North Carolina Oral Health Collaborative

NCOHC released its first policy brief in the summer of 2020 to provide an overview of the many policy changes that could increase equity and access to oral health care in North Carolina. This is the second of three deep dives to further expand on the policies within the brief. You can read the first one here.

Read the full policy brief here

As North Carolina grapples with an oral health workforce imbalance, there are several opportunities to improve the efficiency and effectiveness of care delivery. The opportunities in this section are relatively simple—not requiring a change to scope of practice, but rather simply modernizing the Dental Practice Act to better utilize technology for patient care, and to open doors for collaboration between medical and dental providers.

Adoption of teledental service utilization

During the COVID-19 pandemic, teledentistry has proven to be an invaluable tool allowing patients and providers to connect in safe, socially distanced settings. Prior to the pandemic, teledentistry served as a vital tool for increasing access to oral health care, as well. Providers across North Carolina have effectively leveraged the use of technology in community-based and school-based settings, allowing those who traditionally would not see a dentist to receive care through teledentistry.

To learn more about teledentistry and the many ways it is used, join us for Oral Health Day Part 2 on Oct. 23 and hear from some of North Carolina’s dental directors and three renowned experts in remote care technology.

Although health clinics and other providers — in both public and private sectors — regularly have provided teledental services, NCOHC advocates that to ensure future use of teledentistry as a care modality, stakeholders need to take steps to codify its use in North Carolina.

First, NCOHC recommends permanently adopting language to include electronic service delivery within the definition of dentistry, under Chapter 90, Article 2. These changes would simply update the Dental Practice Act, since remote care technology wasn’t even on the radar when the original language was drafted. Not only will the addition of language to Article 2 further define and codify teledentistry as a care delivery modality in our state, but it will also add in consumer protections for the provisions of remote care.

Finally, and specifically to payment reform, NCOHC urges both NC Medicaid and the commercial dental benefit plans to allow for the reimbursement of teledentistry both synchronously and asynchronously. These codes, D9995 and D9996, respectively, have been a part of the national billing nomenclature since 2018. Because of the lasting impact that teledentistry could make — even beyond a pandemic setting — it makes prudent sense to permanently adopt these billing codes.

Integration of Care

NCOHC is a strong advocate for integrated care, another area where teledentistry technology could play an important role. Tools like intraoral cameras are easy to use, and simply capturing images of a patient’s mouth can assist in connecting that patient to the care they need. NCOHC sees a big opportunity for using teledentistry technology in primary care settings to capture supplementary patient information for referral to dental providers.

Finally, NCOHC outlined several options to expand the dental workforce, including the community care coordinator.

Check out what one of NCOHC’s interns, Parker Norman, recently wrote about care coordination, and take a look at how Kintegra Health, a Federally Qualified Health Center west of Charlotte, uses teledentistry and care coordination to complete a network of care for children in Title I schools.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

At Kintegra Health, a Federally Qualified Health Center (FQHC) serving several counties west of Charlotte, care coordination is increasing access to oral health services. Today, Kintegra’s 11 dental navigators are helping families understand their oral health needs, recording an astonishing 70 percent treatment completion rate.

In a recent blog post, Parker Norman shared how dental care management workforce models use care coordination to help providers address social determinants of health and expand access to oral health care services. In this post, she explores two examples in North Carolina.

What is Care Coordination? A Quick Review

As a recap, through care coordination, patients are connected with the resources they need to access oral health care services, including reliable transportation, comprehensive oral health insurance coverage, providers who accept that insurance, and providers who speak the same language as their patients.

Communicating with patients in their native language is especially important.

By speaking the same language as the people in the communities they serve, care coordinators can often help patients feel more comfortable. Coordinators — often referred to as “navigators” — can also promote oral health literacy through patient education delivered in a patient’s native language. With an understanding of the importance of good oral health, people are more likely to seek and utilize oral health care services.

Dental Care Management Models

Dental care management models include dental navigator models and the ADA-formalized Community Dental Health Coordinator model (CDHC). Both models aim to employ culturally competent individuals from the communities they serve. These coordinators are better able to understand vulnerable patient needs and connect them with the resources necessary to access optimal oral health.

Dental navigator models and the CDHC model are already used in North Carolina, and both are expanding access to care. Dr. William (Bill) Donigan, dental director at Kintegra Health, and Crystal Adams, a registered dental hygienist and director of Catawba Valley Community College’s (CVCC) dental hygiene program, provide insight about these models and offer recommendations for North Carolina as more are put into practice.

Care Coordination Case Study: The Dental Navigator Model at Kintegra Health

Kintegra Health first began to use the dental navigator model in 2006 as part of a school-based program, with hygienists calling parents to schedule their children’s appointments. By 2010, dental navigators joined the hygienists at schools to help schedule appointments. Starting in 2012, Kintegra hired a dental navigator for every county served by its school-based program —one navigator each in Davidson, Lincoln, Catawba, and Iredell Counties, and two in Gaston County.

By 2016, Kintegra Health was placing dental navigators in other health care areas, including pediatric medical, OBGYN, and Women Infant Children (WIC) clinics. These navigators provide patient and parent education, schedule appointments in communication with parents, and apply fluoride varnish for children. Although this program primarily serves children, some adultOBGYN patients are also served. There is limited space for adults in Kintegra’s dental clinics, so teledentistry is often used during medical appointments to bridge this gap.

To learn more about teledentistry, join NCOHC for Oral Health Part 2 on October 23rd, watch how Kintegra and other clinics provide remote care, and hear from some of the nation’s leading experts.

At Kintegra Family Health in Statesville, the pediatric medical clinic and family dentistry clinic once shared a waiting room. Since the offices were side-by-side, it was assumed that a medical provider would give a dental referral to patients and their parents, who would then schedule the appointment. Because of this, no dental navigator was employed at that location.

In 2016, almost 970 new patients saw a dentist at Kintegra Health in Gaston County, where a dental navigator was employed in the pediatric medical clinic. During the same year, only 48 new dental patients were seen at Kintegra’s Statesville location. Howeer, after a navigator began working in the Statesville WIC clinic, more than 50 new patients saw a dentist in just one month. The figure below compares expected patient volumes during one year with dental navigators and one year without.

Kintegra Health has measured a 70 percent treatment completion rate for patients receiving oral health care with the help of dental navigators, compared to about a 30 percent completion rate in private practice.

With statistics like that, it is clear to see that Kintegra Health’s dental navigator model is increasing access through care coordination. There are now a total of 11 navigators employed by Kintegra Health and, during the last eight years, these navigators have helped more than 9,500 patients access dental care.

If Dr. Donigan were to start a new clinic, he said he would first employ a CDHC, rather than a dental navigator. A CDHC is trained to present the program to key stakeholders, some of whom are outside of the clinic setting, such as at school board meetings. CDHCs are also trained to use motivational interviewing techniques to expand the program.

After patient volume began to increase, Dr. Donigan would then start employing dental navigators to speak one-one-one with parents and patients. As he already does at “Dr. Donigan’s School of Dental Navigation,” he would train the new dental navigators on-site in oral health education. He would also require that they complete the Smiles for Life program, which equips primary care providers to promote oral health for all age groups, and he would require that they become Dental Assistant IIs (DA2).

Catawba Valley Community College CDHC Program

Catawba Valley Community College’s CDHC program is a year-long program with specific curriculum, training, and internship requirements. Before entering the program, a CDHC candidate must also have a professional DA2, Child Development Associate, or Registered Dental Hygienist license. It often takes longer for a CDHC to be able to find employment, compared to a dental navigator, given the formalized criteria that must first be met. However, once employed, a CDHC is already equipped with education and training.

In North Carolina, there are no CDHC-title jobs available — most jobs are marketed as general dental navigators without a specific CDHC requirement. Because of this, most students in CVCC’s program complete it as part of their continuing education and go on to work in other oral health roles. The positive outcomes of the program need to be proven to stakeholders so that CDHC jobs are actually funded before CDHCs will be employed as CDHCs.

“Let’s not look at the dollar, let’s look at the people,” Adams said, referring to the important work CDHCs could do to help people navigate barriers and access oral health care.

Adams also mentioned that while the CDHC curriculum is nationally formalized, care coordination is not “cookie cutter,” and there is no one-size-fits-all model. Different dental offices serving different populations will go about care coordination differently. At CVCC, Adams is adapting the program to make sure it is up-to-date and applicable for target populations in North Carolina. This includes educating students on things that may vary across state borders, such as insurance coverage.

CVCC will enroll its third cohort of CDHC students this January.

Dental navigator and CDHC models in North Carolina expand access to oral health care for vulnerable populations, addressing oral health inequities and improving overall oral health outcomes. The positive consequences and areas for improvement for both models should be considered as we move forward to implement future models effectively.

Over the 2020-2021 academic year, Parker Norman will be conducting a formative process evaluation of the CDHC program at CVCC. The evaluation will confirm if the program is feasible, appropriate, and acceptable, as well as inform decision-making related to the program’s improvement and ensure long-term success. Be on the lookout for the outcomes of this research, which will be applicable to other current and future programs!

In eastern North Carolina, Greene County Health Care (GCHC) is embracing teledentistry, one of many innovative steps they are taking to improve patient care and meet the needs of traditionally underserved populations.

“I think the thing that’s most exciting about teledentistry is the integration of medical and dental,” said Dr. Rob Doherty, chief dental officer at GCHC. “I’m looking at the patient and I’m talking to them face-to-face, and I also have that medical provider there in case there are questions.”

Dr. Doherty and Chi Nguyen, a physician assistant at GCHC, recently filmed a joint teledentistry appointment with a patient, which you can watch during Oral Health Day Part 2, a follow up to NCOHC’s annual oral health advocacy event. Learn more, register, and join the virtual event on October 23 from 1-3 p.m.

During a screening with Nguyen, the patient mentioned experiencing pain in his mouth. Rather than schedule a separate appointment with a dental provider, Nguyen was able to loop Doherty into the video call.

Doherty consulting with Nguyen and her patient through GCHC’s teledentistry software platform.

“Chi had a patient on the line who she was just checking on. He had made a comment that he had a hard time sleeping because a tooth was bothering him, and it was a little bit swollen,” said Doherty. “So, she just sent me an email and I was able to speak with him face-to-face and really get an idea of what the problem was. I had the schedule right in front of me and I was able to get him an appointment at 2:30 that afternoon.”

Doherty said that the video call helped him get a much better idea of the problem, something he wouldn’t have been able to do had the patient just called in and said he had tooth pain.

“It is awesome, us being able to see a patient and have a three-way appointment,” said Doherty. “We can get so much done, we can be so convenient for that patient, and it’s just plain better care.”

Of the benefits that teledentistry provides, Doherty highlighted just how important time saved can be. Health centers like GCHC see large volumes of patients who otherwise wouldn’t have access to affordable care.

“Every time we open up a new site, we’re swamped,” said Doherty. “We have a long waiting list, and we have to limit the number of patients that we see.”

With technological innovations like teledentistry, providers can increase efficiency, provide care to more patients, and work through those waiting lists.

“I think the horizons are really opening up for us in teledentistry,” said Doherty.

Join NCOHC, Doherty, and the dental directors for Kintegra Health and Piedmont Health on October 23, 2020 to explore the many ways clinics in North Carolina are using teledentistry to improve patient care. At the virtual event, you will also hear from national experts, including the “father of teledentistry,” Dr. Paul Glassman, and more! Register today!

 

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Thousands of young children in the counties west of Charlotte receive annual dental care in their schools’ parking lots. With an active, and growing, mobile dental network, Kintegra Health’s Dental ACCESS Program is improving children’s oral health, and teledentistry is a vital piece of the puzzle.

On board one of Kintegra Health’s mobile buses, complete with three chairs, an x-ray room, and plenty of cartoons to keep children occupied.

“The program has just blossomed,” said Melissa Boughman, director of the ACCESS Program. “We have 60 schools that we work with now, and we saw 5,500 children last year.”

If schools remain open this fall and avoid COVID-19 outbreaks, the ACCESS Program is on track to see between 6,000 and 7,000 students this year, according to Boughman.

Students now receive temperature scans to screen for COVID-19 symptoms at the beginning of their visits to the Dental ACCESS Program.

“Parents working (with limited) access, specifically transportation access, means that parents sometimes can’t get to the dental office, or they can’t get time off of work to come to the dental office,” said Dr. William Donigan, dental director at Kintegra Health. “We need these children to get as much care as we can give them without the parents having to be here.”

“In Title I schools, transportation is such a major issue,” said Boughman. “It’s so wonderful that we’ve been blessed with these mobile dental units that we can drive right up, park, and they bring the children out to us.”

In one day at Battleground Elementary in Lincoln County, the hygienists and assistants on this mobile bus will see around 30 kids.

The ACCESS Program has two mobile dental buses, complete with three dental chairs and an x-ray room, as well as a dental van for follow-ups and dental sealants.

Once a child is on the bus, Kintegra’s dental team takes a series of nine photographs of the child’s teeth as well as x-rays, if necessary. While the dental hygienists and assistants can only provide preventive care on the mobile buses, the care doesn’t stop once a child goes back to class. Thanks to the Kintegra’s teledentistry software, those photos and x-rays are automatically uploaded, made immediately available to dentists and staff at one of their brick-and-mortar sites.

The computers on Kintegra Health’s mobile buses transmit data in real time to staff at clinic sites.

“Literally immediately, we can view all of that information at one of our sites,” said Donigan. “So, our Dental ACCESS Program navigators can then talk to the dentist and direct the parents to get the patient in for the care that they need.”

Dental navigators are another vital piece of the puzzle. Kintegra employs navigators to help parents and patients efficiently get the care that they need. For parents experiencing any of a slew of social determinants of health that make accessing care more difficult, having someone there to guide the process along can have a big impact on the care a child receives.

For more on dental navigators and how they increase access to care, check out a blog by one of our summer interns on community care coordination.

With a complete network, connecting the staff on Kintegra’s dental buses to the dentists at their clinic locations, children who may have not received care otherwise now have the opportunity to receive regular care.

“We see the difference in the children we have seen for many years versus the newcomers like the kindergarteners, and in some schools pre-k,” said Boughman. “When we see them yearly, we see a big difference. We also do education because we all know that education is the most important part of all of this. Once we clean their teeth (plaque and tartar) will come back quickly, but if we teach them how to take care of their teeth, they can have a lifetime of great (oral health).”

Want to see teledentistry in action?

Join NCOHC for Oral Health Day Part 2 to see how clinics like Kintegra Health use teledentistry to improve access to patient care. We just announced a change of plans. Instead of in-person tours, we will bring tours of clinics, including Kintegra Health, to you virtually on [DATE], along with a star-studded panel of teledentistry experts from across the country!

Learn more and register here.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

“Historic and systemic structural racism are inherent parts of the United States,” said Jen Zuckerman, director of strategic initiatives at the Duke World Food Policy Center. “This means every single system that exists within the United States is rooted, designed, and based in racism, and has been built on the system of oppression. Nobody alive today is to blame for the unfairness of our history, but we each hold a responsibility to create a better future.”

Continuing NCOHC’s series on the social determinants of health and how they impact equity in oral health, we spoke with Zuckerman to discuss how the Duke World Food Policy Center approaches inequities in food systems and the policy work that can make a lasting impact.

 

Click here for more on equity in oral health.

 

Access to food is an important social determinant of health, and healthy food options can significantly impact oral health. Unlike other posts in this series that directly break down relationships between the social determinants and oral health, this post will focus on food systems, underscoring how Zuckerman and the Duke World Food Policy Center are addressing inequities, while drawing parallels to oral health systems.

 

 

The Center for Assessment and Policy Development defines racial equity as “the condition that would be achieved if one’s racial identity no longer predicted, in a statistical sense, how one fares.”

Racial inequity plagues food production, distribution, financing, ownership, and access in the U.S., so much so that Zuckerman said there is no true working example of an equitable food system. To understand the fundamental role that racism plays in creating systems of inequity, the World Food Policy Center looks toward ownership structures.

“An equitable food community is one where there is an equitable distribution of ownership as it relates to the ability to grow food, distribute food, and provide retail,” Zukerman said. “An equitable food community would also have equitable access to capital.”

 

 

The ability — or lack thereof — to build generational wealth has been fundamental in creating inequities. According to the Duke World Food Policy Center, barriers to building generational wealth should also be front and center in policy work to address and reverse inequities.

“When we think about food, or when we think about anything in the United States, history has demonstrated that the white community has continually gotten investment through policies, programs, and initiatives,” said Zuckerman. “And communities of color have continually gotten programs and services, which do not build wealth.”

While programs and services for those who lack access are incredibly valuable, it is simultaneously important to take conversations of equity a step further to encompass the financial, policy, and power structures at play.

 

 

Zuckerman pointed to housing as an example of racist policies that have created lasting impacts on generational wealth. White veterans returning from World War II were able to buy homes through the GI bill, while returning Black veterans were disproportionately blocked from homeownership due to redlining and other policies rooted in racism.

“Broadly speaking, instead of home loans, Black veterans got public housing from government support,” said Zuckerman. While policies like redlining are illegal today, “think about the wealth built over generations of homeownership versus the wealth you cannot build by living in public housing.”

 

 

Racist policies, no matter when they were enacted or ended, have contributed to an historic disparity in wealth between white and BIPOC communities. Because of this, a lack of direct racism is not enough to reverse past racism. Whether we are aware of it or not, there are still people, policies, and structures in place today that have disproportionate negative impacts on communities of color.

So, how do we actually change racist systems and create equitable structures?

According to Zuckerman, ownership, which refers to both wealth creation and agenda setting, is a central piece of the puzzle.

“There need to be changes in financing and philanthropic investments,” Zuckerman said. “More philanthropic dollars need to be invested in BIPOC-led organizations, and those community organizations need to be able to set the agenda for what they would like their community to have.”

In oral health, significant focus is given to providing low-cost oral health services to those who have historically lacked access. While these programs and services are incredibly important, and this post is not in any way meant to downplay the hard work that so many people do to extend access, oral health champions can learn a lot from the Duke World Food Policy Center’s perspective.

As oral health policy champions, how can we help create more equitable structures that include a diverse workforce more representative of the population as a whole? Where is wealth being built in the dental industry, and how can we work to increase access to and equity in that side of the equation?

“Technology has really changed the field of dentistry since March,” said Dr. Katrina Mattison-Chalwe, Piedmont Health’s dental director, referring to the need for dramatic shifts in how providers approach patient care to adapt to the COVID-19 pandemic.

As COVID-19 closed economies across North Carolina and the U.S., health departments and the American Dental Association recommended that dental providers reduce services to only treat patients with emergent needs. As a result, many practices and clinics began to re-think how they could use teledentistry to maintain patient care.

“When we were all confined to our homes and only able to come out for essential needs, teledentistry came into play,” said Dr. Mattison-Chalwe. “It has opened up our ability to treat patients—we are now able to talk with someone face-to-face without actually being face-to-face.”

 

While a full slate of dental services cannot be provided remotely—your dentist can’t reach through the computer screen to perform a filling—many diagnostic, education, and consultation services can be performed remotely, connecting patients to a provider for these essential services.

“Teledentistry has enhanced our abilities tremendously,” said Melvin Williamson, a dental assistant at Piedmont Health. “We are able to reach out to our community, especially the younger kids, who need help really bad right now.”

Remote care technology is also helping providers reduce the amount of time a patient needs to be in the office to receive care.

“Teledentistry has allowed us to triage our patients better,” said Dr. Lauren Harrison, a general dentist at Piedmont Health. “It has allowed us to screen our patients without exposing ourselves to anything that’s not necessary, and we’ve also been able to reserve more clinic time for patients who really need that time.”

Traditionally, dental care can require several appointments from start to finish, beginning with an examination, where a dentist and staff would assess the patient, develop a treatment plan, and schedule a follow-up appointment to deliver the care needed. With teledentistry, providers have been able to perform the initial examination remotely, minimizing the time a patient would need to be physically present in clinic.

Earlier this year, NCOHC launched a teledentistry fund with support from the Blue Cross and Blue Shield of North Carolina Foundation. The fund has helped award 20+ grants, including one for Piedmont Health, to purchase annual teledentistry subscriptions. These subscriptions will help health centers and other clinical facilities provide remote patient care both during and after the COVID-19 pandemic.

“We were not prepared for COVID-19. No one was. As a result of that, we didn’t have extra funds to be able to purchase teledentistry licensing for all our providers,” said Dr. Mattison-Chalwe. “The (NCOHC) Teledentistry Fund helped us purchase licenses for all 12 of our providers, so we are able to be on the teledentistry platform while we were all in quarantine, and we are still able to use it now.”

The Next Generation Dental Office is Here

In the 21st century, modern dental practices have evolved to further place the overall health and well-being of the patient at the center through interprofessional collaboration and integration. Most notably, many dental practices now monitor blood pressure, screen for glycemic control, and educate patients on the connection between oral health and chronic diseases such as diabetes, osteoporosis and heart disease.

Will you get your next flu shot at the dentist, too?

In this blog post, we’ll examine the opportunity for dental professionals to improve and protect public health by administering vaccines, particularly for HPV and seasonal influenza.

Vaccinations in the United States: A Brief Background

Vaccinations are a core component in the fight against disease, helping build immunity prior to infection. Today, vaccines are available to help protect against diseases such as tetanus, Hepatitis B, measles, mumps, rubella, and whooping cough, just to name a few. In recent years, effective vaccination even eliminated smallpox.

A list of vaccine schedules outlining what vaccines are recommended at which ages can be found here.

Despite their effectiveness, millions of U.S. residents forgo vaccination each year. Fueled by scientific skepticism, distrust, cost, lack of insurance coverage, and other factors, vaccination rates in the United States are declining. A 2019 study found that between 2009 and 2018, 27 U.S. states reported a drop in the percentage of vaccinated kindergarten-age children.

According to the study, “For diseases with deadly potential … vaccination rates have fallen or remained below ideal thresholds.”

Despite this unfortunate reality, significant opportunities exist to improve and protect public health through vaccination, and oral health professionals can and should be part of the solution.

Dentists and Vaccination

You might be surprised to learn that dentists administer injections far more often than their medical counterparts. Each year millions of patients visit the dentist without visiting a medical provider. According to information from the Agency for Health Research and Quality (AHRQ), in 2017 alone, more than 31.1 million people in the U.S. sought care from a dentist, but not from their physician. According to the American Dental Association (ADA), “approximately 9 percent of Americans see a dentist, but not a physician, annually.”

Because dentists are skilled at administering injections, and they routinely engage with patients who do not frequently visit medical providers, dental visits are a prime opportunity for vaccination.

There is historical precedent for dentists and dental professionals delivering vaccinations as well. During the H1N1 pandemic in 2009, dentists in certain states were permitted to administer vaccinations to help fight on the frontlines of the pandemic response.

In 2019, the Oregon state legislature approved a bill allowing dentists to prescribe and administer vaccines. The law is expected to go into effect later in 2020. Other states that allow dentists to administer vaccinations include Minnesota and Illinois, which permit dentists to deliver the flu vaccine.

Allowing dentists to administer vaccines could have particular significance as the nation prepares to optimize delivery of an anticipated Coronavirus vaccine. According to the American Association of Dental Boards (AADB), at least one half of U.S. states have considered allowing the administration of COVID-19 vaccines by dentists once they become available.

HPV Vaccine and Reducing Oropharyngeal Cancer Risk

Even with scope of practice modifications, the dental office will likely never become a major access point for certain common vaccinations, like those for tetanus and Hepatitis B. However, there is a significant opportunity for oral health professionals to play a key role in providing vaccines for diseases with strong connections to oral health, as well as seasonal vaccinations.

The human papillomavirus (HPV), for example, is the most common sexually transmitted infection in the United States, and it significantly raises the risk of oropharyngeal cancer. According to the Centers for Disease Control and Prevention (CDC), HPV causes an estimated 70 percent of oropharyngeal cancers.

HPV’s connection to oral health means that dental professionals are prime candidates for delivering HPV vaccinations, monitoring vaccine compliance, and providing patient education. Allowing dental professionals to provide these services would increase efficiency and vaccination rates while lowering costs.

Routine vaccinations, including the seasonal flu vaccine and anticipated coronavirus vaccine (which is likely to be required annually), could also be effectively administered by dental professionals, achieving the same objectives.

Federally-Qualified Health Centers (FQHCs), in particular, are excellent sites for providing these vaccines, as dental-medical care is often integrated in pursuit of whole-person health.

Challenges to Dental Professional-Administered Vaccines

This not to say there are not challenges for this model of dental professional-administered vaccination.

Perhaps most significantly, throughout modern history, dentistry has been seen as separate from medicine. Rather than being viewed as an integral part of whole-person health, oral health has been siloed, effectively undermining opportunities to promote vaccination. Unfortunately, there will always be those who push back against further dental-medical integration.

Other, more practical, obstacles also present challenges to dental vaccine programs. In a recent op-ed published by the ADA, Dr. Joseph Kwan-Ho Yun outlines several of these, including a lack of training, a lack of adequate medical history, and payment and billing practices.

These challenges are certainly not insurmountable, and Kwan-Ho Yun acknowledges the benefits of such programs.

“Dentists may find it beneficial to focus on seasonal and targeted interventions such as the flu and HPV vaccines,” said Kwan-Ho Yun.

Regardless of how dental vaccine programs evolve, it is also apparent that dental-medical integration is both a prerequisite and an outcome. “This policy furthers integration of dentistry and medicine,” said Kwan-Ho Yun.

Outlook for Dental Vaccine Programs

Will your next vaccine be administered by a dentist?

Scope of practice expansions are under consideration in multiple states, and it is clear that dental professionals have the experience and expertise to play an important role on the frontlines of improving and protecting public health through vaccination, especially for HPV and seasonal diseases like influenza.

The coronavirus pandemic, in particular, presents a unique opportunity and may prove to be the impetus for driving policy changes necessary to expand dental vaccine programs nationwide.

Let’s hope so.

“Dental professional-administered vaccines, especially for oral health-related diseases like HPV, can have a tremendously positive impact on increasing vaccination rates, improving population health, and encouraging dental-medical integration,” said Dr. Zach Brian, NCOHC director. “It will be prudent that oral health stakeholders further explore this opportunity, and collaboratively enact policy to accomplish it.”

To join the effort to improve access and equity in oral health care in North Carolina, sign up to become a member today. Membership is free and by joining you’ll get instant access to our exclusive resources, events and updates for oral health advocates.