There is a growing need in the United States to provide oral health care to special populations. These populations include; people who are homebound or residing in a residential facility, people who are physically isolated, people who have disabilities and children who do not have access to routine preventive dental services. One mechanism to address these needs is to provide access directly where the people live, work, go to school, worship, or receive social services.31 This phenomenon is referred to as “community-based care.”
Dental care in the United States is typically provided in private dental offices or public dental clinics when patients present to the facility for treatment. This phenomenon could be termed a “reactionary model” because patients have identified the need for care and call to schedule an appointment.32 This model depends on the patients’ knowledge, attitudes, and resources.32 Furthermore, patients must be able to navigate through financial, structural and cultural barriers. These barriers can be further defined as shortage of providers, inadequate transportation, cultural insensitivity and lack of funding for care.33 Although these barriers exist in all regions, they often present greater challenges in the rural areas.30
Community-based care can be very effective in rural communities as a result of the small number of people and the ability to build relationships among the local stakeholders.30 Integration of community-based care is a way to efficiently utilize resources and get the community involved in taking care of one another.30,34
Several well recognized community-based care models that utilize tele-dentistry for communication between mid-level dental hygienists and dentists, exist across the U.S.32,35-38 Teledentistry allows dental personnel to use technology to capture images of the oral conditions. These images, along with other electronic data, such as radiographs, can be sent to another site where another provider can offer feedback and direction. This may be done with the dental hygienist capturing data for a dentist at another site to complete an exam. Or, data may be transferred to a specialist to secure an advanced diagnosis.39-43
It is helpful to examine existing models of care when considering a structure for a model in your community. Summerfield, in collaboration with the Northern Arizona University Dental Hygiene Department developed a tele-dentistry model that digitally links the oral health care team.41 This highlights the need for the dental team to remain intact, even if all members cannot be present in the same location. Simmer-Beck, in collaboration with University of Missouri Kansas City School of Dentistry developed a school-based tele-dentistry model that used a store and forward method to exchange clinical information.44 Glassman and Helgeson, report on community models which target individuals where they live, work, go to school, or obtain other health or social services.32 These community-based clinics provide “virtual dental homes’ or sites for dental services, for individuals who are unable to access care in the traditional private practice setting.42,43
Many states have begun revising their dental practice acts to allow dental hygienists to provide care in places where people live, work, go to school or receive social services. At the present time 40 states permit some form of “direct access” allowing dental hygienist the capacity to “initiate treatment based on his or her assessment of patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and can maintain a provider-patient relationship.”45
Application of fluoride varnish in a community-based setting.