Oral Health in Primary Care – A Framework for Action

Timothy Martinez DMD

January 2, 2023

Primary Care

When a patient seeks dental care, referrals from other providers are often necessary. Referrals from other professionals, however, are not always easy to make. This article explores the barriers that exist and outlines some strategies for improving referrals. Oral health in primary care is still in its infancy. It also discusses the role of interprofessional education in improving the quality of dental referrals.

Communication and referral networks

The integration of oral health into primary care is still in its infancy. Currently, a limited number of studies and demonstration programs have been published in the peer-reviewed literature. They are mostly focused on early childhood. These studies are aimed at improving access to preventive services for children and evaluating the effectiveness of integrated healthcare systems.

There are several barriers to integrating oral health into primary care, including inadequate reimbursement and lack of clinical knowledge. This research should focus on how to improve the process of coordinating dental care with medical care.

Health literacy is crucial for providers to communicate with their patients. One way to increase communication between providers is to use electronic tools that facilitate the exchange of information and referrals from one provider to another. Electronic tools can also be used to promote patient education.

Obstacles to dental referrals

There are many obstacles to the implementation of dental referral guidelines in primary care. These include a lack of staff buy-in, lack of time, inadequate reimbursement, and lack of clinical knowledge. However, it is important to note that there are also benefits to these integration initiatives.

For example, integrating oral health into a primary care practice will enhance patient care by coordinating care and promoting bidirectional communication. Moreover, a well-developed referral mechanism can ease the process of referring patients to the appropriate specialty. Achieving this goal will require increased communication among the providers.

Although there is no comprehensive national survey to report the extent of referrals between medical and dental practices, there are some demonstration programs that have provided insights into the challenges of linking primary and dental care.

Examples of referral programs to improve patient integration and overall care

Integrated high-quality primary care has been shown to improve patient health outcomes and lower healthcare costs. It combines functional integration of various medical and health services, such as ambulatory and inpatient care, behavioral and mental health, and social determinants of health.

Primary care practices are beginning to respond to calls to incorporate social risk factors into clinical care. These practices include Southcentral Foundation’s Nuka System of Care, which is based on relationship-based care, and the Women’s Health Initiative, which supports healthy families in obstetrics/Gynecare settings.

Behavioral health integration is a growing trend, with evidence supporting its effectiveness. Integrated primary care should be tailored to individual patient’s needs and the unique challenges they face. However, many of the benefits of integration, like reduced cost and increased effectiveness, are not yet fully realized.

Interprofessional education

The American Dental Education Association has been leading efforts to promote the inclusion of oral health in interprofessional education. ADEA’s 2017 annual senior survey indicates that 84 percent of graduating seniors believe they are prepared to integrate oral health into medical care. However, many barriers remain. Among them, are a lack of clinical knowledge, staff buy-in, and inadequate reimbursement.

Interprofessional education and collaboration activities are a great way to improve communication and patient care. They also build an attitude toward interdisciplinary teamwork. Often, these interactions occur within classrooms or in extracurricular activities.

Several national organizations are working to foster integration. One organization, the National Institute for Interprofessional Orientation and Education (NIIOH), is building a shared culture across professions. Its activities include resource development, training, and cultivating leaders.

Practice-based outcomes research

Practice-based outcomes research is needed to assess the effectiveness of oral health in primary care. This research should focus on developing effective links between primary care teams and dental practitioners. The goal of this integration is to improve patient health and preventive care across the lifespan.

Many barriers to integration exist. In particular, there is insufficient reimbursement for oral health services. There are few clinical guidelines or training programs targeted at dental and medical audiences. Most dental and medical practitioners have not been trained in interprofessional education.

One way to advance communication between providers is to use shared electronic health records. These tools provide information about the patient’s record and allow for a referral from one provider to another. Additionally, an EHR prompts providers on preventive reports.