It is 2 AM and your child is writhing in pain from an abscessed tooth. For most of us, a trip to the emergency room (ER) or urgent care is likely for pain medication, followed by a visit to our family dentist to have the tooth addressed. Dental care, while expensive for most people, is still typically affordable in an emergency. However, for a large segment of the population, dental care is a need they cannot fulfill. This may be due to several factors, notably, lack of finances, transportation issues, childcare for other siblings, or lack of dental knowledge.
For this reason, the American Dental Association (ADA) has developed a Community Dental Health Coordination (CDHC) curriculum that attempts to address these needs.1,2 Rio Salado College (RSC) in Tempe, Arizona, is one of several schools that offer the CDHC curriculum in an online format, culminating in a community project. The goal of a CDHC program is to provide students with skills to help them assist patients in the reduction of disparities in dental health. This includes education in patient advocacy, intercultural and intracultural communication, finance planning, coordination of care, documentation and referral, as well as addressing legal and ethical issues that might arise. Key points addressed in a CDHC program are to increase patient knowledge and encourage patient engagement with the dental office. The result is to provide high quality care at lower costs.
The role of a CDHC
The emerging role of a community dental health coordinator (CDHC) may take many forms. For some, it is an extension of the duties of a dental hygienist, dental assistant, or office personnel. You may be asked to help patients find appropriate transportation to and from your clinic/office. You might be instrumental in providing translation to those in need or for those with low literacy levels. Your training in motivational interviewing will be tested as you share treatment plans with patients who are unfamiliar with dental procedures and perhaps need more time than typically available during the treatment plan presentation. A CDHC becomes a valuable resource to whom patients are referred when they have questions. Often, a dental hygienist, a dental assistant, or office staff member may not have the time to explain those details during the course of a dental appointment; therefore, taking the opportunity to work through these issues with patients will distinguish your practice from those that perform only scheduled dental procedures.
Consider your increased value to your employer when you earn this new credential. You will have the knowledge to understand not only dental aspects of your career, but so much more. You will demonstrate to your employer that you are fully vested in helping your community, your patients, and your practice thrive.
COVID-19 has proven to be a challenge in terms of projects in the community, but with practices reopening, how can this new team member be fully utilized? Consider the following scenario: Your patient calls and has lost a crown. Her ability to commute to your practice is hampered by lack of a vehicle and she needs to be available to pick up her children in the early afternoon when her spouse arrives home with the car. A more traditional approach would be to ask what time works best for her and schedule accordingly.
A CDHC approach might involve a new tactic. As a CDHC dental hygienist, you might find that a teledentistry call is the place to start. Is she experiencing pain or swelling? If so, this qualifies as an emergency, and you might discuss the possibility of ride sharing or how to navigate her closest city transit schedule. Is the crown in her possession? If not, this appointment might require a longer period for treatment. How can you help arrange for child pickup? Is there a financial concern? If so, you will be able to discuss payment options. Is your patient concerned regarding infection control and her safety while in your office? What could you share to alleviate those fears? The resources you bring will not only mitigate distress for the patient but will also provide variety to your career and pride in how you are increasing your contribution as a dental professional.
The best candidates for this new dental team member are those who are already trusted members of their communities. Registered dental hygienists (RDHs), dental assistants (DAs), and dental office staff are identified by the ADA as potential CDHCs and are vetted through each individual college’s application process. These professionals have already completed a course of study or have the necessary dental experience that allows them to understand how this additional certification could benefit their employment. They understand how to converse with other dental offices and insurance entities, have the skills to describe dental procedures to patients, and can share with patients the process and progression of dental disease.
Courses within a CDHC program teach students to develop case management strategies and act as a liaison between the patient and the dental practice. The benefit of this new certification is that these skills can prove useful to private practices, community clinics, federally qualified health centers (FQHCs), hospital ERs, or anywhere patients need coordination of care.3
The culminating project in Rio Salado’s CDHC program is explored and developed over the span of three 16-week terms, with project implementation occurring during the final term. Students work semi-independently, collaborating with one another, with a personally identified mentor, and with community groups to ultimately implement a community-based project/event, collecting pre- and post-data to determine outcomes. The final course is a culmination of all previous courses, which explores legal and ethical issues, oral health communication, interviewing skills, dental finance, advocacy/outreach, and project planning. The student is guided by faculty each step of the way as each course builds upon the previous one. The initial step in the project planning course involves conducting a community analysis to determine where a need exists. From there, goals and objectives are created, action plans are developed, and strategies for evaluating outcomes are created.
Reviewing the last three CDHC cohorts, which this author has worked with at Rio Salado College, dental hygienists, dental assistants, and dental staff have shown great ingenuity and passion in reaching out to their communities. It appears that the graduates have taken on a greater role, not only on a large scale such as with school districts, but also within the walls of their own workplaces. While dental hygienists have often had more freedom to conduct projects, due to greater scope of practice, dental assistants and office staff have proven to be resourceful in developing interventions and recruiting assistance when needed.
Three years of notable projects
In 2017, notable projects encompassed topics that included helping foster care families obtain dental care for their foster children, and educating diabetic patients about the need for consistent dental care to help with glycemic control and to decrease the severity of periodontal disease. Other projects involved visits to day-care and senior centers, where they shared with clients information on proper nutrition relating to oral health. Pregnant women were also populations of interest, conveying the need for prenatal as well as infant and young child dental care. Implementing and supporting a restorative functions dental assistant (RFDA) program in North Dakota was a very compelling project with three students collaborating, as was one student’s achievement of creating a 501(c) nonprofit to bring portable dental hygiene care to schools in her community.
In 2018, projects addressed working in conjunction with Head Start, training caregivers in how to provide basic dental care to Head Start students, organizing mobile dental care in rural areas, providing oral health education to seniors at senior centers, and incorporating dental care with children’s well visits in the Medicaid system.
In 2019, projects included addressing dental care for the homeless, ways to decrease hospital emergency room visits for dental issues, decreasing no-show rates for HIV patients, improving the utilization of expanded functions dental assistants (EFDAs) to improve access to care, and working to increase HPV immunization rates in the community.
The results of these projects demonstrate that dental hygienists, dental assistants, and front office staff are willing to devote time and effort to advancing their education. As explained by the Rio Salado College faculty, this is not a brief CE course, but rather an investment of significant time and energy. Once completed, graduates of the program have the knowledge and experience to plan and implement a community-based project with outcomes, not to simply provide a one-time presentation. This effort and the CDHC credential add more value to the graduates’ careers, as well as making them vital to their employers. Patients have come to realize that they have an advocate who will help them navigate the jargon and protocol of medicine and dentistry, in addition to providing guidance in filling out government documents that might help them obtain housing and food assistance.
The roles of dental hygienists and dental assistants have been clearly delineated by the dental practice acts of each state. The new role of CDHC advances that scope of practice and allows the CDHC to reach beyond what they are currently delegated and share new information with current and future patients.
A final assignment in the Rio Salado CDHC program is a reflection paper. Below are some thoughts posted by former students. Comments such as these and others lead us to believe that we are onto something beneficial that will help improve access to care or, at minimum, make navigation of the system more accessible.
Comments from former students
“Reflecting on the CDHC program from the rearview mirror, I see an expertly designed student- and community-centered experience that I would do again. If the purpose of the program is to impart knowledge, generate enthusiasm, and build confidence, I consider it a success. From the first assigned chapter of Foundations for Community Health Workers, I knew I was home.”
“Collectively, these courses have played a vital role in each step of the program, and I have gained invaluable insight into the world of community dental health.”
“I never could have imagined the type of experience this program would bring. The knowledge that I’ve gained, the networking I’ve done, and more importantly, the self-improvement that I didn’t feel possible at this point in my career have been life changing.”
“The most eye-opening part of this course for me was when we had to do the community profiles. When I discovered the amount of people living in poverty in my own community, it really gave me a new perspective on the diverse needs that need to be addressed.”
“I feel strongly after taking this CDHC program that we need to reduce disparities in dental health access and improve the oral health in those in underserved communities, especially those who do not typically receive regular care from a dentist.”
1. Solutions: About CDHCs. American Dental Association. https://www.ada.org/en/public-programs/action-for-dental-health/community-dental-health-coordinators
2. News releases: Rio Salado College offers Community Dental Health Coordinator program. July 28, 2015. https://www.ada.org/en/press-room/news-releases/2015-archive/july/rio-salado-college-offers-community-dental-health-coordinator-program. Accessed June 15, 2020.
3.Healthcare programs. Community Dental Health Coordination. Rio Salado College. https://www.riosalado.edu/healthcare/community-dental-health-coordination. Accessed June 15, 2020.
Diane Paz, DrBH, MEd, RDH, earned her CDA and RDH from Phoenix College, and her BSDH, expanded functions, and master’s degree in education from Northern Arizona University. She earned her doctor of behavioral health from Arizona State University. Dr. Paz currently instructs first through fourth year dental students at AT Still University (Arizona School of Dental and Oral Health), Mesa, Arizona, and instructs online for Rio Salado College in Tempe, Arizona, concentrating on the Community Dental Health Coordination program. She can be reached at [email protected].