Embedding Dental Hygienists into Medical Care Teams: Implementation and evaluation of a medical-dental integration approach in Colorado

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. Keywords medical dental integration, dental hygienists, dental hygiene care, access to care, vulnerable populations NDHRA priority area, Population level: Access to care (interventions). Submitted for publication: 4/26/23; accepted after revision: 5/19/23.
INTRODUCTION In 2000, the first-ever United States (US) Surgeon General's Report on Oral Health stated that 'oral health is more than healthy teeth and is integral to the general health [...]