduce disparities.

Satcher’s report also highlighted how oral health is essentially the gateway to general health and well-being. Yet so often, oral health is disregarded in primary health care settings. In order to improve general health and well-being, we must work strategically to integrate oral health prevention and improve the dental referral system in primary care in order to promote oral health and reduce the many relative disparities.

As MPCA works to align and integrate oral health with primary health care, we will utilize the practical model introduced by Qualis Health, and released this year in a white paper: Oral Health: An Essential Component of Primary Care. Among a call to action and many other educational discussion topics on oral health, the white paper models a framework for successful preventative oral health delivery and referral improvement in primary care settings.

Briefly, the strategic integration model is essentially a 5-step streamlined framework. The five steps that can be easily taken to integrate oral health care into an already established system can be simplified to the following terms: Ask, Look, Decide, Act, and Document. The first step in the process is to ask brief questions regarding patients’ oral health care (i.e. do you have a dentist?). Second, the physician or even the medical assistant looks in the patient’s mouth to determine if there is anything significant they can see. Then, the physician or medical assistant can decide what actions to take next by reviewing and discussing their findings. Acting involves discussing intervention and referrals, if needed. Lastly, documenting the findings and actions taken. This way, follow-up and referral close-out is possible.

The white paper also compares this integrative strategy with behavioral health integration to illuminate the similarities and help visualize the possibility. For example, early intervention can reduce impact and prevent complications. Both are present in primary care, and can interfere with general health care. Differences that are important to recognize include provider education, underdeveloped relationships, billing and payments and the lack of a structured referral process.

The strategy used to drive change in behavioral health integration can be adopted and adapted in order to successfully integrate oral health in the primary care setting. As MPCA works to introduce this framework, our efforts will be focused on protecting and promoting oral health within established medical care offices in an organized and efficient manner.

                Soon we will be releasing a survey to: 1) gather baseline data/information regarding the state of Oral Health in Maine’s FQHCs; 2) seek out grant opportunities for improving access to Oral Health, reducing Oral Health disparities and improving overall Oral Health; and 3) build concrete Oral Health offerings and implement effective Oral Health improvement strategies to enhance the overall health of Maine’s FQHC patients.