Primary care, oral health must undo ‘years of separation’

Patients and clinicians can benefit by closing the gap between primary care and oral health care, speakers at an online event said.

The event, hosted by the Primary Care Collaborative (PCC), focused a recent report titled “Innovations in Oral Health and Primary Care Integration: Alignment with the Shared Principles of Primary Care,” which included data on the cost of unmet oral health needs to patients, taxpayers, the government and society, and it offered strategies on how to integrate oral health with primary care.

“Just as there is no health without oral health, there is no health justice without the inclusion of oral health,” Lisa Simon, MD, DMD, a fellow in oral health and medicine integration at the Harvard School of Dental Medicine, told Healio Primary Care.

“For all primary care clinicians who seek to eliminate suffering and promote equity, oral health has to be key to our efforts — we have so many years of separation to undo.”

The importance of closing the gap between primary care and oral health cannot be understated, according to Darilyn V. Moyer, MD, FACP, the ACP’s executive vice president and CEO.

“For at least one-third of Americans, oral care is unreachable,” Moyer said during the event. “They live in pain or visit emergency rooms because the current system of [dental] care is hampered by high costs and too few oral health providers. The patients in our health care system pay the price of unmet oral health issues. There's also a larger economic cost from missed work and school days.”

The PCC report detailed other downstream effects of poor oral health, including lower glycemic control in people with diabetes, higher risk for preterm birth, increased likelihood of insufficient vitamin consumption and higher risk for pneumonia.

The report also provided dozens of examples of successful primary care and oral health collaborations, including:

• the Center for Pediatric Dentistry in Seattle, which created and used a food-insecurity screening tool for all families attending dental visits;
• the National Maternal and Child Oral Health Resource Center at Georgetown University, which supplies technical assistance for pilot grantees across the United States with a focus on creating learning partnerships among health systems, primary care networks and social services for women and children;
• the Begin with a Grin program in Virginia, where community health nurses and pediatric nurse practitioners visit the homes of families with young children who are enrolled in Medicaid to provide fluoride varnish, oral health assessments and preemptive guidance;
• the Indian Health Service, which has community health representatives help with dental-related needs such as patient transportation, outreach between visits, health education and support;
• the Finger Lakes Health Center in New York, which uses teledentistry to provide specialty pediatric dentistry consults to determine which patients from underrepresented groups have untreated dental disease; and
• the Willamette Dental Group in Oregon, which operates as a dental accountable care organization and reimburses its clinicians for reaching quality-measure benchmarks instead of providing fee-for-service payments.

Myechia Minter-Jordan, MD, president and CEO of the nonprofit CareQuest Institute for Oral Health, encouraged primary care clinicians to set up collaborations that prioritize patients with chronic disease or who are pregnant and do not have a dentist.

“As you began to ensure that they have access to oral health, and most importantly, preventive oral health, we will see a reduction in their overall cost of care because of that correlation between chronic disease and oral health,” she said.

Simon said structural changes also need to occur, including more training in oral health for primary care clinicians, increasing Medicaid coverage for adult dental care and creating “more robust referral networks.”

She added that primary care clinicians who practice in urban areas “have a lot to learn” from their counterparts in rural locations, including “warm hand‐offs” between medical and dental providers and partnerships with schools, food banks and nursing homes.

Reference:

The Primary Care Collaborative. Innovations in oral health and primary care integration: Alignment with the shared principles of primary care. https://www.pcpcc.org/resource/innovations-oral-health-and-primary-care-integration-alignment-shared-principles. Accessed April 5, 2021.