Improving access to oral health care requires an understanding of the social, cultural, political, financial, and manpower factors that influence access. Armed with this knowledge, individuals and organizations desiring to improve access can innovate to change public policy, garner resources, create clinical programs, and expand public health interventions as demonstrated by the examples in this article. This article highlights past and contemporary innovations that have improved access, or have the potential to improve access to oral health care. These innovations are grouped into six categories: the dental profession, public health, community-based care delivery, oral health care funding, dental education, and evidence-based dentistry.
Concern about access to oral health care has been expressed by the dental profession since its organizing years in the nineteenth century. Concern by patients or their advocates, non-dental health care professionals, and policy makers is articulated most often after the realization that uncontrolled oral diseases have negative effects for both individuals and society. Each individual or organization addressing access to oral health care has its own motivations, perspectives, experiences, and tools, and these assets often lead to innovations that improve access. Effective innovations often are the result of collaborations between dentists, advocacy groups, and policy makers, but innovations also can result from changes in public policy or judicial decisions that are not related to the issues of oral health care access. In the twenty-first century the process of collaboration, development of health care policy, initiatives for care delivery, and legislative changes continues to be the wellspring of innovation to improve access.
This article highlights past and contemporary innovations and initiatives that have improved access or have the potential to improve access. These innovations are grouped into six categories: the dental profession; public health; community-based care delivery; oral health care funding, dental education; and evidence-based dentistry.
The dental profession
Innovation to improve access to oral health care began with the founding of the dental profession in the nineteenth century. Current innovations by the American Dental Association are discussed elsewhere in this issue, but the dental profession has a rich history in improving access through the marketing of professional services. Edgar Randolph (“Painless”) Parker (1872–1952) promoted his practice empire using blatant advertising that was characterized as unethical and fraudulent by the dental profession. Parker defended his advertising by saying, “I have spent more time fighting for better teeth for more people than any other man.” Although Parker was shunned by the dental profession, his innovative advertising techniques became standard practice in the twentieth century. In 1931 the American Dental Association, with the financial support of manufacturers of oral health products, embarked on a $500,000 advertising campaign to promote oral health to the more than 36 million Americans who did not take care of their teeth. The dental profession continued to forbid the use of advertising by individual dentists until 1977, when the Supreme Court ruled in Bates-O’Steen v. State Bar of Arizona that the legal profession’s restrictions on advertising were in restraint of trade. The Federal Trade Commission applied this decision to all learned professions and in 1979 settled out of court with the American Dental Association, which no longer could restrict truthful advertising by dentists. Since the Federal Trade Commission settlement, advertising has become a standard dental business practice that, along with the advertising of oral health products, improves access to care by increasing awareness of oral health, reducing costs through increased competition, and increasing consumer knowledge of the availability of service and the importance of disease prevention. Dentists and dental service organizations continue to innovate in advertising through brand development, electronic and printed media, Web sites, e-mail communications, direct mail, and billboards. Although advertising may increase awareness of the importance of oral health, it is not known which form of dental advertising is most effective in improving awareness or what specific effects advertising has on access to oral health care.
The dental profession is regulated by state law through dental boards that typically are composed of dentists, dental hygienists, and consumer representatives. Because workforce qualifications and scope of practice are controlled by state boards, an opportunity to improve access to oral health care exists in permitting alternative models of care delivery by expanding the scope of practice of dental hygienists, physicians, and other health care professionals. In six states (Connecticut, Iowa, New Mexico, North Carolina, South Carolina, and Washington) where dental practice laws or regulations were changed to allow dental hygienists or physicians an expanded role in providing preventive services, however, there was no immediate effect on the delivery of preventive health care. Impediments to establishing a new workforce model can include provider acceptance, lack of funding, and facility costs. Improved access through permitted alternative models of care remains elusive.
Mobile dental care is an innovative alternative for patients who cannot access conventional office-based care. The State of South Carolina regulates mobile and portable dental operations by requiring the registration of these facilities to prevent perceived fraudulent operations. Dental Access Mobile Clinics, LLC successfully applies an entrepreneurial model to deliver comprehensive care to children at their schools in six South Carolina counties. In 2001, 14,700 visits of 5000 children were recorded. Other attempts to deliver mobile dental care may not be successful because of the reliance on low and inconsistent Medicaid dental funding rather than a mixed funding stream of self-pay, private insurance, and Medicaid. Dental Access Mobile Clinics, LLC also may be successful because it is a dentist-developed enterprise.
It is projected that in 2010 there will be 180,875 professionally active dentists in the United States, most of whom were trained in United States dental schools. The projected number of professionally active foreign-trained dentists is not known. Information about the success rate of foreign-trained graduates in qualifying examinations could provide insight on foreign-trained graduates who practice, but privacy concerns limit this indicator. From 1993 to 2002 the number of foreign-trained dentists admitted to United States dental schools decreased from 930 to 441. Because the most common path to dental licensure for foreign-trained dentists is completion of a United States dental degree, the licensing of foreign graduates seems to be declining. This decline may affect dental manpower and thus access to oral health care. In contrast, nearly 25% of United States physicians are foreign trained, and many of these physicians practice in the inner city, in small communities, and in poor rural areas. Indeed, without professionally active foreign-trained physicians in the United States, the lack of medical care access would be catastrophic. The lack of dentists willing to treat the underserved could be improved if the number of foreign-trained dentists practicing in the United States was comparable to the medical professions.
Public health interventions
The concept of public health, as it is known today, did not exist in this country in the eighteenth and nineteenth centuries, and dealing with outbreaks of disease was stymied by a lack of knowledge of disease causation. Oral disease was treated on an individual basis with no population-based disease control. It was not until the 1860s that the federal government began to consider the importance of access to oral health care. In the context of military preparedness, Secretary of War Jefferson Davis, serving under President Pierce, advocated for a dental corps, and as President of the Confederacy Davis instituted a dental program, which the Union Army lacked. An Atlanta dentist, James Baxter Bean, established the first military hospital program to treat maxillofacial trauma using interdental splints. Confederate Surgeon General Moore promoted this technique by having Bean establish a ward at a hospital in Richmond that provided maxillofacial trauma care and also elevated the status of the dental profession by recognizing the importance of dentistry in the treatment of trauma.
After the Civil War, The Quarantine Act of 1878 conferred national quarantine authority on the Marine Hospital Service, which evolved into the Public Health and Marine Hospital Service in 1902. The growth of biologic knowledge and sanitary reform in the late nineteenth century coupled with political influence of the Progressive Movement provided the impetus for rapid expansion of the Service and its renaming by Congress as the Public Health Service with broad national authority over disease control and sanitation. The importance of dentistry in public health was demonstrated by Frederick McKay and H. Trendley Dean, who promoted the importance of optimal fluoride in the water supply. Dean was one of the first dentists commissioned in the Public Health Service and became the first dental research scientist of the new National Institute of Health in 1931.
The innovations of fluoridated water to prevent dental caries, immunization, and the establishment of potable water supplies were collectively the greatest disease prevention initiatives in the history of man. In 2006, 69.2% of the United States population received optimally fluoridated water, although these percentages vary by state. It would not be considered acceptable to have only 69.2% of the United States population immunized against contagious diseases or to have access to potable water, so continued innovations in public policy are needed to establish optimal dietary fluoride levels for all Americans. Current best practice for fluoride prevention therapy includes twice-daily use of a fluoridated dentifrice for children in optimally fluoridated communities and, in fluoride-deficient communities, the additional use of office-applied topical fluoride gel, foam, or varnish. For children without access to fluoridated water or regular oral health care, school-based dental care is an important means of providing oral screening and prevention intervention, including topical fluoride applications. One study, however, determined that children who were susceptible to decay did not benefit appreciably more from any of these preventive measures than did children in general. Other methods of accessing the benefits of fluoride in non-fluoridated communities include school water fluoridation and the use of dietary supplements, fluoride varnish or gel, and fluoride rinses. Communal water fluoridation remains the most cost-effective means to prevent decay at an annual cost of $0.72 (1999 dollars) per capita, whereas fluoride mouth rinses cost $3.29 per capita. Innovation and change in public health policy are needed to improve access to water fluoridation and to meet the Healthy People 2010 objective that 75% of the United States population using public water sources receive fluoridated water. Between 1992 and 2002 five additional states joined the 22 states that already had achieved the Healthy People objective of 75%. Recently, Louisiana enacted Act 761, mandating that community water systems with at least 5000 hookups work with the state to find grants and state funds to implement fluoridation. The Louisiana Dental Association estimates that nearly 2 million citizens will be affected by the new law.
In the United States more than 30,000 new cases and 8000 deaths occur annually from oral and pharyngeal cancers. Public health preventive innovations have focused on tobacco use and alcohol consumption, two factors implicated in these cancers. Oral Health America’s National Spit Tobacco Education Program was founded in 1994 as an effort to educate the American public about the dangers of smokeless or spit tobacco, to prevent young people from using spit tobacco, and to help users quit. The program enlists professional baseball personalities to advocate for spit tobacco cessation for both the American public and professional athletes. Recently, many state health departments have conducted oral cancer awareness campaigns aimed at both the general public and non-dental health care providers. The Nevada State Health Division partnered with the University of Nevada School of Medicine Office of Continuing Education, the Northeastern Area Health Education Center, and the Northern Nevada Dental Society to provide all-day continuing education courses on the prevention and detection of oral cancer. The Health Division also maintains an educational oral cancer Web site. There have been no large-scale intervention initiatives for preventing oral cancer by targeting alcohol abuse, but most communities have programs that stress responsible drinking by adults and discourage drinking by young people. These programs are sponsored by local health departments, law enforcement agencies, and alcohol producers and vendors.
There are few initiatives promoting access to early detection of oral and pharyngeal cancers. These conditions are diagnosed most often by dental professionals, but many Americans do not see dentists regularly. All primary care providers should include oral cancer detection in their examinations, but one study found that fewer than 24% of family physicians provided an oral cancer examination to patients 40 years of age and over. In Illinois, a cancer-control partnership was convened, supported by the Illinois Department of Public Health, with representatives from public, private, professional, and voluntary agencies and policymakers in Illinois concerned about cancer. The partnership was charged with providing leadership and a forum for identifying and implementing Illinois’ cancer-control priorities. The inclusion of oral cancer into a state comprehensive cancer-control plan capitalizes on resources not normally available to a state oral health program; as a result, Illinois has been able to educate stakeholders on the impact of oral cancer, to build capacity for oral cancer prevention and control, and to obtain funds through the National Institutes of Health to leverage funds from the tobacco master settlement agreement for activities supporting oral cancer prevention.
Public health interventions
The concept of public health, as it is known today, did not exist in this country in the eighteenth and nineteenth centuries, and dealing with outbreaks of disease was stymied by a lack of knowledge of disease causation. Oral disease was treated on an individual basis with no population-based disease control. It was not until the 1860s that the federal government began to consider the importance of access to oral health care. In the context of military preparedness, Secretary of War Jefferson Davis, serving under President Pierce, advocated for a dental corps, and as President of the Confederacy Davis instituted a dental program, which the Union Army lacked. An Atlanta dentist, James Baxter Bean, established the first military hospital program to treat maxillofacial trauma using interdental splints. Confederate Surgeon General Moore promoted this technique by having Bean establish a ward at a hospital in Richmond that provided maxillofacial trauma care and also elevated the status of the dental profession by recognizing the importance of dentistry in the treatment of trauma.
After the Civil War, The Quarantine Act of 1878 conferred national quarantine authority on the Marine Hospital Service, which evolved into the Public Health and Marine Hospital Service in 1902. The growth of biologic knowledge and sanitary reform in the late nineteenth century coupled with political influence of the Progressive Movement provided the impetus for rapid expansion of the Service and its renaming by Congress as the Public Health Service with broad national authority over disease control and sanitation. The importance of dentistry in public health was demonstrated by Frederick McKay and H. Trendley Dean, who promoted the importance of optimal fluoride in the water supply. Dean was one of the first dentists commissioned in the Public Health Service and became the first dental research scientist of the new National Institute of Health in 1931.
The innovations of fluoridated water to prevent dental caries, immunization, and the establishment of potable water supplies were collectively the greatest disease prevention initiatives in the history of man. In 2006, 69.2% of the United States population received optimally fluoridated water, although these percentages vary by state. It would not be considered acceptable to have only 69.2% of the United States population immunized against contagious diseases or to have access to potable water, so continued innovations in public policy are needed to establish optimal dietary fluoride levels for all Americans. Current best practice for fluoride prevention therapy includes twice-daily use of a fluoridated dentifrice for children in optimally fluoridated communities and, in fluoride-deficient communities, the additional use of office-applied topical fluoride gel, foam, or varnish. For children without access to fluoridated water or regular oral health care, school-based dental care is an important means of providing oral screening and prevention intervention, including topical fluoride applications. One study, however, determined that children who were susceptible to decay did not benefit appreciably more from any of these preventive measures than did children in general. Other methods of accessing the benefits of fluoride in non-fluoridated communities include school water fluoridation and the use of dietary supplements, fluoride varnish or gel, and fluoride rinses. Communal water fluoridation remains the most cost-effective means to prevent decay at an annual cost of $0.72 (1999 dollars) per capita, whereas fluoride mouth rinses cost $3.29 per capita. Innovation and change in public health policy are needed to improve access to water fluoridation and to meet the Healthy People 2010 objective that 75% of the United States population using public water sources receive fluoridated water. Between 1992 and 2002 five additional states joined the 22 states that already had achieved the Healthy People objective of 75%. Recently, Louisiana enacted Act 761, mandating that community water systems with at least 5000 hookups work with the state to find grants and state funds to implement fluoridation. The Louisiana Dental Association estimates that nearly 2 million citizens will be affected by the new law.
In the United States more than 30,000 new cases and 8000 deaths occur annually from oral and pharyngeal cancers. Public health preventive innovations have focused on tobacco use and alcohol consumption, two factors implicated in these cancers. Oral Health America’s National Spit Tobacco Education Program was founded in 1994 as an effort to educate the American public about the dangers of smokeless or spit tobacco, to prevent young people from using spit tobacco, and to help users quit. The program enlists professional baseball personalities to advocate for spit tobacco cessation for both the American public and professional athletes. Recently, many state health departments have conducted oral cancer awareness campaigns aimed at both the general public and non-dental health care providers. The Nevada State Health Division partnered with the University of Nevada School of Medicine Office of Continuing Education, the Northeastern Area Health Education Center, and the Northern Nevada Dental Society to provide all-day continuing education courses on the prevention and detection of oral cancer. The Health Division also maintains an educational oral cancer Web site. There have been no large-scale intervention initiatives for preventing oral cancer by targeting alcohol abuse, but most communities have programs that stress responsible drinking by adults and discourage drinking by young people. These programs are sponsored by local health departments, law enforcement agencies, and alcohol producers and vendors.
There are few initiatives promoting access to early detection of oral and pharyngeal cancers. These conditions are diagnosed most often by dental professionals, but many Americans do not see dentists regularly. All primary care providers should include oral cancer detection in their examinations, but one study found that fewer than 24% of family physicians provided an oral cancer examination to patients 40 years of age and over. In Illinois, a cancer-control partnership was convened, supported by the Illinois Department of Public Health, with representatives from public, private, professional, and voluntary agencies and policymakers in Illinois concerned about cancer. The partnership was charged with providing leadership and a forum for identifying and implementing Illinois’ cancer-control priorities. The inclusion of oral cancer into a state comprehensive cancer-control plan capitalizes on resources not normally available to a state oral health program; as a result, Illinois has been able to educate stakeholders on the impact of oral cancer, to build capacity for oral cancer prevention and control, and to obtain funds through the National Institutes of Health to leverage funds from the tobacco master settlement agreement for activities supporting oral cancer prevention.
Community-based innovations
The concept of community-based care began with innovations in primary care delivery in Great Britain in the 1930s and was defined and embodied in the United States by the Institute of Medicine in 1983. Community-based oral health care can replicate or be part of the model of community-based primary care, which has one or more of the following characteristics: provision of population-based care using an assessment of needs; community participation; a focus on health and prevention rather than illness; providing continuous and comprehensive care; sponsorship by religious, secular, or government organizations; integration of social service programs; outreach activities; and demonstration of cultural competency.
The delivery of community-based oral health care is aimed primarily at the dentally underserved. The 1996 Medical Expenditures Panel Survey estimates that 43% of the United States population 2 years of age and older had at least one dental visit during the survey year. Data from the National Health Survey states that in 1997 65.1% of the United States population 2 years of age and older reported having visited a dentist in the preceding year. Even though estimates of overall access to oral health care, as measured by annual dental visits, vary by study, it is well documented that use of and access to professional services also varies by gender, race/ethnicity, and socioeconomic standing and that these differences lead to substantial disparities in care. Americans who belong to populations with a disproportionate lack of access to professional services are or can be served by the delivery of community-based care.
There are five federal resources supporting community-based programs, each offering opportunities for innovation in financing, organizational structure, or outreach to improve access.
Dental Health Professions Shortage Areas (D-HPSAs) are areas identified as having a shortage of dental providers (a population to practitioner ratio of less than 3000:1) and may be urban or rural areas, population groups, or medical or other public facilities. Currently 47 million people live in 3951 identified Health Professions Shortage Areas (HPSAs). The HPSA designation calls attention to areas where access to professional health care services may be inadequate and makes community-based programs eligible for resources such as the assignment of a public health dentist.
The National Health Service Corps (NHSC) is dedicated to improving the health of underserved Americans by supporting communities in need (as identified by D-HPSAs), recruiting and retaining health professionals, developing and preparing sites, and seeking innovative solutions. The NHSC offers programs for both students and clinicians, including scholarships, loan repayment programs, and rotations in Community Health Centers. In 2000, approximately 2526 clinicians, including 306 dental care providers, delivered care to more than 4.6 million people through these programs. Only about 6% of the dental need was being met in the approved 1198 D-HPSAs with a population of 25.9 million persons. It is estimated that an additional 4873 dental care providers are needed to meet the current demand.
Area Health Education Centers are academic and community partnerships that train health care providers in sites and programs that are responsive to state and local needs with the intent of improving the supply, distribution, diversity, and quality of the health care workforce. In a typical year, 37,000 health professions students (17,000 medical students and 20,000 in other health professions, including dental students) are placed in community-based sites.
Federally Qualified Health Centers (FQHCs) are the backbone of community health centers in the United States, with one in three providing dental care. Federal support for entities that later would be called health centers began in 1962 with passage of the Migrant Health Act. Two years later, the Economic Opportunity Act of 1964 provided federal funds for two “neighborhood health centers,” which were launched in 1965 by Jack Geiger and Count Gibson, physicians at Tufts University in Boston. In 1991, FQHC’s were authorized as part of Medicare when Congress amended §1861(aa) of the Social Security Act. FQHCs were intended to be “safety net” providers for public housing centers, outpatient Indian Health Service facilities, and programs serving migrants and the homeless, but their mission has changed since their founding. They now bring primary health care to the underserved, underinsured, and non-insured people in urban and rural communities through more than 1000 health centers that operate 6000 service delivery sites in every state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. In 2002, the Health Centers Program sought to increase significantly the access to primary health care services through FQHC’s. As a result of this initiative, FQHCs provided care for more than 15 million patients in 2006, an increase of more than 4.7 million over 2001. Nearly 2.6 million patients received dental services in 2006, an increase of more than 80% over 1.4 million in 2001.
Medicare Direct Graduate Medical Education (DGME) payment compensates teaching hospitals for some of the costs related directly to the graduate training of physicians, dentists, and other professionals. Medicare does not pay the costs of the clinical portion of medical education of students that occurs in teaching hospitals. In fiscal year 1997, DGME payments for residents were about $2 billion. Academic health centers, teaching hospitals, and community hospitals that receive DGME payments may be located in underserved regions and provide additional manpower through the education program for care or may participate in community-based dental care programs through resident placement. Community-based oral health care programs also can rely on DGME facilities for specialty care referrals.
Examples of Innovative Community-based Dental Programs
Chase Brexton Health Services in Baltimore, Maryland evolved from a single urban location serving only the gay community into a multifaceted health center offering a continuum of care to a diverse, medically underserved community. The program now has two suburban and one rural locations and has incorporated oral health services in two of the community-based programs. The dental population has grown from 743 in 2002 to more than 5000 in 2007 and offers a sliding fee schedule as well as accepting commercial insurance and Medicaid. In the current dental patient population, 57% of the patients are uninsured, 79% are over 21 years of age, 51% are African American, and 16% identify themselves as gay.
“Into the Mouths of Babes” is a collaborative effort of six partners: the North Carolina Academy of Family Physicians, the North Carolina Pediatric Society, the North Carolina Division of Medical Assistance, the North Carolina Oral Health Section, the University of North Carolina School of Dentistry, and the University of North Carolina School of Public Health. Grant funding has been provided by the Centers for Disease Control, the Center for Medicare and Medicaid Services, the Health Resources and Services Administration, and, most recently, the State Oral Health Collaborative Systems. The objective of the “Into the Mouths of Babes” program is to train medical providers to deliver preventive oral health services to high-risk children from the time of tooth eruption until the third birthday, including oral screening, parent/caregiver education, and fluoride varnish application. Since year 2000, medical and dental services have increased 30-fold with participation by 425 practices and local health departments, training of more than 3000 providers, and more than 100,000 visits per year. Services now are provided in every county in the state; formerly one third of the counties did not have these services. Because of dentist referrals, there is a significant increase in the use of restorative care with improved dental health.
Community Dental Care in Texas has provided dental care and education about the prevention of oral disease to low-income families for more than 4 decades by working with local school districts and county health agencies to provide dental services through seven strategically located Community Dental Centers. Since 1982, the population of Community Dental Care’s service area has increased by more than 1 million people. The organization now operates 11 Community Dental Centers and is the largest nonprofit provider of dental care to low-income individuals in Texas. Community Dental Care has partnerships with Baylor College of Dentistry and five Dallas County clinics and has conveniently co-located dental programs with community primary health care centers. In 1997, Community Dental Care and Baylor’s College of Dentistry entered into a program to incorporate undergraduate students into the Community Dental Care staff, and in 1998, graduate pediatric residents were added. A staff of 70 dentists, dental assistants, and hygienists provides care and dental health education to children, adults, and senior citizens. The patient base includes the homeless, patients who have HIV/AIDS, low-income expectant mothers, and persons who have physical or mental disorders.
The Choptank Community Health System is an FQHC that received more than $3 million in Health Resources Services Administration funding in 2007. This amount is less than 30% of the annual operating budget, which exceeds $10 million. Federal funding supports services to the uninsured and provides additional enabling services for all patients. The Choptank Community Health System offers services to all in need and maintains appropriate services for a diverse community through seven primary care facilities and programs for migrant health, school-based wellness, and pharmacy assistance. A dental program started in 2000 with BlueCross BlueShield and federal block grant funding, expanded to a second primary care facility in 2005, and linked to school-based programs by providing dental screenings and preventive care. In 2005, the Choptank Community Health System partnered with a regional hospital system and Area Health Education Center to create a hospital-based pediatric dental surgery program.
The Ohio State University Geriatric Dentistry Program, Appalachian Outreach Project provides dental service in Appalachian Ohio, which has high unemployment, high poverty rates, substandard housing, and poor access to medical care, including dental services. Supervised senior-year dental students provide community-based basic dental services using mobile dental equipment; patients needing more extensive dental care are referred to the Ohio State University Geriatric Dental Clinic in Columbus. More than 700 older adults had been served through December 2004. The clinic is set up in senior centers, senior housing units, or nutrition sights.
FirstHealth of the Carolinas attempts to meet the health care and dental needs of residents of the mid-Carolinas. In a dental needs assessment, oral health care was cited as the primary unmet need for low-income children in the region, but only 10% of dentists participated in publicly assisted programs. FirstHealth developed an integrated model of dental service delivery by creating an oral health task force to identify strategies to address the lack of access to oral health care. With support from the W. K. Kellogg Foundation and local philanthropies, including the Duke Endowment and the Kate B. Reynolds Charitable Trust, FirstHealth opened a community-based dental care center in three counties. Two of the three dental care centers use existing medical centers, and the third operates in a newly constructed facility. These dental care centers provide comprehensive dental care for more than 7000 children, or nearly 60% of the targeted underserved population.
The Community DentCare delivery system provides oral health services to Northern Manhattan residents across the entire age spectrum, from children in the Head Start program to the elderly. A network of community-based health centers, school-based health centers, neighborhood practices, a mobile dental van, the Columbia University School of Dental and Oral Surgery, and the Harlem Hospital Dental Service are used to deliver care to residents regardless of their ability to pay for services. The Network recorded 50,000 patient visits and provided 7000 school children with preventive dental services in 2003. The DentCare model’s success comes from its focus on providing services, building a strong foundation of community-based support, and developing a sustainable funding stream that relies on patient revenue rather than soft-money grant funding.
In 2005, the Health Resources Services Administration initiated the Oral Health Disparities Collaborative pilot study to investigate whether a planned-care model could be applied to manage oral disease within a group of four community health centers. The aim of the collaborative was to develop comprehensive changes in the primary oral health care system that would lead to major improvements in process and outcome measures for perinatal oral health and early childhood caries prevention and treatment. A core principal of the model was to change oral health care from emergency care to outreach, prevention, and proactive management. The four centers have 18 full-time dentists and 360 medical providers and have instituted a physician-training program to screen pregnant women and children from birth to 5 years of age for obvious oral health problems and to provide some initial oral health counseling. Medical staff has access to the dental schedule and provides follow-up counseling to assure that dental treatment and preventive care has been received. Between December 2005 and June 2006, the percentage of pregnant women receiving dental care nearly tripled, and the percentage of very young children in care increased eightfold.
The Head Start Dental Home Initiative is a collaboration of the American Academy of Pediatric Dentistry and the Office of Head Start, which awarded a 5-year, $10 million contract to the American Academy of Pediatric Dentistry to help establish dental homes for approximately 1 million children across America. The objectives of the collaborative are to provide quality dental homes for children, to train teams of dentists and Head Start personnel in optimal oral health care practices, and to assist Head Start programs in obtaining comprehensive services to meet the full range of Head Start children’s oral health needs.
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