Oral Health and Dental Care Teams Issue
FROM THE NACHC LENS

Oral Health Is Overall Health

“The mouth is the gateway to the body,” stresses Ethan Kerns, DDS, Chief Dental Officer, Salud Family Health, “because oral health is an essential component to overall health.”

A growing body of evidence builds the relationship between oral health and health problems such as high blood pressure, diabetes management, Alzheimer's disease, even pregnancy complications. As integrated health care experts, community health centers are leading the way in dental-medical provider collaborations to improve patient health outcomes. 
 
One clear strategy is to focus on preventative dental care during medical care visits. At Salud Family Health, a hygienist goes to the medical exam room to perform preventative screenings, patient education, and fluoride treatment following a patient’s primary care appointment. If the hygienist learns that the patient has an urgent need, the patient can immediately be seen in the dental clinic.
 
With health center programs being smaller than medical programs, dental teams must be very strategic in their use of staff, space, and financial resources for comprehensive oral health care. “We don’t have enough capacity," says Ramona English, DDS, Chief Dental Officer, Petaluma Health Center (PHC), “so we focus on upstream intervention for more impact.” 
 
Using its Electronic Health Record (EHR) the dental team at PHC runs a care gap report every morning to identify patients eligible for integrated dental care. When patients six months to three years old come in for a well-child visit in the medical clinic, the dental team is notified to give a dental examination, risk assessment, cleaning, fluoride varnish, anticipatory guidance, and self-managing goal setting without the patient and parent leaving the medical exam room. 
 
As part of the medical-dental integration, dental teams regularly perform blood pressure screenings and blood glucose screenings. In health centers where medical and dental teams use the same EHR, both teams can review prescriptions, screening and lab results, and note any special concerns that would affect patient care during a visit. At PHC, dental assistants perform A1Cs while a patient is waiting for the dentist. This helps the medical teams with chronic disease management and population health outcomes. 

These are just a few examples of how health centers practice integrated dental care.
Tips to Strengthen Your Dental-Medical Team Collaboration

  • Don’t reinvent the wheel. Learn and adopt from other health centers.
  • Connect to experts. Consider dental teams from other clinics or tap into resources from the CareQuest Institute for Oral Health, National Network for Oral Health Access, and Oral Health Progress and Equity Network.
  • Champions are the “secret sauce.” Get support from the Chief Medical and/or Dental Officers. They can motivate staff and drive the process.
  • Establish priorities. If not able to offer comprehensive services, you can offer prevention. Start small, evaluate, refine, re-evaluate, and then expand.
  • Create a structure. For example, dental teams can routinely incorporate chronic disease screenings that support medical care teams.
  • Consider oral health care with trained medical providers. If your health center does not have a co-located dental clinic, train medical providers to administer fluoride varnish.
Oral Health for High-Risk Populations

Without the capacity to serve all health center patients, dental care teams often prioritize care. They consider how they can have the greatest impact, which patients are at higher risk for oral health disease, and/or which has the greatest need for care. Pediatric and obstetric patients are two populations that are often prioritized.  
 
Bringing Dental Care to Pediatric Patients and Agricultural Workers

Dental cavities are one of the leading chronic disease of childhood. It is preventable, which is one reason Salud Family Health partners with almost 100 schools across Colorado to bring preventative treatments such as fluoride and sealants directly to children.

“Unfortunately, a lot of Americans do not access oral health services, so when we take care to them, we can reach a lot of patients who would otherwise not get this care,” says Dr. Kerns. His team provides care to thousands of school-aged children, and in rural areas, they have also implemented an asynchronous teledentistry model to offer a higher level of service in those schools.

PHC took a slightly different approach to improve access and health equity with children and agricultural workers living in California’s rural coastal farming communities. The health center has an integrated medical dental van that provides preventive oral health services to thousands of children at schools and agricultural workers at their job sites.
 
Engaging Pregnant Patients 
 
Research has found that poor oral health during pregnancy can contribute to pre-term births and babies born with low-birth weight. Engaging busy pregnant women in oral health care can be challenging and requires health centers to try different approaches. 
 
At PHC, obstetrics teams partner directly with the dental team to engage pregnant patients in oral care. During a patient’s initial obstetrics visit, the patient is scheduled for a dental appointment and given educational materials. PHC monitors how many of these patients show up for their dental appointments and reaches out to patients to make sure they are rescheduled if they miss an appointment. Currently, PHC is exploring ways to make it easier for pregnant women such as scheduling dental appointments on the same day as initial obstetrics appointments.

Dental Teams – Experts in Behavior Change 

Oral health care often requires behavior change and commitment. Thus, dental teams find themselves developing skills in behavior change communication to work with patients across all life stages. 

Dental teams at both Salud Family Heath and PHC are trained in motivational interviewing to engage patients in their care, empower them to administer self-care, and inspire them to commit to improved oral health care practices and disease prevention.
CARE TEAMS SPOTLIGHT
Sodabeh Etminan, DMD, MPH
Dental Director
Mile Square Health Center, Chicago
 
Sodabeh Etminan, DMD, MPH, Dental Director, Mile Square Health Center, leads a team of five dentists, one hygienist, and 14 dental staff across five dental clinics in Chicago and northern Illinois. The team serves a wide range of patients including those with medical complications such as uncontrolled diabetes and cancer.
 
Dr. Etminan began her career as a dental assistant with a mentor who encouraged and supported her to become a dentist. As the leader of the health center's dental practice, Dr. Etminan understands the important role she can play in helping her dental practice grow its own talent.
 
“Many dental directors hope they get a fully formed doctor on their staff fresh out of school," says Dr. Etminan. “I would not be in my role right now and I would not be as effective as I am if I had not had that dental assistant experience.” 
 
Growing Her Own Dental Assistants

A few years ago, Dr. Etminan observed her dental team needed more well-trained dental assistants who were hard to find. With grant funding secured, Dr. Etminan purchased a 12-week dental assistant curriculum and received state accreditation that enabled her to launch a dental assistant certification program three times a year. Her dental assistants lead the program, a hybrid of in-person and virtual learning accessible by mobile phone or computer. 

Two years in, the certification program has achieved great success. Class size has grown from four to 12 students. Recently, 100 applications were received mostly from communities often served by health centers. 

Dr. Etminan facilitates career networking by hosting a virtual dental assistant job fair the week before graduation. The program has seen 100 percent job placement among graduates.

“We were always mentoring informally and now can be official about it,” says Dr. Etminan. She is looking forward to welcoming a new class of dental assistant students in February and seeing their growth and learning.  
RESOURCES
DENTAL THERAPY RESOURCE GUIDE

Want to explore the growing field of dental therapy, and what is needed to hire or train dental staff to become dental therapists? Get started with NACHC’s recently published Dental Therapy Resource Guide.

USE OF PRAPARE® IN ORAL HEALTH CARE PROGRAMS

NACHC would like to learn how PRAPARE® is being used to assess and address social needs of patients within dental clinics/oral health care programs. Please help by taking the survey.
Mindful Meditation
Mindfulness help us find grounding in our everyday lives. Starting your day with mindful meditation can positively impact how you deal with more stressful situations during your workday. Follow these easy steps to start your day with Wake-up Mindful Meditation*, right from the comfort of your bed.

  1. Set yourself an alarm to wake up 15 minutes earlier than usual.
  2. Keeping eyes closed take note of your calm heartbeat as you breath in and out as you connect with your body and mind.
  3. Empty your mind of any thoughts about work. This is your time now. Enjoy this moment and listen to the beautiful sounds of morning around you.
  4. When ready, raise your arms over your head and point your toes. Enjoy this long stretch.
  5. Sit up and give yourself a deep hug. You are now ready to start your day!

*adapted from Happier Human
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