The Growing Benefits of Establishing Teams to Provide Care

Throughout the 20th century, it was commonplace for dental school graduates to purchase or establish a private practice clinical model to deliver oral care to patients in need. However, in the latter third of the 20th century there was an increased presence in the establishment of group and corporate-owned practices. In addition, in the first quarter of the 21st century, this trend has exponentially increased. A brief from the American Dental Association Health Policy Institute, stated that according to 2012 data there was a reduction in the proportion of dentists who were in solo practice from 67% to 57.5%.⁴⁴ In 2019, the American Dental Education Association Snapshot reported that in 2015 11.7% of the graduating students intended to be employed in a corporate-owned group practice, and in 2018 this increased to 16%. One of the take aways from both of these reports is that group practices are on the increase in the US. This trend demonstrates oral health providers are already working in uniprofessional team settings to provide dental care to patients, and it appears the trend is growing. IPCP is an extension of this team care model that builds on oral health professionals’ proven ability to work collaboratively, potentially fully elements of the Triple Aim.⁴⁵ This extension would be accomplished by collaborative care models that incorporate nurses, physician, pharmacist, social worker, and others as a team of health providers.

As oral health care professionals, we have multiple patient encounters with the same patient throughout the course of a year, and therefore, have an opportunity to have a significant impact on improving the oral and overall health of our patients. The dental clinic setting provides an opportunity for diagnosis and treatment of disease processes in the oral cavity, both acute and comprehensive oral issues. In addition, there is a unique opportunity to screen, assess, and monitor patients who are at risk and/or have been diagnosed with chronic systemic medical conditions. Evaluating the patient's medical status, discussing disease prevention, monitoring vital signs and reviewing the patient’s medication list are already part of a routine dental visit. Therefore, integrating a comprehensive medical and medication therapy management program in collaboration with other healthcare providers could be a natural extension with minimal impact on the dental visit that would facilitate dentists collaborating with other health providers to improve overall patient health.

As a consequence of establishing these relationships with other health care providers, oral healthcare providers could work together to educate patients, discuss a comprehensive care plan and make the appropriate referrals to manage the medical, mental health and oral health components of the disease. As other healthcare professionals become more aware and recognize the importance of oral health on overall health, this knowledge should result in earlier referral, diagnosis and treatment for patients with oral disease to an oral healthcare provider, recognition of the importance of dental clearances prior to medical surgical procedures, better oral management of patients with systemic diseases that impact oral health and better management of patients taking medications that have negative side effects on the oral cavity to mention a few. The shifting landscape in healthcare is an opportunity for oral healthcare providers to be proactive in establishing its role as a key member of collaborative care teams. One example of this shift, is a collaboration between Harvard School of Dental Medicine and Northeastern University, in which nurse practitioner students and dental students work collaboratively to provide direct care for patients under the supervision of their perspective faculty.⁴⁶ Another relates to screening patients for unmet social needs and referral to resources to reduce barrier and improve health outcomes.^47-49 The need for greater collaboration with oral health is supported by a quote from the ADA Health Policy Resource Center, “This is a critical moment in dentistry and not a time for complacency. Understanding the key forces at work will assist the profession in defining its own destiny. Ignoring what is happening in the health and consumer environments will mean ceding the future of the profession to others."³⁵