Filling the Oral Health Care Gap: Medical-Dental Integration

THE PROBLEM: UNMET ORAL HEALTH NEEDS

This article originally appeared in the fall 2022 edition of Minnesota Family Physician magazine.


by Erin Westfall, DO, FACOFP, & Nancy Franke Wilson, MS 

In 2000, the Office of the U.S. Surgeon General published its first report on oral health, which marked a milestone for oral health in America and charged health care institutions, professional organizations and government agencies to address unmet oral health needs through comprehensive integrated care (1). Unfortunately, it’s been over 20 years since the report was released, and the chasm between medical and dental services remains large.

Dental disease is still the most prevalent unmet health need in the United States and the most common chronic disease in childhood (2,3) In Minnesota, 2 out of every 10 third graders in public schools have untreated tooth decay, and nearly 35% of adults ages 18 and over have had at least one permanent tooth removed due to dental disease (4,5). Large disparities exist in the oral health of Minnesotans, with households with low socioeconomic status, households of color and households in rural areas experiencing nearly one and half times the dental disease of wealthy, urban, white households (4). These disparities are largely due to a lack of access to dental care, including a lack of insurance coverage, lack of dental offices that take state insurance and lack of a dental workforce. Thus, the populations with the highest burden of disease are not reached by the current system.

Dental needs of Minnesotans and those across the country have fallen into a prevention gap. And yet, dental disease is an infectious, transmissible and nearly 100% preventable disease that, when left untreated, can have severely detrimental effects on overall health.

Family physicians and other primary care providers are perfectly situated to help fill this prevention gap and expand the oral health workforce to ensure that the holistic needs of our patients are met. Addressing the needs of the whole patient is fundamental to the vision of family medicine, and family physicians are proficient at disease prevention and screening, engaging patients in behavior change and helping patients navigate the health care system. Many family physicians have already begun to address oral health in their clinics, through topical application of fluoride varnish to the teeth of children or by prescribing fluoride supplementation to those without adequate sources of fluoride in the water. Additionally, providing dietary counseling to protect teeth and gums, addressing nicotine use, administering the HPV vaccine and changing medications that can lead to oral dryness is already a routine part of the care provided by family physicians.

THE NEXT STEP: MEDICAL-DENTAL INTEGRATION

The next step in addressing the oral health needs of our communities is to integrate medical and dental care. Integrated care is not a new concept to primary care teams and is a well-known means to improve health outcomes, access to care and lower overall health care costs.

In fact, the new Minnesota State Oral Health Plan 2020-2030 is a renewed call to action for organizations and communities to collaborate to improve the oral health of all Minnesotans. The plan identifies five areas of focus:

  • Oral health infrastructure: Strengthen, stabilize and sustain Minnesota’s oral health infrastructure.
  • Access to oral health care: Increase access to timely, culturally appropriate, geographically suitable and financially viable dental care.
  • Health systems integration: Improve integration of medical and dental care systems to provide more holistic care.
  • Disability, special care needs and inclusion: Make oral health care accessible, safe, respectful and timely for all Minnesotans who seek it.
  • Data: Share oral health data and indicators to inform data-driven strategies and actions (6).

The Minnesota Oral Health Coalition (MOHC) has developed a multidisciplinary workgroup to address the state’s call to action and is working closely with the Minnesota Department of Health (MDH) to develop actionable steps.

PRIMARY CARE & DENTAL CLINIC PARTNERSHIPS IN MINNESOTA

Primary care physicians are adept at team-based care and helping their patients and communities achieve health in creative, innovative ways. Medical-dental integration is key to addressing the oral health gap.

There are several examples of medical-dental integration clinics across Minnesota:

  • Community Dental Care has developed a collaborative medical-dental integration program with M Health Fairview Clinic – Roselawn. In this program, the dental hygienist delivers preventive oral health services on site at the medical clinic in conjunction with well-child visits and offers referral assistance for patients with dental concerns for necessary and often urgent treatment.
  • Children’s Dental Services also has developed medical-dental integration partnerships with M Physicians Broadway Family Medicine Clinic and Dakota Child and Family Clinic, where on-site dental care is co-located with primary medical services, targeting individuals who are underserved.
  • Apple Tree Dental recently established a dental clinic within the Mayo Clinic Health System in Fairmont targeting older adults’ dental needs.

HOW YOU CAN GET INVOLVED IN ORAL HEALTH INTEGRATION

Family physicians can and should join in the fight for oral health equity.

If you are interested in learning more about oral health integration, consider joining the MOHC (www.minnesotaoralhealthcoalition.org); reaching out to the MDH for your local community’s oral health data (www.health.state.mn.us/people/oralhealth) and grant opportunities (health.oral@state.mn.us); and joining the medical-dental community conversation.

REFERENCES

  1. Oral Health in America: A Report of the Surgeon General. U.S. Public Health Service Department of Health and Human Services; May 2000.
  2. Unmet Oral Health Care Needs of Adults Aged 20-64 Years. National Center for Chronic Disease Prevention and Health Promotion Division of Oral Health; February 2021.
    www.cdc.gov/oralhealth/infographics/unmet-needs.htm. Accessed 9/23/22.
  3. Benjamin RM. Oral health: The silent epidemic. Public Health Rep. 2010;125(2):158–159. doi.org/10.1177/003335491012500202
  4. The Basic Screening Survey for Third Graders. Minnesota Department of Health Oral Health Program; 2015.
  5. Minnesota Behavioral Risk Factor Surveillance System. Minnesota Department of Health; 2020.
  6. Minnesota State Oral Health Plan 2020-2030. Minnesota Department of Health; 2020.

About the authors: Erin Westfall, DO, FACOFP, is an Assistant Professor and the Associate Program Director and Director of Osteopathic Education at Mayo Clinic Family Medicine Residency – Mankato. Nancy Franke Wilson, MS, is the Executive Director of the Minnesota Oral Health Coalition.

Left, Erin Westfall, DO, FACOFP; right, Nancy Franke Wilson, MS

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