Community health centers often fail to provide easy access to oral care

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Locating both dental and medical providers at a community health center can better ensure that low-income patients get the oral health services they need, in part by enabling these providers to more easily coordinate patient-centered care.

Yet by these measures, many clinics in California’s safety net system are falling short. Only one third of the state’s community health centers offer dental care, a team from the UCLA Center for Health Policy Research (CHPR) has found.

James Crall

James Crall

“Co-location of dental providers in primary care settings can greatly improve accessibility of dental care in several ways,” the team said in a paper published in the September issue of CHPR’s Health Policy Brief. “The co-location model can enable patients to obtain more than one service in a single trip. It can also make it easier for medical providers to screen and refer high-risk patients to dentists who will see them and allow medical and dental providers to easily collaborate case management.”

Equipping and staffing clinics to offer dental care requires additional spending but co-location is an important step to consider, particularly in communities facing shortages of Medicaid dental providers, according to the paper. “The decision by organizations co-locate is likely to have a significant and positive impact on access to dental care and improved oral health of the population,” the study’s authors concluded.

The benefits of good oral health care don’t stop at the mouth, the researchers observed. Oral health helps people eat and communicate better and can affect employability. While the relationships between oral infections and systemic diseases are complex and not yet fully understood, a growing body of research links poor oral health to worse outcomes for chronic conditions such as diabetes and heart disease.

Hannah Guznik highlighted the new findings in a Sept. 30 article for the California Health Report.

“Dental care is often an afterthought compared to medical care,” study co-author James Crall told her.

“But oral health is vital for good overall health and having a dental home helps avoid costly care that becomes necessary when oral health care is neglected,” said Crall, a professor and chairman of the public health and community dentistry division at the UCLA School of Dentistry.

While one-third of the clinics studied offered dental care, services at some locations were limited because they only employed part-time dentists and hygienists.

Another third of the clinics lacked co-located dental services but were part of organizations that offered dental services at other sites. Yet in many cases, the sites where the dental services were offered were “not within easy walking distance” of the community health center, the authors noted.

“Distance – even relatively small distances within urban areas – may be a substantial barrier to successful referrals and access to dental care within multisite organizations,” the study said.

Roughly one third of the clinics did not offer dental services at all, according to state data analyzed by the researchers.

“Medical and dental practices can be aligned to provide coordinated, efficient, patient-centered care that addressed both the medical and oral health needs of patients in a single setting,” the study said.

In 2014, Federally Qualified Health Center organizations provided dental care to 21 percent of their patients nationwide, and to 20 percent of their patients in California, according to federal data also cited in the study.

Is a safety net clinic in your community offering dental services? It might be worth finding out.

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