WHOLE PERSON DENTAL CARE: BREAKING DOWN TREATMENT BARRIERS TO IMPROVE PATIENT CARE

Dentistry can resolve many of the common oral health problems patients face. Modern materials and techniques are evidenced based and provide long lasting functional and cosmetic results. Why then, when we have these capabilities, do people still struggle with dental problems? Although people may want to go forward with treatment barriers exist preventing them from doing so. These barriers come in many shapes and sizes, and only by applying a tailored solution that takes into consideration the whole patient can we overcome them. Where some offices may view patients as a collection of dental problems, our department is taking a holistic approach that strives to understand our patients and doing so help them better navigate the issues that are keeping them more completely from optimal health. In this article, I’m going to focus on three of the biggest barriers that our patients face and how our team is helping to remove them.

Socioeconomic barriers are perhaps the easiest to recognize. Modern dentistry is incredibly advanced but often has a price tag that many find out of reach. Fortunately for our patients, the Federally Qualified Health Center (FQHC) model has largely removed finances from the equation, because all treatment rendered at the clinic is completely covered by Medi-Cal or for a nominal fee based on income. Despite this huge benefit, indirect costs associated with care still make dental treatment too expensive for some. For example, not all patients have paid time off, so missing work means losing income, and taking time off work now becomes an expense. With this in mind, we strive to accommodate work and childcare schedules. We also make a deliberate effort to help patients group their dental visits with their other appointments, so they miss less work and can complete treatment in as few visits as possible, minimizing these indirect costs. Additionally, those with socioeconomic barriers are often forced to choose between access to care and quality. I am extremely proud that the dental techniques and materials used in our clinics are exhaustively researched and are of equal and often better quality than those found in private dental practices. All of our clinics utilize state of the art equipment with institutional levels of infection control and quality assurance. We are truly removing this barrier, improving access to care without sacrificing quality or the patient experience. ics are generally located close to public transportation. In general, our patients face a lot less resistance when establishing care at our office. It isn’t unusual for an individual who hasn’t seen a doctor in years to quickly find themselves with a new primary care provider and dentist all in the same day. Finally, even if patients can access care, other barriers could prevent them from achieving optimal treatment outcomes. Research is linking systemic health to oral health and emerging evidence suggests that treating oral health conditions may even improve chronic problems elsewhere in the body. Perhaps the best example of this connection is gum disease. According to the CDC, 47.2% of adults aged 30 and older and 70.1% of adults 65 years and older have some form of gum disease. Left untreated, this chronic condition can affect or worsen the body’s ability to manage other inflammatory conditions like cardiovascular disease, rheumatoid arthritis and type 2 diabetes. If our treatment takes a one-sided approach, we diminish our ability to overcome this last barrier. This is why our team makes it a priority to educate patients on these connections with the end goal of helping them to improve both their oral health and their systemic health. However, even patients without dental problems benefit from our holistic care messaging. Because of our shared electronic health record (EHR) we can help track their blood pressure, stress the importance of taking prescribed medications and help remind patients of necessary vaccinations. By engaging with patients as part of a collective healthcare team, we help patients achieve optimal outcomes.

Our patients also face numerous logistical barriers. Navigating the healthcare field in a second language, arranging reliable transportation, and locating an in-network clinic can take weeks. However, because dentistry is one part of a common facility (with our colleagues in primary care, pharmacy and behavioral health right down the hall) our patients only wage this war once. We also utilize the same electronic health record—Epic—allowing us view and share information with the other healthcare teams. So, when a patient comes into the dental clinic often, we are building on an existing relationship. We already know their primary care providers, their medications, and their current health issues, so patients don’t have to start from scratch when they see us. Most of our staff is bilingual and we have translation services readily available. Our clin-

Treating the whole person is essential to developing long lasting relationships with patients. At our clinics where dentistry is integrated into the healthcare team, patients benefit from our holistic approach to healthcare at a level they may not be able to find elsewhere.