At a time when scope- of- practice, access-to-care concerns, and health equity are at the forefront of conversations among oral health providers, the value of community health programs cannot be overstated. When looking at the desperate oral health needs of our nation, positive strides are seen in states like Florida, where dental therapists are now permitted to address workforce shortages and access-to-care concerns. Utah recently passed legislation that officially designated hospitals as public health settings, which allows dental hygienists to provide preventive oral care in these settings. On the contrary, states like Arizona and Virginia are turning to oral preventive assistants and foreign-trained dentists to meet their states’ pressing oral health needs. All of this is occurring while water fluoridation is under intense scrutiny nationwide.

The oral health goal of Healthy People 2030 is to “Improve oral health by increasing access to oral health care, including preventive services.”¹ So, I ask, with all these changes seen within our profession recently, do we feel that we are addressing this goal adequately? Some may firmly disagree, and while I do not necessarily agree with legislative changes to the scope of practice for my dental colleagues, I am hopeful for the promising future of midlevel dental providers and what integrated care could look like for health equity. Meanwhile, I want to highlight community health initiatives, because, again, at a time when our nation is striving to improve preventive care, this could serve as a clear path to meet people where they are.

Health equity

The Center for Oral Health (COH) is a nonprofit organization that aims to improve oral health for underserved populations through community programs, advocacy, research, and education.² In 2025, the COH released a white paper outlining how equality cannot be the driving force behind access to care because not everyone accesses care in the same way. Rather, pushing for health equity and looking toward solutions tailored to each community is the answer to achieving fair outcomes for all.³

This report is critical because it provides solutions to oral health equity, such as school-based services, mobile dentistry, medical-dental integration, and community health worker programs. For a parent who is unable to drive their child to a dental appointment, the child could receive preventive care at school. For a rural population with limited access to providers, they could receive preventive care through periodic mobile dental visits. While a patient is being seen by their medical provider, an oral health concern related to medical and dental integration could be addressed. Each of these real-world examples is a community-driven initiative that meets patients right where they are, all while prioritizing prevention.

Community health initiatives

The expansive reach of oral health care beyond traditional dental offices helps bridge gaps in health equity. The value of preventive care provided in various settings, such as oral hygiene education for care partners, fluoride varnish applications, sealant placements, and oral hygiene intervention for medically compromised individuals, is critical.

A systematic review and meta-analysis were conducted to evaluate the effectiveness of oral health promotion programs in reducing xerostomia and improving the quality of life related to oral hygiene among older adults visiting senior centers.⁴ These programs included education on oral exercises, toothbrushing, and salivary massage skills through lectures, videos, handouts, and demonstrations. With these simple interventions, the effectiveness of oral health promotion programs was deemed statistically significant, as evidenced by increased salivary secretion.⁴ As oral health professionals, we are keenly aware that increased saliva not only supports disease prevention, but overall quality of life and nutrition improve as well.

Another systematic review and meta-analysis evaluated community health interventions to improve adolescents' knowledge, behavior, and oral health status.⁵ In this study, health promotion interventions included educational videos, dental prophylaxis, fluoride varnish application, sealant placement, and take-home products. Education on various oral health concepts was not only provided by dental personnel, but by teachers, student peers, and health education specialists as well.⁵ Indices used to measure the effectiveness of various programs included gingival indices, plaque indices, and decayed, missing, filled surfaces (DMFS) for caries incidence. Overall, statistically significant improvement in each of these parameters was found in programs that had a duration longer than 12 months. This review also demonstrated across various studies that education alone was not enough for caries reduction, so comprehensive interventions, such as fluoride varnish and sealant applications, are vital.⁵ Plaque scores and gingival health did improve with education; however, the incidence was higher in those who received more invasive interventions. This systematic review and meta-analysis demonstrates the pivotal role of oral hygiene education and preventive treatments provided in community-based settings, not just in the adolescent demographic, but across age groups.

Looking to the future

A critical element to the success of an oral health program is the partnerships that help develop and implement the initiative. Without the support of health-care disciplines, such as community health workers, nurses, behavioral health team, grant funders, and various other resources, community oral health-based programs may not be successful long-term. Interdisciplinary health is the answer to solving concerns with health equity.

Health equality does not address challenges with accessing health care at a systemic level. Rather, creating spaces for various health-care disciplines to work together as a team in nontraditional settings allows patients to receive the care they need in their own environment.

The World Health Organization Global Oral Health Status Report discusses inequalities in access to oral health services by stating, “Oral health care is largely a demand-led service rather than the result of a rigorous planning process and therefore can be poorly aligned with the oral health needs of the local population.”⁶ The local needs of the population are pointing directly to health equity, rather than equality.

Numerous hygienists across our nation are pursuing health equity and providing care through affiliated practice agreements, expanded functions, mobile dentistry, and direct access/independent practice in their specific communities. If you are one of these trailblazers, I commend you. Planning a community health-based program is rigorous and takes time, but this takes into consideration the specific needs of the community and is what drives preventive-based care provided outside of a traditional dental office setting.

References

1.     Oral conditions. Healthy People 2030. 2026. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions

2. Who we are. Center for Oral Health. 2026. https://www.centerfororalhealth.org/

3. Turner T, Milam R, Gurudath, P. Health equity in oral health: Moving beyond equity to justice. [white paper]. Center for Oral Health. 2025. https://www.dentistrytoday.com/the-center-for-oral-health-releases-groundbreaking-white-paper/#:~:text=%E2%80%9CEquity%20requires%20more%20than%20good,the%20full%20white%20paper%20here

4. Seo, K, Kim HN. Effects of oral health programmes on xerostomia in community-dwelling elderly: A systematic review and meta-analysis. Int J Dent Hyg. 2020;18(1):52–61. https://doi.org/10.1111/idh.12418

5. Tsai C, Raphael S, Agnew, C, McDonald G, Irving M. Health promotion interventions to improve oral health of adolescents: A systematic review and meta-analysis. Comm Dent Oral Epidemiol. 2020;48(6):549–560. https://doi.org/10.1111/cdoe.12567

6. Global oral health status report. World Health Organization. (2022). World Health Organization. 400(10367), 1909–1910. https://www.who.int/team/noncommunicable-diseases/global-status-report-on-oral-health-2022/