Community-Based Dental Care: An Alternative Approach to Improve Access to Dental Providers

Current evidence indicates that despite previous attention drawn to oral health disparities, children and adults in low-income families, the elderly residing in residential facilities, adults and children with special needs, and people living in “Dental Health Provider Shortage Areas” (DHPSAs) continue to have significant oral health problems due to lack of ready access to dental professionals.^1-12 Nationwide, emergency room dental visits nearly doubled from 2000 to 2018 increasing from 1.1 million to 2.0 million.¹² The oral health problems high risk populations experience stem from geographical constraints, inadequate numbers of oral health professionals treating Medicaid eligible patients, financial limitations, difficulties interacting with culturally-diverse populations, and/or lack of appropriate knowledge about the need for proper oral health practices.^2,4,9,13-15 Untreated oral health problems will inevitably result in developing unnecessary chronic pain, exacerbation of systemic disease such as aspiration pneumonia, reduced quality of life, poor performance in school, and large dental bills.^15-17 Figure 1 provides a list of resources that can be used to describe the health of individual communities. It also includes links to state and national data for comparison purposes.

Quality affordable healthcare for all Americans was the influential factor for establishing the Patient Protection and Affordable Care Act of 2010 (ACA).²⁸ To support implementation of this legislation, the Institute for Healthcare Improvement (IHI) established three goals, commonly referred to as the “TripleAim,” to optimize the U.S. healthcare system and improve accountability. The TripleAim framework seeks to improve the patient experiences of care, improve the health of populations, and reduce the costs of health care.²⁹ Recognizing the need to to be mindful of the well-being of the health care workforce and the importance of advancing health equity, the TripleAim has evolved into the Quintuple Aim.²⁹ The ACA has mechanisms in place to develop new patient care models, such as community-based health care, that should improve the health of individuals and the community.²⁸ To facilitate ACA initiatives, the role of public health must measure the health of communities and integrate the provision of health care services into communities.^28,30