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Three Flavors of Oral Health Care

Training primary care physicians to identify and treat oral health problems will go a long way toward integrating care for those problems with general medical care, according to a study in the Journal of the American Board of Family Medicine.

“The historic separation of oral health care from the broader health care delivery system has fostered among providers a culture in which oral health is not valued as part of overall health,” the study states.

Convincing primary care physicians of the importance of oral care will go a long way toward “achieving total patient care.”

“Physicians who have received oral health–related training are more likely to provide not only more comprehensive emergency care but also more appropriate and thorough counseling to their patients experiencing dental problems or to patients who may not have a regular source of dental care,” the study states.

Researchers looked at five federally qualified health centers that have successfully integrated oral health care and primary care: Bluegrass Community Health Center in Lexington, Ky., Holyoke Health Center in Holyoke, Mass., Salina Family Health Center in Salina, Kan., and Yakima Valley Farm Worker’s Clinic in Grandview, Wash. They identified three distinct roles that primary care physicians play at those centers: the doctor as a champion, as a collaborator, or as a member of an interprofessional team.

Bluegrass uses the physician champion model. Holyoke and Yakima Valley use the physician collaborator model. Salina and Salud use the physician-led interprofessional model.Physician champions consider oral health a primary responsibility. Bluegrass “contracts with a dentist in the community to provide care to patients through a voucher program.” Screenings by primary care physicians allow Bluegrass to provide local dentists with a picture of each patient’s needs.

Physician collaborators are involved in a more peripheral level. At Holyoke and Yakima Valley, the primary care physician will delegate dental services, such as fluoride varnish, to nurses and medical assistants. The medical and dental clinics are on the same campus. “Information is exchanged between medicine and dentistry on a routine basis,” the study states.

PCPs as members of an interprofessional team have a dental hygienist practicing with them. The hygienist will diagnose oral health problems and provide preventive intervention.

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