Oral Health As Part of Primary Health Care

In many countries, poor oral health is one of the most common barriers to accessing primary health care.

To combat this, some programs have integrated dental care into primary health care, bringing dentists and physicians together in the same office.

Advantage Dental Plan sends hygienists to Women, Infants and Children clinics to seek out expectant mothers and treat gum disease—which can lead to preterm or low-birthweight babies.

Preventive care

Most oral conditions, such as dental caries (tooth decay) and periodontal disease, are largely preventable. Oral diseases also contribute to other non-communicable conditions, such as heart disease and diabetes. Public health strategies such as community water fluoridation, school sealants, and behavioral changes can reduce the burden of oral diseases.

Primary care providers are in a position to screen patients for oral disease, as well as deliver preventive services and structured referrals to dentistry. In addition, many state Medicaid programs now reimburse for fluoride varnish applications delivered in physicians’ offices.

But integrating oral health into primary healthcare is often difficult and slow. One example is a woman with diabetes who visited the emergency department multiple times over two years because of tooth pain caused by an untreated gum infection. The patient was referred to a social worker who connecte her with subsidize dental care and financial assistance to pay for medication copays.

Treatment

Oral health is integral to primary healthcare and should be treated as such. The government should actively reduce barriers to oral care by funding dental benefits and supporting training for traditional and non-traditional providers like physicians, nurses, hygienists, and dentists. Additionally, research into effective messaging and strategies to increase understanding of basic health information can help improve access to care.

Integrating oral health into primary healthcare is a growing area of interest. This includes establishing dental-primary healthcare collaborations and developing models for oral health delivery that are compatible with the scope of practice of primary care clinicians. It also includes creating a framework for incorporating preventive oral healthcare into routine medical care and structuring referrals to dentistry.

The dental-primary health collaboration can include various professionals, including general dentists, dental therapists, hygienists, community dental workers, nurses, and expanded-duty dental auxiliaries (EDDAs). In addition to providing direct care, these professionals can deliver oral education and counseling and monitor occlusal development.

Education

It is important to educate families so they can make good choices about their oral health. For example, parents can ensure their children brush twice daily with fluoride-containing toothpaste to prevent dental caries. They can ensure that they eat healthy foods rich in calcium and phosphates (the building blocks of teeth).

Educational materials should be available in local languages to reach those who cannot read or write. They should also be tailore to the cultural context. For example, cultural norms may influence whether a woman with gum disease seeks treatment.

It is important to integrate oral health care into the primary healthcare system in LMICs. This requires the training of community health workers to recognize oral manifestations of systemic diseases and to refer them for appropriate care. It also means that treatment-oriented services like the application of silver diamine fluoride or atraumatic restorative techniques should be delivered by trained mid-level oral healthcare providers who can do so using minimal tools in existing PHC infrastructure. At the same time, more complex cases are referred to dentists and other oral healthcare specialists.

Prevention is better than cure.

Because many oral diseases are largely preventable, including them in primary health care is important. But integrating oral health with existing PHC often faces barriers, such as an imbalance between the supply and demand of trained dental professionals.

To help reduce these barriers, community organizations are finding creative ways to deliver oral care. For example, Advantage Dental Plan sends dental hygienists to the offices of Women, Infants and Children to screen expectant mothers for gum disease (see Profile on Klamath County, Oregon). These visits are critical because untreate gum disease has been linke to preterm birth and low-birthweight babies.

Another way to increase access is to train non-dental healthcare providers to screen for oral health problems and provide basic preventive services in physicians’ offices, such as fluoride varnish applications. The goal is to reduce the number of patients with severe dental caries that require expensive restorations and other interventions. Various approaches have been use to do this, including training nurses and physician assistants, relaxing supervision requirements and expanding teledentistry, and establishing community health centers that combine dental and primary medical care.