Emerging Models of Care Seek to Improve the Oral Health of All Americans

Despite major technological advancements in dentistry over the past century, access to care remains a challenge, especially for marginalized populations. This means that millions of people living in rural and low-income communities, those with disabilities, and people of color often suffer needlessly. And the pandemic has only made things worse. 

A recent article published in Health Affairs examines the difficulties faced by some Americans in accessing oral healthcare. Authors Wenyuan Shi, PhD, CEO and chief scientific officer of Forsyth Institute and Myechia Minter-Jordan, MD, MBA, president and CEO of CareQuest Institute for Oral Health, note that in some cases, not much has changed in more than a century.¹

Coverage Shortfalls

The authors suggest that dental coverage access must become a priority in the United States through Medicare and Medicaid expansion. They note that as of 2020, just 18 states included comprehensive dental benefits for adults enrolled in Medicaid, while 10 states provided coverage only for emergencies.¹

The situation is even worse in the case of Medicare, under which almost two-thirds of enrollees have no dental coverage. As the boomer population ages, the authors predict that if things don’t change, by 2030, more than 50 million seniors could be left without dental coverage.^1,2 

The authors note that although financial investment is certainly required to close these coverage gaps, the return on that investment will be significant. Productivity, chronic disease management, long-term cost savings, and quality of life could all benefit through coverage expansion.

Prevention Is Key

Early in the COVID-19 pandemic, 120 leaders in the health professions seized the opportunity to create a new paradigm for sustainable care built around the patient, primary care, and prevention. The Three Domains Framework is an emerging model designed to support dental safety-net practices and equitable, efficient, and cost-effective care. It proposes a primary care-like structure for oral health care delivery, facilitates value-based payment models, and enables patients to invest in their oral health.^1,3

The three domains are: 

1. Advancements in teledentistry
2. Prioritization of minimally invasive care
3. Integration and personalization of oral care delivery

According to Wenyuan and Minter-Jordan, new patient-centered models of care, such as the Three Domains Framework, are enabled by scientific and clinical innovations in oral disease diagnostics and treatment. Such developments include microbiome analysis, in which knowledge of the oral microbiome is used as part of a prevention-based approach; saliva diagnostics, which would allow patients to become more involved in their own oral health in an easy, painless way; and minimally invasive dentistry, which promotes preventive measures such as sealant placement, and low-aerosol restorative care, supported by education and technological innovation.

Scores of technologies are available to support this kind of framework, from innovative new brush designs, to oral rinses, to pro- and prebiotic dietary supplements. According, however, to the American Dental Association, although a version was cleared for emergency use as a home test for COVID-19, there are as yet no US Food and Drug Administration-approved salivary diagnostic tests to evaluate risk of periodontal diseases, dental caries, or head and neck cancers. Research, however, is ongoing.

References

1. Minter-Jordon M, Shi Wenyuan. How access, advocacy, and innovation can help us achieve health equity. Health Affairs. Click here.
2. Freed F, Potetz L, Jacobson G, Neuman T. Policy options for improving dental coverage for people on Medicare. Click here. Click here.
3. CareQuest Institute for Oral Health. System Transformation: A Three-Domain Framework to Innovating Oral Health Care. Click here.