Key points

Introduction

Oral health, as a critical component of health, is embedded in the World Health Organization’s 1948 broadened definition, “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Even so, nearly 70 years have passed and oral health, dental education, and dental care delivery remain disconnected and separate from the larger medical system of care. This disconnect and view of the mouth as separate from the body is perpetuated by segmented models of care and delivery and payment systems that have not substantially integrated oral health in overall health. A 1972 Institute of Medicine (IOM) report echoed that “linkages are inadequate between existing models of health delivery and the educational institutions charged with developing the manpower for these systems.” The report presents the basic argument for interprofessional teams (and integration) in the ambulatory care environment in which the emphasis is on the patient and outcomes of care rather than “on professions, their techniques, or the process of care.” With significant disparities in oral health among segments of the population and multifactorial challenges in accessing care, it is in the primary care environment, in particular, that there is an urgent need for the deployment of effective health care teams. Through differing administrations, budget cycles, and economic cycles, the federal government has taken the lead on key issues, such as health promotion and access to care, that affect the nation.

Periodic efforts to move oral health and dental care delivery into the mainstream of health care, and to reunite the mouth with the body in efforts to achieve overall health, have met with mixed results. In Oral health in America: a report of the Surgeon General , then Secretary of the Department of Health and Human Services (DHHS), Donna Shalala, stated that oral health is integral to general health because “you cannot be healthy without oral health.” She was reflecting the nation’s struggle to achieve a systems-level change to implement true integration of oral health and primary care in a consistent and sustainable manner.

This article describes federal programs, initiatives, and partnerships that have the demonstrated potential to initiate and institutionalize interprofessional practice, which includes agreement that oral health providers are integral to the provider team. A discussion of landmark documents and reports, the role of legislation and statutory authority, and the influence of federal program priorities towards a national movement to increase access to care and bridge the chasms separating the medical health care system, the dental delivery system, and oral health is presented.

In 2000, in the first Surgeon General’s report on oral health, David Satcher wrote, “There are opportunities for all health professions, individuals, and communities to work together to improve health.” Furthermore, this report explicitly states that a principal component of a national oral health plan (NOHP) is an effective health infrastructure that meets the oral health needs of all Americans and integrates oral health effectively into overall health. The DHHS recently took a monumental step forward by promoting an NOHP and publishing the Oral Health Strategic Framework, 2014–2017 ( Framework ) that “builds upon and outlines a strategic alignment of HHS operating and staff divisions’ resources, programs, and leadership commitments to improve oral health with activities of other federal partners.”

The recent realignment of federal priorities and programs that recognize the importance and value of integrating oral health and primary care has ignited renewed interest in innovative approaches to continued progress in improving the nation’s oral health.