Many Californians face serious obstacles in obtaining dental services. These individuals may have complex medical, physical or social conditions that make it difficult to get to a dentist's office. They may be institutionalized, economically disadvantaged or living in remote areas. Regardless of their circumstances, they are failing to get their needs met through the traditional dental care system. As a result, they have significantly worse oral health than those in other segments of the population.
The Pacific Center for Special Care at the University of the Pacific, Arthur A. Dugoni School of Dentistry (Pacific) is demonstrating a new model of care. By creating a "Virtual Dental Home" in sites throughout California, Pacific hopes to deliver oral health services in locations where people live, work, play, go to school and receive social services. The Pacific Center has partnered with a number of funding organizations to implement this demonstration project to bring much-needed oral health services to these underserved populations. These populations range from children in Head Start Centers and elementary schools to older or disabled adults in residential care settings or nursing homes.
The Virtual Dental Home creates a community-based oral health delivery system in which people receive preventive and simple therapeutic services in community settings where they live or receive educational, social or general health services. It utilizes the latest technology to link practitioners in the community with dentists at remote office sites.
The goal is to demonstrate that registered dental hygienists in alternative practice (RDHAP), registered dental hygienists working in public health programs (RDH) and registered dental assistants (RDA) can keep people healthy in community settings by providing education, preventive care, interim therapeutic restorations triage, and case management. Where more complex dental treatment is needed, the Virtual Dental Home connects patients with dentists in the area.
This system promotes collaboration between dentists in dental offices and these community-based dental hygienists and dental assistants. Most importantly, it brings much-needed services to individuals who might otherwise receive no care.
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How does it work?
This model relies on the advanced training and community-based practice of a group of oral health professionals. In the Virtual Dental Home, the RDHAP, RDH, or RDA collaborates with a dentist to provide care. Technology helps bridge the geographic gap between the community provider and dentist.
Equipped with portable imaging equipment and an internet-based dental record system, the RDHAP, RDH or RDA collects electronic dental records such as X-rays, photographs, charts of dental findings, and dental and medical histories, and uploads the information to a secure website where they are reviewed by a collaborating dentist. The dentist reviews the patient's information and creates a tentative dental treatment plan. The RDHAP, RDH or RDA then carries out the aspects of the treatment plan that can be conducted in the community setting. These services include:
The RDHAP, RDH or RDA refers patients to dental offices for procedures that require the skills of a dentist. When such visits occur, the patient arrives with a diagnosis and treatment plan already determined, preventive practices in place and preventive procedures having been performed. The patient is likely to receive a successful first visit with the dentist as the patient's dental records and images have already been reviewed. All of this adds up to a more successful dentist visit.
In some cases the dentist may come to the community site and use portable equipment to provide restorations or other services that only a dentist can provide. In either case, the majority of patient interactions and efforts to keep people healthy are performed by the RDHAP, RDH, or RDA in the community setting, thus creating a true community-based dental home.
The Virtual Dental Home has been implemented at a number of in California including:
The Virtual Dental Home model expands the duties and reach of RDHAPs, RDHs and RDAs practicing in the community. Once trained, these oral health professionals are able to collaborate with dentists to establish diagnostic services and to provide preventive and temporary restorative services directly to people who might otherwise not be able to get dental care. This model demonstrates that RDHs, RDHAPs or RDAs can help maintain the oral health of underserved people in the communities where they live, while still connecting patients to dentists if they need more complex care.
The Virtual Dental Home project is demonstrating a new model for creating and maintaining oral health of vulnerable populations. This model has numerous policy implications. In addition to the demonstration project, Pacific is organizing the work of a high level Policy Advisory Committee. The committee is composed of individuals from diverse professional, governmental and advocacy organizations. The charge of the committee is to consider the policy implications of this model and make recommendations for regulatory, reimbursement, and system reform that will facilitate future spread of the model. In addition the committee will consider strategies and reforms needed to incorporate this in model general health reform efforts and in initiatives designed to develop comprehensive health homes for vulnerable populations.
The following organizations are supporting aspects of the Pacific Center's Virtual Dental Home demonstration project:
For more information about the Virtual Dental Home, please call 415.749.3384.
