“The relationship between serious gum disease and diabetes is a two-way street. Not only are people with diabetes more likely to get periodontal disease—chronic infection of the gums—but people with chronic, uncontrolled gum infections may be more likely to develop diabetes.”Emily Hendel, MS, NP-C
Director of Clinical Services, CommunityHealth
“Back in 2009, we were able to add a dental component to our clinic, to begin to really integrate oral and primary health care under one roof.
“About 10 percent of our patient population is diabetic, and a subset of those patients really struggles to keep their diabetes under control. Most diabetics’ A1c, or blood glucose, levels are below 7 percent; we were seeing levels in excess of 9. Several years ago, we went a step further in our integration and began piloting the Diabetes Care Group for these patients.
“The care group crosses sectors: physicians, dentists, nurses, social workers, and a clinical pharmacist review each case together and make recommendations. Participating patients receive regular assessment and titration of their treatment, plus priority scheduling for dental services, with automatic recalls every three-to-six months. They also receive oral hygiene instruction from trained nurses.
“We’ve been tracking outcomes and the results have been more than encouraging. Of the 67 care group patients who received dental services, the average drop in A1c was 2.1 percent, compared to 1.2 percent for diabetic patients who were not part of the care group and received no dental services.
“One care group patient—a 60-year-old Hispanic woman who came to us in 2014 with an A1c of 14.1—stands out in particular. She started receiving intensive dental services in 2016; over the past year, she has been seeing our endocrinologist, as well. Her most recent A1c was 7.1, which is excellent. It’s a great example of the kind of outcomes we can achieve with primary, dental, and specialty care working in collaboration in one place.”
Oral health is linked to some of the most serious—and costly—chronic diseases in America today, including diabetes, heart disease, and stroke.
The findings have implications for all of us, but those implications weigh most heavily on people with limited income. For them, dental care, whether preventive or restorative, is too often out of reach.
Free or low-cost dental clinics are few and far between, and wait times can exceed six months. Being seen at a private practice is rarely an option, even for those with Medicaid. A 2016 study cosponsored by Michael Reese reveals that the state’s reimbursement rates for oral health care are fourth lowest in the nation for children and dead last for adults. With payments often falling short of the cost of materials and equipment, there’s little incentive for dentists to accept Medicaid.
Recognizing the urgent need for oral health care, a number of healthcare facilities that serve low-income patients have added dental services. With support from Michael Reese, a handful of those facilities are taking the next step to improve health, becoming fully-integrated, easy-to-access, comprehensive healthcare homes for their patients.
Explore Illinois’ dental shortage areas
In 2017, roughly 124 dentists served Illinois’ low-income population dental shortage areas. That’s 289 dentists short of the number required to reach the target population-provider ratio of 4,000:1 in places like the South, West, and Near North Sides of Chicago.
In fully integrated clinics, primary care staff—nurse practitioners, nurse midwives, physicians, and physician assistants—are trained to conduct patient-specific oral health risk assessments, screenings, and evaluations. That means every patient gets regular oral health visits, while scarce dental clinic hours are preserved for treatments only dental staff can provide. Dental-medical teams work together to identify, prioritize, and implement preventive strategies and treatments for both oral and systemic diseases. Referrals pass from dental staff to medical and vice versa. Medical records are shared. Oral health education—critically important for patients who have rarely, if ever, seen a dentist—is routine.
Poor oral health contributes to
|Deaths per year||Healthcare spending per year|
|CDVs and stroke||36%||$199 billion|
One day, higher Medicaid reimbursement rates for oral health services will open the door to more medical homes providing holistic care, including comprehensive oral health care. One day, we will find a way to increase the number of dentists willing and able to serve in community health settings. But today, by working to integrate oral and primary health care, we’re beginning to give more patients the care they need to improve their health.
Maintaining no-cost, integrated oral health services
Project: Oral Health Program
Expanding access to integrated oral health care on Chicago’s Southwest Side
Grantee: Mile Square Health Center
Project: Portable dental care services for 12 medical clinics with no in-house dental clinics
Increasing capacity to provide integrated oral health services
Grantee: Inner-City Muslim Action Network (IMAN
Project: Support for a part-time dentist and development of 3-year, pro forma business plan