December 24, 2015 – The American Academy of Family Physicians (AAFP) has thrown its support behind a new model for delivering preventive oral health care as a component of routine medical care and enhancing partnerships between primary care and dentistry. The model, dubbed the Oral Health Delivery Framework, was presented in a white paper (www.safetynetmedicalhome.org) titled “Oral Health: An Essential Component of Primary Care,” which was released earlier this year by population healthcare consultant Qualis Health.
The framework has been endorsed by nearly a score of healthcare and dental professional, public health, and advocacy organizations.
The paper reviews the cost and consequences of oral disease, presents the Oral Health Delivery Framework with suggested actions to help primary care teams promote oral health, and offers guidance for primary care and dental teams that want to partner with one another.
"Oral disease is largely preventable and can complicate the management of other chronic conditions such as diabetes and heart disease," said Qualis Health President and CEO Jonathan Sugarman, MD, MPH, in a news release (www.qualishealth.org). "Engaging primary care teams in oral health is a critical strategy for reducing the impact of oral diseases and improving population health."
Mark Deutchman, MD, professor in the Department of Family Medicine at the University of Colorado Anschutz Medical Campus School of Medicine in Aurora, helped develop the Oral Health Delivery Framework along with family physicians Bruce Bagley, MD, and Russell Maier, MD.
"Oral health is closely linked to overall health across the lifespan," Deutchman told AAFP News. "Early childhood caries is the most common chronic disease of childhood."
He explained that children with severe cavities are in pain, can't eat properly, and have poor school performance and poor self-esteem. "Treatment is very costly and often needs to be repeated," said Deutchman. "As soon as physicians understand that dental caries is a vertically transmitted, infectious preventable disease, they understand that addressing it needs to be part of our care."
In adults, Deutchman continued, periodontitis is closely linked to poor diabetic control. "There also is emerging evidence that periodontal disease is linked with heart disease, stroke, obesity, adverse pregnancy outcomes and other systemic disorders," he said.
The Oral Health Delivery Framework consists of five actionable steps primary care teams can take to protect and promote oral health, including offering preventive interventions and structured referrals to dentistry.
The panel of experts that developed the framework included the aforementioned family physicians along with dental care providers; leaders from medical, dental and nursing associations; payers and policymakers; a patient and family partnership expert; and oral health and public health advocates.
The framework is being field-tested at 19 community health centers and private practices in five states to determine the viability of the model in diverse primary care settings.
Qualis Health is providing technical assistance to participants, as are primary care associations in Kansas, Massachusetts, and Oregon.
After field-testing of the framework is complete, an oral health integration toolkit will be published in 2016, including impact data, supporting resources and tools to help accelerate adoption among primary care practices nationwide.
Family physicians can support this initiative by educating their medical colleagues about the importance of oral health in overall health, said Deutchman.
"Until now, oral health has been a neglected topic in medical education," he said. "We need to communicate that it takes only a very short time to look at the teeth and gums and inquire about oral hygiene habits."
Physicians and many other healthcare professionals can readily identify dental and gum disease, counsel patients about diet and oral hygiene, and encourage patients to establish a dental home. "Look at the teeth and gums; teeth are part of the body, not just what's in the way when looking at the tonsils," said Deutchman. "Advise patients to see a dentist regularly. Inquire about diet, provide oral hygiene counseling and apply fluoride varnish to children's teeth at the time of well-child visits — nearly every state’s Medicaid program pays medical providers an extra fee to do this as part of well-child visits."
He said focusing on the oral health of all patients is important, but this is especially the case with patients at high risk for oral issues, including individuals with diabetes, those from low-income families and Native Americans.
"It also is important to note that the best predictor of a child’s oral health is the parents' oral health," Deutchman said. "Diet, oral hygiene habits and the bacterial load that is associated with cavities are all vertically transmitted."
Ultimately, to improve oral health care of patients, a better bridge must be built between family physicians and dentists.
"We need each other to provide complete care," he said. "Dental professionals need to be part of team-based care, even if they are physically located beyond our walls."
The AAFP has supported several oral health initiatives, including the Society of Teachers of Family Medicine's Smiles for Life (www.smilesforlifeoralhealth.org) and the American Academy of Pediatrics' Campaign for Dental Health (www.ilikemyteeth.org).
Deutchman pointed out that the Smiles for Life national oral health curriculum is an important tool in supporting the overall goal of integrating oral health in primary care.
"This was developed by the oral health group of the Society of Teachers of Family Medicine," he said. "It consists of eight modules that cover oral health across the lifespan. Each module takes about 45 minutes to complete. They can be completed online or downloaded for self-study or presentation to others. It is pre-approved for Prescribed AAFP credit and has been endorsed by 14 professional organizations."
The AAFP also has a member interest group on oral health.