Growing awareness of the importance of oral health creates opportunity for more than just dentists.
In 2007, Deamonte Driver, a 12-year-old boy outside Washington, D.C., died of a brain infection stemming from untreated tooth decay. Driver’s family couldn’t afford health insurance, and he wasn’t approved by Medicaid in time to visit an oral surgeon for the treatment that would have prevented his death. His death sparked a national outcry over the state of United States healthcare, and brought the importance of oral health into sharp focus.
Insurance kicks in
Since Driver’s death, oral health has become recognized as a critical component of overall health assessments, says Kevin Brown, senior vice president at Premier Medical Products. “For too long, oral healthcare has been separated from routine medical care,” he says. “By overseeing the medical products division of Premier Dental Products, this is a frequent topic of discussion for us.”
Incremental progress has been made in building awareness of the importance of oral health to systemic health. The beginning of 2015 brought the establishment of Medical CPT code 99188, allowing physicians and other professionals reimbursement from insurers, including Medicaid, for applying fluoride varnish to patients under six years of age. Brown notes that some states also allow medical practitioners to perform annual oral risk assessment exams.
In 2015, the American Academy of Pediatrics (AAP) added fluoride varnish to its Periodicity Schedule of Recommendations for Preventive Pediatric Health Care. Brown says that since pediatricians and family practice physicians are most likely to see these young patients – especially those like Driver, from underserved populations, who are often without a dental home – they are being targeted by professional organizations such as the AAP to get involved in oral health.
Bridging the gap
According to a 2015 article released by the American Academy of Family Physicians (AAFP), dental caries is the most common chronic disease among children. At the same time, the people who need the most urgent treatment for caries commonly lack access to insurance that covers it. Brown points to the 2013 Affordable Care Act, which includes basic oral health as a medical coverage benefit, as a step in the right direction.
The AAFP article quotes Kathryn Phillips, MPH, program director at consulting firm Qualis Health, who observed that though expanding access to affordable dental care is important, “that alone is unlikely to solve our current problem. The need is simply too great.”
The first step to incorporating oral health in overall health is for primary care physicians and their staff to be willing to talk with patients about oral health, adds Jeff Hummel, M.D., MPH, medical director for informatics at Qualis, in the same article. “Patients appreciate the attention to oral health, and they respond to coaching.”
In December 2015, the AAFP voiced its support for the Oral Health Delivery Framework, a five-step plan that primary care teams can take to incorporate oral health into their practices. Qualis formed the plan based on an initiative “to develop, test, and disseminate an actionable pathway for delivering oral health care in the primary care setting,” according to a white paper published by the firm. The Framework is currently being tested at several community health centers and private practices across five states.
In addition to offering preventive interventions, the plan also calls for the primary care physician to refer the patient to a dentist or other medical specialist. The AAFP notes the importance of the bridge between family physicians and dentists. “Dental professionals need to be part of team-based care, even if they are physically located beyond our walls,” says Mark Deutchman, M.D., professor in the Department of Family Medicine at the University of Colorado Anschutz Medical Campus School of Medicine, and a key member of the Framework’s development team.
David Krol, M.D., MPH, and chairman of the AAP’s Section on Oral Health, agrees. “The ultimate goal is always to get the child connected to a dental home,” he says. Krol also observes that because referral is such an important part of the process, “relationship-building between physicians and dentists is critical for success. Once that relationship is developed, a strong collaboration built on trust and communication can be formed that benefits the patient.”
David Thill is a contributing editor for Repertoire.