Pediatrician Patricia Braun and her team at a community health clinic in Denver are part of a growing trend across the United States to integrate oral health into medical checkups for children, pregnant women, and others who cannot afford or do not have easy access to dentists.
With federal and private funding, these programs have expanded in the past 10 years, but they face socioeconomic barriers, workforce shortages, and the challenge of dealing with the needs of new immigrants.
Beyond assessment, education, and preventive care, primary care providers refer patients to on- or off-site dentists, or work with embedded dental hygienists as part of their practice.
Tara Callaghan, director of operations for the Montana Primary Care Association, notes that providing oral health services during medical visits increases the frequency of fluoride application and improves parents’ knowledge of caring for their child’s teeth.
However, challenges remain, including the difficulty in recruiting dental professionals in rural areas, the lack of Medicaid-accepting dentists, and the lack of access to fluoridated water in some communities.
Embedding dental hygienists with medical doctors is one way to reach patients in a single medical visit. Valerie Cuzella, a registered dental hygienist, works closely with Dr. Braun and others at Denver Health, which serves nearly half of the city’s children and has embedded hygienists in five of its clinics that see children.
State regulations vary on which services hygienists can provide without supervision from a dentist. In Colorado, Cuzella can independently perform X-rays and apply silver diamine fluoride, a tool to harden teeth and slow decay.
Dr. Braun and Cuzella work so closely that they often finish each other’s sentences. Throughout the day they text each other, taking advantage of brief lulls when Cuzella can pop into an exam room to check for gum disease or demonstrate good brushing habits.
Dr. Braun herself takes similar opportunities to assess oral health during her exams, and both focus on educating parents.
Katy Battani, a registered dental hygienist and assistant professor at Georgetown University, is trying to bridge the divide between medical and dental care by helping community health centers in nine states integrate dental care into prenatal visits for pregnant women.
In Denver, housing instability, language barriers, lack of transportation, and the high cost of dentistry without insurance make dental care inaccessible for many children, the migrant community, and seniors, said Sung Cho, a dentist who oversees the dental program at STRIDE Community Health Center.
STRIDE tries to overcome these barriers by offering interpretation services and a sliding pay scale for those without insurance.
In the past year, Cho has seen an influx of migrants and refugees who have never seen a dentist before and need extensive care.
Even with growing needs, Cho said the Medicaid “unwinding” the process underway to reexamine post-pandemic eligibility for the government program that provides health coverage for people with low incomes and disabilities has created financial uncertainty.
At STRIDE’s Wheat Ridge clinic, two hygienists float between dental and pediatrics as part of the medical-dental integration. Yet Cho said he needs more hygienists at other locations to keep up with demand. Ideally, STRIDE could hire two hygienists and three dental assistants.
In 2022, Colorado enacted a law to alleviate workforce shortages by allowing dental therapists midlevel providers who do preventive and restorative care to practice. But Colorado does not have any schools to train or accredit them.
Before age 3, children are scheduled to see a pediatrician for 12 well visits, a metric that medical and dental integration capitalizes on, particularly for at-risk children.
As part of Dr. Braun’s program in the Rocky Mountain region, providers have applied more than 17,000 fluoride varnishes and increased the percentage of children 3 and younger who received preventive oral health care to 78% from 33% in its first 2½ years.
Callaghan, at the Montana Primary Care Association, witnesses that on the ground at community health centers in Montana. “It’s about leveraging the fact that kids see their medical provider for a well-child visit much more often and before they see their dental provider if they have one.” [KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF the independent source for health policy research, polling and journalism.] ©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.
