Oral Health and Primary Care: Exploring Integration Models and Their Implications for Dental Hygiene Practice

Abstract

Background: Historically, the oral health care system has been separated both administratively and clinically from the larger health care delivery system. Despite this historical separation, providing oral health care services lies within the scope of all health care professionals' practices. Current efforts to shift the compartmentalized American health care system to a total patient care model provide an opportunity to integrate oral health care with primary care in order to improve the population's oral health. This article seeks to acquaint dental hygienists, the oral health care professionals focused on disease prevention, with new and emerging models of oral health care delivery and interprofessional collaborative practice in the hope that they soon will participate in and expand the implementation of these practice models. Methods: This study focused on five health centers, all of which have been identified as organizational leaders in the development and implementation of models designed to support the integration of oral health care with primary care. Quantitative information on each health center was derived from annual reports submitted to the Uniform Data System (UDS) and information on the integration models was obtained through structured key informant interviews. Results: Each organization has incorporated oral health risk assessment, clinical assessments, education, preventive interventions, and dental care coordination into primary care services. One organization provides oral health care as part of its outreach services and programs. The health care team members involved in integration vary. Some of the health centers primarily call on doctors to implement integration of oral health care while others employ dental hygienists, nurses, medical assistants, and outreach team members. Interprofessional collaboration was observed in each organization but took on different forms. Conclusions: Although their methods of integrating oral health care with primary care differed, the five health centers described in this study successfully used integration to improve the delivery of oral health care services to their patients. All of these organizations placed a high value on interprofessional collaboration regardless of the particular collaborative model employed and identified a champion tasked with overseeing the improvement of oral health care delivery.