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INTRODUCTION: The authors of this study sought to (1) describe the prevalence of social needs and (2) determine whether social needs were associated with closure of care gaps among patients aged ≥65 years seeking dental care. METHODS: In this retrospective cross-sectional study, the authors identified 754 Kaiser Permanente Northwest patients aged ≥65 years who completed an index dental visit; had at least 1 of 23 preventive care gaps (e.g., flu vaccination) or disease management care gaps (e.g., diabetes HbA1c screening test) documented in their medical record; and had completed a social needs assessment through survey evaluating financial strain, food insecurity, housing needs, social isolation, and transportation needs. The authors described the prevalence of social needs at the index visit and then used logistic regression to evaluate the association between the number of social needs (0, 1, ≥2) and closure of all care gaps over the following 60 days (yes versus no), adjusting for patient characteristics. Identification and closure of care gap were assessed through Kaiser Permanente Northwests Panel Support Tool. RESULTS: Approximately 28% of patients reported ≥1 social needs. The prevalence of social needs was as follows: social isolation, 13.7%; financial strain, 11.3%; food insecurity, 7.7%; transportation needs, 5.4%; and housing needs, 3.3%. Those with 1 social need were more likely to close care gaps than those with no social needs (OR=1.82, 95% CI=1.17, 2.85). No significant association was found with care gap closure among those with ≥2 versus zero social needs. CONCLUSIONS: The prevalence of social needs was nearly 30% among patients aged ≥65 years with dental and medical coverage. Patients with 1 social need were more likely than those with no social needs to close all care gaps after their visit.

Introduction: In recent years, the demand for behavioral health services has grown. There is increased need for early access to behavioral health and improved understanding of the relationship between oral health and behavioral health. Objective: The objective of this article is to provide understanding of how oral health and behavioral health can be integrated in health centers. Methods: This paper discusses the relationship between oral health and behavioral health, reviews the history of integration, and highlights health centers that have developed systems for dental professionals to engage in two aspects of integration of behavioral and oral health (IBOH) – behavioral health screenings and referral management Results: Health centers across the country are implementing strategies to increase access to oral health and behavioral health care through integration of the two disciplines. Conclusion: In health centers, disciplines like primary medical care, dental care, behavioral health, and pharmacy are often co-located. This creates a unique opportunity to provide integrated care, including oral health and behavioral health. [ABSTRACT FROM AUTHOR]

Objectives: To determine the feasibility of a medical dental integration program to provide overdue vaccinations to adolescents ages 9–17 and evaluate the facilitators and barriers to the process. Methods: The program was developed and implemented at one dental clinic co‐located within a medical clinic at a federally qualified healthcare center in Denver, Colorado. Utilizing a shared electronic health record, human papillomavirus, meningococcal, and/or tetanus‐diphtheria‐acellular pertussis vaccines were recommended by dental providers and then administered by the medical team. Plan‐do‐study‐act cycles informed implementation. Descriptive analyses of eligible patients were performed and run charts were used track process implementation outcomes. Results: One hundred and sixty eligible adolescents were identified during a 6‐month period. Overall, 29 patients (18%) received 41 vaccines. Process facilitators included staff buy‐in and individual provider feedback and barriers included staff shortages and family vaccine refusal/preference to receive vaccines in the medical home. Conclusions: Many adolescents see dental providers more than their primary care providers, creating an opportunity to vaccinate adolescents overdue for immunizations during dental visits. A medical dental integration program to provide adolescent vaccinations was feasible in a federally qualified health center with co‐located medical and dental services. Expansion to diverse healthcare settings is necessary to further explore implementation outcomes. [ABSTRACT FROM AUTHOR]

Access to high-quality, preventive oral health care is fundamental for an individual to achieve positive health outcomes. Recognizing that health is influenced by where a person lives, it is important to consider how systems of care must adapt to meet the changing needs of a community over time. Medical-dental integration is a critical component designed to enhance and broaden the oral health care delivery model. MORE Care® is a framework for communities to leverage their resources and relationships by providing tools and resources to integrate preventive oral health services into primary care settings. This report will show how local stakeholders advocated for an innovative approach to improve oral health gaps for children in Ohio. The MORE Care Ohio pilot is expanding access to preventive oral health services by featuring medical-dental integration to close patient care gaps and build an integrated oral health network. Providing a framework for medical and dental teams to collaborate, seven clinical practices (three medical and four dental) agreed to participate in a 9-month learning collaborative and 16-months of performance monitoring. [ABSTRACT FROM AUTHOR]

CareQuest Institute for Oral Health's mission is to improve the oral health of all. One way to achieve this is through programmatic initiatives, which train dental clinics to provide equitable, integrated and accessible care for their communities. The Community Oral Health Transformation (COrHT) Initiative, allowed CareQuest Institute to collaborate with the North Carolina Oral Health Collaboration (NCOHC) and Blue Cross Blue Shield (BCBS) of North Carolina Foundation to implement and support the initiative in North Carolina. This mixed methods study was designed to collect quantitative and qualitative data while 11 dental clinics and a control clinic participated in the program through the end of the program. Quantitative data included patient demographics, claims data, and financial and data measures. Descriptive statistics of participating clinics and the control clinic were analyzed, and aggregated clinic data showed improvements in patient care delivery measures. Qualitative interviews were also conducted at midpoint and conclusion, and an outcome evaluation was completed. This short report will provide readers with results from the COrHT Initiative, with an emphasis on medical-dental integration (MDI) as an integral component of comprehensive, person-centered care. The evaluation of programmatic strengths and weaknesses has been included to identify the potential for future implementation, sustainability, and policy making. [ABSTRACT FROM AUTHOR]

This report explores the changing landscape of oral health care delivery in the United States, highlighting the evolving role of dental hygienists. The 2021 National Institutes of Health report "Oral Health in America: Advances and Challenges" has become a key milestone in addressing oral health inequities, acknowledging the important role that dental hygienists could play in expanding innovative care models, and promoting medical-dental integration. The Rainbow Model of Integrated Care offers a framework to examine facilitators of oral health integration in primary care models, revealing supportive policies, interprofessional collaborative practice, incremental change, and local leadership as some of the crucial components needed for success. Dental hygienists emerge as catalysts for change, as such, the overarching aim of this report is to contribute to the broader conversation about optimizing oral health care accessibility through integrated care models led by dental hygienists. [ABSTRACT FROM AUTHOR]

Introduction: The authors of this study sought to (1) describe the prevalence of social needs and (2) determine whether social needs were associated with closure of care gaps among patients aged ≥65 years seeking dental care. Methods: In this retrospective cross-sectional study, the authors identified 754 Kaiser Permanente Northwest patients aged ≥65 years who completed an index dental visit; had at least 1 of 23 preventive care gaps (e.g., flu vaccination) or disease management care gaps (e.g., diabetes HbA1c screening test) documented in their medical record; and had completed a social needs assessment through survey evaluating financial strain, food insecurity, housing needs, social isolation, and transportation needs. The authors described the prevalence of social needs at the index visit and then used logistic regression to evaluate the association between the number of social needs (0, 1, ≥2) and closure of all care gaps over the following 60 days (yes versus no), adjusting for patient characteristics. Identification and closure of care gap were assessed through Kaiser Permanente Northwest's Panel Support Tool. Results: Approximately 28% of patients reported ≥1 social needs. The prevalence of social needs was as follows: social isolation, 13.7%; financial strain, 11.3%; food insecurity, 7.7%; transportation needs, 5.4%; and housing needs, 3.3%. Those with 1 social need were more likely to close care gaps than those with no social needs (OR=1.82, 95% CI=1.17, 2.85). No significant association was found with care gap closure among those with ≥2 versus zero social needs. Conclusions: The prevalence of social needs was nearly 30% among patients aged ≥65 years with dental and medical coverage. Patients with 1 social need were more likely than those with no social needs to close all care gaps after their visit.

This case report describes the implementation approach and evaluation of a medical-dental integration (MDI) project in Colorado that embedded dental hygienists (DHs) into 10 medical practice settings. Through the MDI Learning Collaborative, DHs were integrated into primary care medical care practices to provide full-scope dental hygiene care to patients. Dental hygienists were trained to collect quality-improvement metrics on all encounters, including untreated tooth decay, and referred patients with restorative needs to partnering dentists. Cross-sectional, aggregated clinic-level oral health metrics were submitted monthly from 2019-2022. Descriptive statistics were used to describe the population receiving MDI care and interviews were conducted with MDI staff to describe their perspectives on this approach to comprehensive care. A logistic regression model, adjusted for time and practice, compared untreated dental caries in established vs new MDI patient-visits. From 2019-2021, integrated DHs completed 13,458 visits to low-income patients, Medicaid (70%, n=9,421), uninsured (24%, n=3,230), SCHIP (3%, n = 404), private (3%, n = 404), of various ages: 0-5 (29%, n = 3,838), 6-18 (17%, n = 2,266), 18-64 (51%, n = 6,825), >65 (4%, n = 529). A total of 912 visits were provided to pregnant patients. Services included caries risk assessment (n=9,329), fluoride varnish (n = 6,722), dental sealants (n = 1,391), silver diamine fluoride (n=382), x-rays (n = 5,465) and scaling/root-planing (n=2,882). Improvement was found in untreated decay of established vs. new patient-visits in four of the practices. Dental hygienists integrated into medical teams provided full-scope dental hygiene care to patients and expanded access to dental services. Medical-dental integration (MDI) care was variably associated with reduction in untreated decay. Integrating dental hygienists into primary care medical practices has potential to improve oral health-related outcomes, however access to restorative dental care remains a challenge. [ABSTRACT FROM AUTHOR]

Disparities exist in access to early oral health care, disproportionately impacting minority ethnic groups and populations with low socioeconomic status. Medical dental integration provides an opportunity to create a new dental access point for early prevention and intervention as well as care coordination. The Wisconsin Medical Dental Integration (WI-MDI) model expanded early access to preventive oral health services by integrating dental hygienists (DHs) into pediatric primary care and prenatal care teams to address oral health inequities with the goal of reducing dental disease. This case study will describe how DHs were incorporated into the medical care teams in Wisconsin and how legislation expanding scope of practice made this possible. Since 2019, five federally qualified health systems, one non-profit clinic, and two large health systems have enrolled in the WI-MDI project. Thirteen DHs have worked across nine clinics in the WI-MDI project and over 15,000 patient visits to a medical provider included oral health services provided by DHs from 2019 to 2023. Dental hygienists working in alternative practice models such as those demonstrated in the innovative WI-MDI approach are positioned to reduce oral health disparities through the provision of early and frequent dental prevention, intervention, and care coordination. [ABSTRACT FROM AUTHOR]

Dental hygienists (DHs) are well positioned to be part of primary care teams to increase access to oral health care, particularly for those who encounter barriers to oral care, such as pregnant people. The Michigan Initiative for Maternal and Infant Oral Health (MIMIOH) integrates DHs into obstetrics and gynecology (OB/GYN) clinics in federally qualified health centers (FQHCs) to improve pregnant people's oral health. Evaluation of the MIMIOH program revealed that selecting DHs with personal characteristics desirable for integrated-care delivery was a major factor for successfully integrating DHs into OB/GYN clinics. Additionally, designing appropriate clinical workflows, gaining buy-in from prenatal health care professionals, presenting oral health care as part of prenatal care, having co-located OB/GYN and dental clinics, and maintaining adequate funding were all critical to program success. Analysis of Medicaid data showed that the MIMIOH model increased the percentage of pregnant people receiving oral health care at FQHC dental clinics. Innovative programs like MIMIOH add to the evidence that integrating DHs into primary care settings can increase access to oral health care, especially for those who face difficulties accessing the traditional oral health care system. There is great potential for DHs to leverage collaborative practice agreements and remote supervision to increase access to oral health care for the public. Providing DHs with autonomy to practice to the highest level of their scope of practice and permitting direct Medicaid reimbursement for DHs would make oral health care more accessible for underserved populations. [ABSTRACT FROM AUTHOR]

The authors examined adults' perceptions about the importance of the human papillomavirus (HPV) vaccine in preventing oropharyngeal cancers and dental care providers' role in HPV prevention and identified associated factors. Adults (≥ 18 years) completed a national survey of consumer and patient attitudes, experiences, and behaviors on oral health. Descriptive and multivariable logistic regression models determined associations between perceptions regarding HPV and attitudes toward dental care providers' role and HPV knowledge, HPV vaccine recommendation, and sociodemographic characteristics. One in 3 adults (32.8%; n = 5,320) said the HPV vaccine was very important, 1 in 2 said it was somewhat important (48.1%), and 1 in 5 said it was not important (19.1%) in preventing mouth and throat cancers. More than one-half (56.7%) of adults had positive perceptions about dental care providers' role in HPV education and were comfortable discussing the HPV vaccine with a dental care provider (59.4%). Adults with knowledge about HPV and oral health linkage and those who received HPV vaccine recommendation from a dental care provider had 2.0 to 2.5 times higher odds of reporting positively for all 3 outcomes (P <.001). Most adults are comfortable discussing HPV and the HPV vaccine with their oral health care provider. Perceptions about the HPV vaccine's importance in preventing oropharyngeal cancers and the role of dental care providers in HPV prevention can be improved by means of increasing adults' knowledge about the relationship between HPV and oral health. Dental care providers' engagement in HPV conversations with patients may increase their knowledge about the HPV and oral health linkage and their understanding of the role of the HPV vaccine in preventing oropharyngeal cancers. [ABSTRACT FROM AUTHOR]

Background Telehealth is a technology in medicine designed to facilitate the delivery of healthcare services remotely. These obviously, are lacking in resource-limited areas. A holistic approach to health care does not take out the mouth as an integral part of the body but unfortunately, the inclusion of oral health care in Primary Healthcare is still stalling in many countries. Complete and equitable healthcare access in resource-limited areas is facilitated by government policies, the presence of trained capacities, and the procurement of facilities to make the Primary Healthcare centers functional and viable for expert consultations, diagnosis, treatment, and monitoring. Purpose This topic projects Telehealth as an important 21st-century telecommunication technology for increasing access to healthcare in resource-limited areas and medical-dental integration concerted efforts as an approach to providing holistic healthcare intervention. Methods Journals and online publications were searched for this review. Search engines used were Google Scholar, Microsoft Academic, ProQuest, Cochrane Library, PubMed, and EMBASE. Also, online libraries were used to confirm if someone else has done a review on the topic. Result The effectiveness of Telehealth and medical-dental integration strategies have been tested and proven to improve interprofessional collaboration and serve as the comprehensive and integrated care plan to reduce healthcare inequality in resource-limited areas. These strategies are already adopted in many countries and that improves the outcome of their healthcare strategic goals of the countries. Conclusion The use of Telecommunication technologies in dentistry and general medicine are an effective approach to the professional delivery of healthcare services to resource-limited areas with little or no limits. Medical dental integration is another concerted strategy for reducing oral health inequality at all levels of the health care system.

The first few months of the coronavirus disease 2019 (COVID-19) pandemic challenged health care facilities worldwide in many ways. Inpatient and intensive care unit (ICU) beds were at a premium, and personnel shortages occurred during the initial peak of the pandemic. New York State was the hardest hit of all US states, with a high concentration of cases in New York City and, in particular, Bronx County. The governor of New York and leadership of hospitals in New York City called upon all available personnel to provide support and patient care during this health care crisis. This case study highlights the efforts of Jacobi Medical Center, located in the northeast Bronx, from March 1 through May 31, 2020, and its use of nontraditional health care personnel, including Department of Dentistry/OMFS (Oral and Maxillofacial Surgery) staff members, to provide a wide range of health care services. Dental staff members including ancillary personnel, residents, and attendings were redeployed and functioned throughout the facility. Dental anesthesiology residents provided medical services in support of their colleagues in a step-down COVID-19–dedicated ICU, providing intubation, ventilator management, and critical and palliative care. (Step-down units provide an intermediate level of care between ICUs and the general medical–surgical wards.) Clear communication of an acute need, a well-articulated mission, creative use of personnel, and dedicated staff members were evident during this challenging time. Although not routinely called upon to provide support in the medical and surgical inpatient areas, dental staff members may provide additional health care personnel during times of need. [ABSTRACT FROM AUTHOR]

Increasingly, the medical community is recognizing how oral health relates to overall health and engaging in oral health promotion. In 2012, the Massachusetts Medical Society set out to explore how to prioritize oral health as a part of its public health agenda. It began with an Oral Health Forum, which evolved into a Committee on Oral Health. This committee is the first of its kind in a state medical society and is comprised of a diverse group of medical and dental professionals. In this article, we review the process by which the committee was established, report on projects, and reflect on lessons learned. [ABSTRACT FROM AUTHOR]