Analysis Highlights Need to Reform Dental Care Delivery Model

The current delivery model for dental healthcare needs an overhaul.

That’s the message of a pointed analysis of the dental-medical divide, highlighted in the most recent issue of Health Affairs.

“It remains unclear whether twenty-first-century dental science, information technology, interprofessional practice, and population health needs can be mounted onto the current nineteenth-century dental care delivery model,” writes analysis author Elizabeth A. Mertz, an associate professor in the Department of Preventive and Restorative Dental Sciences at the University of California, San Francisco.

Mertz’s article underscores the inequity of access to dental and general healthcare, and how a decade of research has emphasized the oral-health, whole-body health connection. Though access to general healthcare has improved under the Affordable Care Act (ACA), access to dental care has languished. The question is, why?

As dentists know, the two most prevalent oral health issues — cavities and periodontal disease – can have implications for the entire body. However, the cost of associated complications, Mertz writes, is typically not carried by the dental healthcare system, but rather, the general healthcare system. And so the divide persists.

So, what’s to be done about the problem?

“Integration of oral health within broader health care systems promises to improve patient experiences and outcomes through better screening, referrals, and coordination of care, while decreasing overall costs (both dental and medical) through increased prevention and early treatment,” Mertz writes.

This can be accomplished in several ways. Mertz notes the success of “strategic initiatives” on the federal and state level, as well as community-based efforts. On the local levels, these efforts can include school-based fluoride and sealant, as well as general water fluoridation, and the dental home initiative. Mertz also writes that mimicking integration and reform efforts that have succeeded in the behavioral health field would be beneficial.

Ultimately, however, Mertz concludes that success of integration is reliant on the answers to these three questions.

1. “Will the professional dominance that dentists hold over the delivery system continue to be used to resist reform, or will it be deployed toward innovation in care quality, patient experience, and practice productivity?”

2. “Can the communities of payers, philanthropists, health providers, public health, and consumers muster the political will necessary to reorient policy structures toward improved accountability and value?”

3. “Can the current dental education and delivery model adapt to change quickly, or will old structures simply die as new ones are created?”