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Integrating Oral Health Care into Primary Care: A Resource Guide

To support the integration of oral health care into primary care, the National Maternal and Child Oral Health Resource Center at Georgetown University is pleased to announce a new resource:

• Integrating Oral Health Care into Primary Care: A Resource Guide

This guide features resources to help health professionals, program administrators, and others implement oral health care integration in materials, programs, and systems of care. It includes descriptions of and links to materials on policy, practice guidance, practice tools, professional education and training, and program development. It also offers descriptions of organizations that can provide additional support for activities to promote the integration of oral health care into primary care.

National Maternal and Child Oral Health Resource Center
Georgetown University
E-mail: [email protected]

Excerpt

The following text is the introduction of the resource guide.

In 2000, Oral Health in America: A Report of the Surgeon General emphasized that oral health is integral to overall health and should not be viewed as separate from overall health. (1) Since then, several federal reports have highlighted integrating oral health care into primary care as a promising strategy for expanding access to oral health care and reducing health inequities; improving care coordination, health outcomes, and patient satisfaction; and reducing health care costs. The 2011 Institute of Medicine reports Advancing Oral Health in America and Improving Access to Oral Health Care for Vulnerable and Underserved Populations recommended that the Health Resources and Services Administration (HRSA) address the need for improved access to oral health care through the development of a core set of oral health competencies for non-oral-health professionals. (2, 3) In response, HRSA released Integration of Oral Health and Primary Care Practice, which provides interprofessional oral health core clinical competencies to facilitate change in the clinical practice of primary care health professionals working in safety net settings. (4) This document was followed by the release of the U.S. Department of Health and Human Services Oral Health Strategic Framework 2014–2017, which asserts that interprofessional education and collaborative practice present tremendous possibilities for integrating oral health care into primary care and improving patient-centered care. (5) In 2021, the National Institute of Dental and Craniofacial Research published Oral Health in America: Advances and Challenges, offering strategies for integrating oral health care into primary care as part of a framework for meeting health needs effectively and efficiently. (6)

In addition to federal agencies producing reports, many organizations developed resources to support the integration of oral health care into primary care. The focus of primary care for pregnant women, infants, children, and adolescents includes family medicine, pediatrics, and obstetrics and gynecology. Despite these efforts, the oral health care system remains largely siloed from the broader health care system. Challenges persist that hinder the provision of oral health care as part of primary care. Limited research has been conducted to guide the development of an efficient and effective integrated oral health care–primary care system. (7)

Yet, the primary care setting presents an opportunity for providing oral health care, including risk assessment, screening, preventive interventions, anticipatory guidance and counseling, as well as referral to an oral health professional for needed follow-up care. Primary care health professionals have frequent contact with people across the lifespan, including groups at high risk for oral diseases such as young children, pregnant women, and adults with chronic diseases. (7)

Children under age 5 are more likely to see a primary care health professional than an oral health professional, which means that primary care health professionals have an important opportunity to support preventive oral health practices and connect children to ongoing oral health care. (8) In addition, Medicaid beneficiaries are more likely to have a medical visit than a dental visit each year. In 2019, 38 percent of publicly insured children and adolescents had both a medical visit and a dental visit, while 25 percent had only a medical visit and 13 percent had only a dental visit. (9) Recommendations for Preventive Pediatric Health Care: Bright Futures/American Academy of Pediatrics indicates that infants and children should have 12 well-child visits in the first 36 months of life and that children and adolescents ages 3–21 should have an annual well-child visit. (10)

During these visits, health professionals frequently observe morbidity associated with tooth decay (e.g., pain, compromised oral function). (11) Primary care health professionals have opportunities to detect oral lesions related to infections; systemic disease; or other causes, particularly those that may indicate oropharyngeal cancer. They also have opportunities to make timely referrals for appropriate care. (12)

Early referral to an oral health professional can contribute to maintaining good oral health, preventing disease, treating disease early, and potentially decreasing costs. Establishing collaborative relationships between primary care health professionals and oral health professionals at the community level is essential for increasing access to oral health care for all children and for improving their oral health and overall health. (11)

Pregnancy is a unique period during a woman’s life and is characterized by complex physiological changes which may adversely affect oral health. Access to preventive oral health care is essential for pregnant women to have the best possible oral health and overall health. In all states, pregnant women with low incomes are eligible for Medicaid dental coverage that they don’t have during other periods of their lives. (13) Since non-oral-health professionals (e.g., obstetricians, family physicians, nurse midwives) are often first to assess pregnant women’s health, they play a critical role in connecting women with the oral health care system and community-based programs. (14) These professionals can integrate oral health care into primary care visits, thereby increasing women’s access to oral health care during the perinatal period. (15)

Integrating oral health care into primary care is a key strategy for improving access to oral health care and improving oral health, especially for vulnerable and underserved groups that face barriers to accessing the oral health care system.

References

1. U.S. Department of Health and Human Services. 2000. Oral Health in America: A Report of the Surgeon General. Bethesda, MD: National Institute of Dental and Craniofacial Research.
2. Institute of Medicine, Committee on an Oral Health Initiative. 2011. Advancing Oral Health in America. Washington, DC: National Academies Press.
3. Institute of Medicine, Committee on Oral Health Access to Services and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: National Academies Press.
4. Health Resources and Services Administration. 2014. Integration of Oral Health and Primary Care Practice. Rockville, MD: Health Resources and Services Administration.
5. U.S. Department of Health and Human Services, Oral Health Coordinating Committee. 2016. U.S. Department of Health and Human Services Oral Health Strategic Framework 2014–2017. Washington, DC: U.S. Department of Health and Human Services.
6. National Institute of Dental and Craniofacial Research. 2021. Oral Health in America: Advances and Challenges. Bethesda, MD: National Institute of Dental and Craniofacial Research.
7. Association of State and Territorial Dental Directors. 2024. Policy Statement: Integrating Oral Health Care into Primary Care. Reno, NV: Association of State and Territorial Dental Directors; Washington, DC: National Maternal and Child Oral Health Resource Center.
8. Luo H, Garcia R, Moss M, Bell RA, Wright W, Wu B. 2020. Trends of children being given advice for dental checkups and having a dental visit in the United States: 2001–2016. Journal of Public Health Dentistry 80(2):123–131.
9. Manski R, Rohde F, Ricks T, Chalmers NI. 2022. Trends in the Number and Percentage of the Population with Any Dental or Medical Visits, 2019. Rockville, MD: Agency for Healthcare Research and Quality.
10. Bright Futures/American Academy of Pediatrics. 2024. Recommendations for Preventive Pediatric Health Care: Bright Futures/American Academy of Pediatrics. Itasca, IL: American Academy of Pediatrics.
11. Krol D, Whelan K, Section of Oral Health. 2023. Maintaining and improving the oral health of young children. Pediatrics 151(1):e2022060417.
12. Feierabend-Peters J, Silk H. 2022. Why should primary care clinicians learn to routinely examine the mouth? AMA Journal of Ethics 24(1):E19–26.
13. Eke C, Mask A, Reusch C, Vishnevsky D, Quinonez RB. 2019. Coverage Brief: Improving Access to Oral Health Care in Pregnancy. Washington, DC: Children’s Dental Health Project.
14. Oral Health During Pregnancy Expert Workgroup. 2026. Oral Health Care During Pregnancy: A National Consensus Statement (rev. ed.). Washington, DC: National Maternal and Child Oral Health Resource Center.
15. Association of State and Territorial Dental Directors. 2025. Best Practice Approach: Perinatal Oral Health (upd. ed.). Reno, NV: Association of State and Territorial Dental Directors; Washington, DC: National Maternal and Child Oral Health Resource Center.

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National Maternal and Child Oral Health Resource Center
Georgetown University
E-mail: [email protected]