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Reporter discusses reporting on efforts to make dental health a primary care priority Date: 02/21/17

Elizabeth Whitman

By Mary Otto

Millions of Americans face challenges in finding oral health care services. Creative efforts are underway to tackle the problem.

Some of the more exciting initiatives aim to broaden access by delivering dental care in community and primary care settings rather than traditional dental offices. In a recent feature for Modern Healthcare, quality and safety beat reporter Elizabeth Whitman looked at some of these approaches.

Whitman surveyed a pilot project in Oregon that places dental hygienists in schools and local WIC centers. She also talked with officials at a busy New York hospital where dental residents are teaching primary care providers to perform oral exams on infants, and at a Kentucky program that aims to provide more dental care to homeless adults.

Whitman spoke with a mother who had struggled to get dental care for her children and experts who stressed the importance of finding ways to address longstanding barriers that keep patients from obtaining dental care. She also explored the complexities in bridging the gap between dental and primary care.

Whitman reminded readers that broadening access to dental care helps individual patients and the health care system as a whole. In this Q and A, she talks about how she tackled the story and shares tips on where reporters can find examples in their communities.

Q: Your story does an excellent job of explaining how the gap between dental and medical services in this country complicates access to oral health services. You back up with your points with research from a variety of sources. As you did your reporting, what fact surprised you the most?

A: I was shocked to learn the extent to which dental problems – toothaches, bleeding gums, gum pain and abscesses – send people to the emergency room. The situation is only growing worse. The American Dental Association estimates that visits to the ED for dental problems went from 1.1 million in 2000 to 2.2 million in 2012, while other research has shown that visits to the ED for dental issues from 2001 to 2008 increased disproportionately compared with the overall increase in ED visits.

A fact that was less surprising, but still bears mentioning, is the degree to which socioeconomic status determines access to dental care and thus one’s oral health. Even though the Affordable Care Act mandated pediatric dental services and helped states expand Medicaid – which covers some dental benefits depending on the state – there are still significant coverage gaps that fall along income lines.

Q: You spoke with Brandee Winter, a self-employed Oregon mother who was happy to find dental care for her children at a local WIC office, thanks to a pilot program using dental hygienists. Tell us more about what you describe as "the beauty of the initiative" and why it shows promise?

A: The beauty of the initiative was that it used unconventional but efficient methods that made getting dental care for their kids significantly easier for parents. Not only was the care free of charge, but the services took place at WIC offices, schools or other locations that were part of parents’ regular routines. As a result, parents did not have to go out of their way for their kids to receive preventive dental care. The initiative also used providers’ skills efficiently, such as deploying hygienists instead of dentists, and its own resources, so that only when children needed preventive things like a sealant would they receive it.

The promise of the initiative was in its debunking of the idea that preventive dental care has to happen in a dentist’s office. With that approach, it removed the usual barriers that often make it difficult for parents to get preventive dental care for their children, especially for parents who can’t afford such care.

Q: You spoke with a physician who works with homeless people in Kentucky. What has he discovered about the health care needs of the people he helps?

A: That family doctor, Dr. Steve Wrightson, found that dental or oral health problems contribute consistently and significantly to the health care problems of the homeless population he and his team care for. As I noted in my story, during one clinic, five out of nine patients signed up to see the medical provider because they had oral health issues.

Wrightson also told me that patients’ own expectations have a lot to do with how they seek care. If they don’t value oral health care, or if they don’t know where to seek dental care, their oral health needs will go unmet until their problems, like a cavity or gum disease, become too severe to ignore.

Q: Did the people you talked with seem hopeful that these ideas will catch on? How did they talk about the challenges of closing the gap between dental and medical care?  

A: My sources were hopeful that these ideas are gradually catching on, but they were careful to note that there’s a difference between acknowledging the gap between dental and medical care and closing that gap. They were not optimistic that it would happen soon, mainly because there are so many reasons that dental and medical care are treated as separate.

The medical education system divides dentists, physicians, and nurses. Insurance coverage for dental and medical care tends to be separate. The United States’ long history of having two care systems for treating the mouth versus the body has created the prevailing outlook that this is simply how it’s done. That mindset is so powerful that patients would walk into a clinic with co-located medical and dental services and not realize they could see a dentist after visiting the doctor, according to one of my sources, who had worked for a decade at a federally qualified health center. My sources were unanimous in saying that closing the gap between dental and medical care is important for improving people’s overall health, lowering health care spending and reducing disparities in health outcomes. But each cited different barriers, a few of which I named above, that to them suggested that the dental-medical divide is likely to remain for a long time barring major systemic change.

Q: Would you share some wisdom with reporters interested in discovering whether such programs exist in their communities? Where they should look?

A: So many places! I would suggest scouting for grants from the government or private foundations that fund health care research, then reaching out to grant awardees and asking them about their work. The initiatives I mentioned in my story, for instance, were funded through the Health Resources and Services Administration, and a program of the Robert Wood Johnson Foundation. There are plenty of others out there.

I would also peruse health or medical journals for studies on this subject, because they or their authors might name or know of community efforts to integrate dental and medical care. Health Affairs, for instance, recently published an entire issue on the medical-dental divide.

Other places to look for stories include local federally qualified health clinics, some of which are doing pretty progressive work in this area because they see Medicaid/CHIP patients with a high need for dental care. Medical and dental associations, or NGOs or research groups, such as the Children’s Dental Health Project, which focus on treating the whole patient or on improving dental health, may also be able to point reporters to initiatives in their local communities.

These suggestions are scratching the surface. I’m sure that if reporters start asking around, they will learn of potential stories. If my reporting showed me anything, it’s that a lot of these initiatives are hiding in plain sight.