Literature Review: Improving Access to Oral Health Services
Katelyn Espenship
Health Community and Advocacy, HLTH 634-B01
February 2, 2020
Introduction
According to Healthy People 2020, oral health is directly related to a person’s overall health. Oral health includes the health of the mouth, teeth, and surrounding craniofacial structures.3 While great strides have been taken towards preventative oral health services, like use of fluoride, the people who need oral care the most are the least likely to have access to it.4 Using a combination of school-based oral hygiene programs and mobile clinics can address the gaps in access to oral health care services.
My proposed intervention will include school-based oral health programs and mobile clinics with dental and dental hygiene students. The school-based oral health programs are comprised of screenings to determine health status and skills-based oral health education.5 The intervention will also include mobile clinics that will be located at the schools as well as low-income areas. The mobile clinics will be run by dental and dental hygiene students and provide dental health services like fillings and teeth cleanings.6
I chose references that were peer reviewed articles or government reports from the past eight years. The references chosen include relevant data and information that support the need for the intervention.
Body of Evidence
I grouped my references by four different categories including reviews for school-based oral health programs, reviews for mobile clinics, other reviews, and government sources. There are two peer reviewed articles included in the reviews for school-based oral health programs category. These reviews include Advancing Oral Health Equity Through School-Based Oral Health Programs: An Ecological Model and Review and Getting the Incentives Right: Improving Oral Health Equity With Universal School-Based Caries Prevention.
The first study uses an ecological model to influence multiple levels to advance oral health. Ultimately, the review concludes that “school-based oral health programs that target multiple levels of determinants of health care access, health and well-being, and skills-based health education” are more effective and more equitable in regard to health outcomes.5 The second study suggests dental insurance is partly responsible for disparities in oral health and that school-based oral health programs could potentially ease the burden of cost. It also suggested that this type of program could reduce children’s dental caries by 80%.7
The reviews for mobile clinics group includes three peer reviewed articles emphasizing the effectiveness of mobile dental units/clinics. These articles are University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review; An Assessment of Mobile and Portable Dentistry Programs to Improve Population Oral Health; and Reach the unreached – a systematic review on mobile dental units.
The first study focused on university programs that worked towards improving access to oral health care in remote and rural communities. 62 universities were identified to have programs that matched the respective focus.6 The second review, with promising results, is an assessment on the “contributions of mobile and portable dentistry programs to increased access to oral health services.”8 The third review highlights how mobile dental units/clinics “help in overcoming the accessibility, affordability and sustainability barrier.”9
The other general reviews category includes Access to Oral Health Care: A National Crisis and Call for Reform; Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services; and Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health.
The first review states that access to oral health care is a national crisis and identifies the internal and external barriers of oral health care.4 The second review is about the most common barrier, cost, for all Americans of every age, gender, race, and socioeconomic status.10 The third review discusses how health centers that are federally qualified have successfully implemented school-based dental models that are led by registered dental hygienists. Thus, providing more oral health services to those who would not usually have access to them.11
Lastly, the government sources category includes Healthy People 2020 and a Virginia State Fact Sheet. The first government source highlights the Healthy People 2020 objectives including the leading health indicator for access to preventive services that involves increasing the proportion of everyone who utilizes the dental health care system.3 The second government source is a fact sheet about the state of Virginia’s oral health and wellbeing.12
Most references refer to the school-based oral health programs, mobile clinics, or the barriers to access of oral health services. A few references highlight specific areas like the financial barriers of dental services or how utilizing dental and dental hygiene students is a win-win for all sides.
Summary and Conclusions
Proper oral hygiene is essential for all ages, especially children. By instilling an oral health care routine early on, the oral health outcomes improve over their lifetimes. Children considered at or below the poverty line are less likely to have access to any health care including dental care. These children are more than likely part of the federal lunch program. One strategy to combat poor access to oral health services is to target schools with high percentages of children on reduced lunches.8 School-based oral health programs were found to be more effective and efficient in addressing and providing oral health care and preventative services to underserved children than community-based programs.5 As mentioned before, oral health is directly related to overall health. Improving oral health improves overall health, to some degree.
While there are more examples of successful school-based oral health programs, mobile dental units/clinics, unlike other stationary interventions, are able to address underserved and vulnerable populations. Mobile dental units/clinics can be used at schools but more importantly, they can be utilized in areas that would not otherwise have access to dental services. Research studies have noted that mobile dental units/clinics are appropriate for enabling access to oral health preventive and treatment services, addressing unmet oral health service needs, and increasing oral health literacy.8
The pros do out-weigh the cons; however, it is important to note the flaws within the research and intervention. Some of the studies mentioned the lack of sustainability among the mobile dental units/clinics due to them not being guaranteed at that location when needed. Another study mentioned not being able to establish an adequate referral system. This also points to patients who do receive referrals but are not able to follow through due to location and/or time of appointments. Future research should focus on the financial sector of the intervention for every side involved. I noticed majority of the research stating the cost benefits of both school-based oral health programs and mobile dental units/clinics, but I did not come across literature that did an extensive break down of the finances.
Using both school-based oral health programs and mobile dental units/clinics maximizes oral hygiene education, and preventative and treatment services. Vulnerable populations, like underserved children and adults, needs these services the most yet are the last ones to receive them. Instead of bringing the patients to the services, bringing the services to the patients fills in the unmet gaps and disparities within oral health. There is still much to be done; however, this intervention can make great improvements in the oral health care field as well as in people’s lives.
Psalm 23:3 