BY JOANN R. GURENLIAN, RDH, PhD
It seems unfathomable in our country - especially in this day and age when we have so many resources available - that many children do not have access to oral health care. These children are suffering from oral pain and cannot sleep, eat, function in society, or learn in school. How is it that with over 300,000 dentists and dental hygienists in this country, we cannot stop the progression of oral disease in children?
Fortunately, there are two states that are utilizing workforce innovation and technological advances to try to improve the oral health of children. Both California and Colorado are using telehealth as a model to meet the oral health needs of the underserved.
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In California, a bill was signed to expand Medi-Cal coverage to make permanent two components of the state's Virtual Dental Home pilot program. This program uses telehealth to offer dental services in elementary schools, preschools, and nursing home settings. The two components are expanding the scope of practice for dental assistants and dental hygienists as well as providing Medi-Cal reimbursements for telehealth-enabled dental services.
Telehealth in California means that dental assistants and dental hygienists can consult remotely with a dentist sharing records online. They will be able to determine which radiographs are needed and apply temporary restorations without a dentist's supervision.
Colorado is the second state to incorporate a telehealth concept. Improving the oral health of the public in Colorado is not a new idea. In 2002, the Caring for Colorado Foundation started its first funding initiative, the Oral Health Improvement Project. The project was a 10-year, $10-million effort designed to strengthen the oral health safety net system within the state in order to improve access to dental care for underserved individuals; promote prevention programs to enable a new generation of children to grow up free of oral disease; and improve the health policies of the state so that all people have access to affordable, quality oral health care.
The efforts of this foundation resulted in 55 organizations receiving grant money totaling over $14 million; 95,000 annual patient visits being added to Colorado's safety net clinics; 10 new safety net dental clinics developing operations in 14 different rural communities throughout the state; 13,000 children in rural and underserved areas in Colorado receiving school-based dental screenings, sealants, and fluoride treatments annually; and 50,000 children under three years of age receiving Cavity Free at Three services.
While these outcomes have been noteworthy, the Caring for Colorado Foundation Board of Directors wanted to do more. Knowing that as many as half of all Coloradans do not receive routine dental care, especially residents from underserved communities, the foundation recently approved a five-year, $3.5 million pilot program to begin a Virtual Dental Home. This initiative will bring access to oral health services to low-income, vulnerable, and isolated children and seniors throughout Colorado using a hub-and-spoke model of dentistry.
Registered dental hygienists will be deployed to community settings to provide preventive oral health care services. They will be linked to a "hub" dentist via telehealth technology for assessment and treatment planning. The dentist will be able to see radiographs, intraoral photographs, and chartings. The dental hygienist will be able to provide care within their scope of practice as well as place interim therapeutic restorations.
This process is designed to facilitate treatment via the hub dental office. Should a patient require further dental care, the hub dentist will assist the patient by accepting that person into their practice or helping identify a dentist closer to the patient who can provide the needed treatment.
These two models using telehealth may be an opportunity for oral health professionals to work with legislators to create a system that will bring quality preventive care to those in need. These programs may also be a first step in assuring dentists that collaboration with dental hygienists in creating alternative workforce models is possible and that the outcomes may be positive and powerful. RDH
JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.
