Oral health is a very important component of health status, but one that is often neglected and not considered a priority in public health policy. Poor oral health can lead to many other acute and chronic health conditions, and unnecessary emergency room utilization and hospitalizations. One associated issue is pain that often results in emergency room utilization and use of narcotics. Oral health has been linked to diabetes, heart disease, stroke, premature births and low birth weight, and mouth and throat cancers [1].
Healthy People 2030 has established oral health goals and objectives to achieve. Community outreach is one strategy that can support achieving objectives. Of the 15 objectives identified, some that may be undertaken by community EMS include reducing untreated tooth decay, increasing cancer detection at earlier stages, increasing the utilization of the oral health care system through referrals, reducing consumption of added sugars by supporting nutritional assessments and monitoring, promoting tobacco and nicotine cessation, and increasing the proportion of children who receive dental sealants. Each state and community has the opportunity to develop the specific strategies most appropriate for their populations and their available resources [2].
Dental care is often accessed in Federally Qualified Health Centers and rural health clinics. The federal Health Resources and Services Administration (HRSA) identifies dental health professional shortage areas (HPSAs) across the country. According to HRSA, 11,675 more dental practitioners are needed to serve 68 million people located in 7,003 HPSAs [3].
Access to a dental care provider has been especially problematic for people who are uninsured or on Medicaid. Even people with medical insurance may not have dental insurance coverage. It is estimated by the American Dental Association that only 38% of dental providers accept Medicaid. Over 40% of non-elderly adults did not seek dental care due to high out-of-pocket costs or lack of insurance [4].
Figure: Dental health professional shortage areas [3]
Photo/HRSA
Community paramedicine role in oral health
Community EMS may contribute to improving oral health status by including oral health screenings in outreach efforts, participating in community and school oral health projects, and making referrals to assist patients in finding an oral health care provider.
An oral hygiene assessment, including screening for signs of dental disease, is often overlooked. During home visits and post-hospitalization visits, community EMS can include an oral assessment in their patient checks. Patients with stroke, for example, may experience difficulty addressing oral care because of physical and cognitive impairments, reduced level of consciousness and comorbidities. Attending to oral health can reduce the risk of pneumonia and other post-stroke complications [5]. Other types of post-medical care patients can similarly benefit from oral hygiene assessments and referrals, which serve to reduce the exacerbation of many chronic disease symptoms.
Screenings that community EMS could perform include nutritional, physical activity, nicotine cessation, stress management, environmental safety and overall health status [6]. An example of an oral health program geared to adults with disabilities, including outcomes, for example, can be found on the Rural Health Information Hub website. This offers educational topics, including brushing and flossing, eating a healthy diet, drinking optimally fluoridated water, visiting the dentist regularly, and finding oral health services.
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Another opportunity for community EMS is in supporting school-based dental sealant programs. Dental sealants prevent tooth decay and can protect against 80% of cavities for 2 years, and 50% of cavities for up to 4 years [7]. Scope of practice and licensure requirements vary from state to state, however, administrative support is needed for scheduling, medical records and other functions of running a sealant clinic. Staff needs depend on the size of the program and location [8].
Fluoride is applied using varnish to young children’s teeth. This is particularly important in locations where the public water system is not fluoridated. A YouTube video explains what fluoride varnish is, what it does, and how it is applied. Smiles for Life has developed a curriculum for fluoride varnish clinics, including staff training and materials needed. Information here covers program implementation guidelines, supplies needed and vendors, and an oral health coding fact sheet. All 50 states’ Medicaid programs reimburse primary care clinicians for applying fluoride varnish to children’s teeth and some private insurances reimburse as well [9].
The CDC has various other funded programs available through cooperative agreements with state and territorial health departments. In addition to school sealant programs, there is funding for community water fluoridation and oral health surveillance projects. The objectives for this funding are to decrease dental caries, oral health disparities, and other chronic diseases co-morbid with poor oral health. The CDC website identifies the states with cooperative agreements and includes a page linking to each state’s oral health plan [10].
Healthy People 2030
By integrating oral health assessments, local programs, and referrals to providers and resources, community EMS can support achieving Healthy People 2030 goals and objectives. Poor oral health can contribute to health problems across a wide spectrum of health conditions and can cause complications leading to hospitalization and readmissions. There is also an economic impact on families, schools, workforce, and productivity. By attending to oral health needs, community health status will be improved.
Acknowledgement: Thank you to Helen Hawkey, BSDH, PHDHP, Executive Director, Pennsylvania Coalition for Oral Health for reviewing this article.
REFERENCES
- Office of Disease Prevention and Health Promotion, “Oral Health,” 6 February 2022. [Online]. Available: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Oral-Health.
- Office of Disease Prevention and Health Promotion, “Oral Conditions,” [Online]. Available: https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions.
- Health Resources & Services Administration, “Shortage Areas,” 8 June 2022. [Online]. Available: https://data.hrsa.gov/topics/health-workforce/shortage-areas.
- J. Huh, “Estimating the Impact of Medicaid Expansions on Dentist Supply,” August 2021. [Online]. Available: https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpibrief_0821_1.pdf.
- T. L. [. a. Green, “Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association,” Stroke, vol. 52, no. 5, pp. e179-e197, May 2021.
- Rural Health Information Hub, “Screening and Health Educator Model,” 2022. [Online]. Available: https://www.ruralhealthinfo.org/toolkits/community-health-workers/2/educator.
- Division of Oral Health, “Dental Sealant FAQs,” National Center for Chronic Disease Prevention and Health Promotion, 30 October 2020. [Online]. Available: https://www.cdc.gov/oralhealth/dental_sealant_program/sealants-FAQ.htm.
- Seal America: The Prevention Invention, “Staffing,” Georgetown University, [Online]. Available: https://www.mchoralhealth.org/seal/step-3-0.php.
- Smiles for Life Oral Health, “Varnish Training Module and Material,” Curriculum Smiles for Life: A National Oral Health, 2022. [Online]. Available: https://www.smilesforlifeoralhealth.org/resources/practice-tools-and-resources/state-specific-fluoride-varnish-information/.
- Division of Oral Health, “CDC-Funded Programs,” National Center for Chronic Disease Prevention and Health Promotion, 1 October 2019. [Online]. Available: https://www.cdc.gov/oralhealth/funded_programs/cooperative_agreements/index.htm.
