Most Americans are open to getting some basic dental care from medical providers and some medical care from dental providers, according to a nationwide survey fielded by The Pew Charitable Trusts and the Harvard School of Dental Medicine (HSDM).
The poll, conducted in the summer of 2018 in 33 states and the District of Columbia, was designed to examine the opinions of dental patients and compare the experiences in getting access to care among privately insured adults with those who have dental coverage through Medicaid, the federal-state program for low-income people.
According to the survey, those with private dental insurance are more likely to see a dentist than those with Medicaid (64 percent versus 47 percent). In addition, more than twice as many Medicaid respondents reported barriers to visiting a dentist when they needed care (42 percent versus 20 percent).
The poll surveyed 423 Medicaid and 405 privately insured adults. Cost was the most frequently cited barrier for both groups. In other findings, 20 percent of Medicaid and 7 percent of privately insured respondents said they had gone to emergency rooms for an oral health problem. Most emergency departments offer no treatment to resolve dental problems.
Harvard and Pew conducted the survey to get a better sense of the barriers to care faced by both those with dental insurance and those who depend on Medicaid. Each organization is pursuing strategies to address those barriers. Integrating medical and dental care is one approach.
The poll found that 61 percent of respondents are willing to receive preventive medical care, such as vaccinations or blood pressure checks, at a dental office. A comparable number—60 percent—said they would be willing to receive preventive dental care, such as an oral health screening or fluoride varnish, from a doctor, nurse, or other trained medical professional.
Another strategy is to expand the dental team to include dental therapists. Fully 71 percent said they would be willing to receive dental care from these lower-cost providers. Trained to provide routine care such as preparing and filling cavities under the supervision of a dentist, dental therapists can be deployed to schools and other community locations to expand access to care.
The Harvard dental school has launched an initiative to promote integration of oral health and medicine to improve health and wellness in communities across the nation. Research shows clearly that oral and systemic health are connected and that a healthy mouth helps maintain overall health.
The HSDM Initiative to Integrate Oral Health and Medicine is working to build the evidence base to demonstrate that oral health care services should be a part of comprehensive disease prevention and management protocols. Such coordination should help prevent and mitigate both oral disease and conditions such as diabetes and cardiovascular disease, which share many common risk factors.
“The recent poll findings underscore the importance of increasing options for integrated care that take the whole patient and their overall health into account,” said Bruce Donoff, dean of the HSDM. “In the Harvard Dental Center, we discovered this firsthand when we piloted a program that offered dental patients the opportunity to see a nurse practitioner while they are here for a dental visit. The success of that pilot showed us that there is a desire and a need for greater coordination of care across oral health and primary care, and that health care professionals can work together to improve outcomes for their patients.”
Meanwhile, dental therapists have been authorized to practice in 11 states in some capacity and are being considered in several others to improve oral health care access, especially for those in areas with dentist shortages and for people on Medicaid.
“These important findings indicate that most consumers are open to receiving basic preventive and restorative care from dental health therapists under the supervision of a dentist,” noted John E. McDonough, a professor at the Harvard T.H. Chan School of Public Health. “Combining this finding with other evidence that 42 percent of Medicaid enrollees encounter significant barriers to receiving dental care when they need it, the case for introducing and expanding opportunities for dental therapists could not be stronger.” The poll suggests that the public is ready for greater integration among medical and dental services, as well as innovations in care delivery that have the potential to improve access and oral health outcomes.
Jane Koppelman directs research for The Pew Charitable Trusts’ dental campaign and Jane Barrow is the executive director of the Initiative to Integrate Oral Health and Medicine at the Harvard School of Dental Medicine.