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Creative Innovations in Oral Health Care

During a time when many in health policy stakeholders are emphasizing health integration and whole-person care, it is surprising that dental care is not more often a part of this discussion. There has been an overwhelming amount of chatter regarding workforce shortages and how to make care accessible to more consumers. However, many (not all) of these conversations revolve around primary care physician shortages, how we can get more doctors into the supply pipeline, and augmenting our existing workforce by expanding scope of practice laws for nurse practitioners and physician assistants. This same fire and passion seems to be lacking for dental providers. But let’s face it. Dental care is not as sexy to some people as other healthcare topics might be.

In any case, dental care workforce challenges should be acknowledged. Data collected by the Office of Statewide Health Planning and Development (OSHPD) for 2013, shows a lack of dentists in nearly every county except Los Angeles, Orange, San Diego, the Inland Empire, and a few northern counties like Contra Costa and Santa Clara.

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Even without social and economic barriers, many Californians simply do not have access to a dentist because of where they live. To help reduce shortage issues, policymakers are considering expanded roles for oral health professionals. The adoption of dental therapists, midlevel professionals similar to physician assistants, is slowly gaining approval in most states. Currently, dental therapists are allowed to practice in Alaska, Minnesota, and Maine.

California has not adopted the use of dental therapists. Instead, a few cities have implemented teledentistry as part of the Virtual Dental Home Demonstration Project (VDH). VDH is authorized under OSHPD’s Health Workforce Pilots Project (HWPP) to provide dental care to vulnerable adults and children. In the pilot, dental hygienists and dental assistants travel to head start sites, schools, and nursing homes to examine and collect dental information. A secure email system then transmits collected information to a dentist offsite, and the dentist creates a treatment plan for the onsite provider to follow. Onsite providers decide which x-rays to take and are allowed to place temporary fillings. If more extensive work is needed, patients are referred to a dentist. Onsite visits relieve parents and children from the burden of a typical office visit. Parents do not need to take time off work, and children are provided care in familiar and comfortable surroundings. Additionally, adults and children are given preventive care as well as services to temporarily prevent further oral health deterioration.

OSHPD’s HWPP program was designed to allow providers the ability to demonstrate the effectiveness of expanded professional roles in advance of any changes to scope of practice laws. And, in fact, VDH has successfully demonstrated the need for oral health care and education, and the ability for dental hygienists and dental assistants to work under the virtual supervision of dentist when conducting preventive procedures. Given these successful outcomes, this project should continue.

Assembly Bill 1174, introduced by Senator Bocanegra and Senator Logue, would allow statewide implementation of VDH, expand roles for dental hygienists and dental assistants, and make teledentistry reimbursable under the Medi-Cal program. AB 1174 is currently before the Senate Committee on Appropriations, and a hearing is set for August 4th.

Because there is a proven linkage between oral health and medical conditions like heart disease, we should rally behind innovations that seek to improve oral health for vulnerable populations. That is something to smile about!

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