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Public health dental hygienist practitioners in Pennsylvania can help improve access to oral health care and patient outcomes by serving as dental navigators in medical offices.

By Donna L. Murray-Schoenecker, PHDHP, MSDH, and C. Eve J. Kimball, MD, FAAP

In December 2009, the public health dental hygiene practitioner (PHDHP) was created in Pennsylvania to alleviate access to oral health care problems.1,2 PHDHPs can provide dental care without the supervision of a dentist in: schools; correctional facilities; health care facilities; personal care homes; domiciliary care facilities; older adult daily living centers; continuing-care facilities; federally qualified health centers; public or private institutions under the jurisdiction of a local, state, or federal agency; and free and reduced-fee nonprofit health clinics.3 Dental hygienists may apply for PHDHP certification after meeting the following qualifications: active license in good standing to practice as a dental hygienist in Pennsylvania; documentation of professional liability insurance; and certification statement signed by a licensed dentist verifying that the dental hygienist has completed a minimum of 3,600 hours of practice as a licensed dental hygienist under the supervision of a licensed dentist.3 One possible career path for PHDHPs is to serve as a dental navigator in a medical practice, providing oral health education, addressing dental fears, and finding dental homes for patients and their families in a cost-effective manner during medical visits.  

STUDY OF EFFECTIVENESS 

In order to investigate the ability of dental navigators to increase access to dental care and improve outcomes, a pilot program was instituted at All About Children Pediatric Partners PC, a large urban pediatric office in Reading, Pennsylvania. During an 8-week period from November 2015 to January 2016, a PHDHP employed by a managed care organization as a dental navigator visited the office weekly. She partnered with 13 unique pediatric providers for half a day each. The PHDHP met individually for 5 minutes to 15 minutes with each patient and his or her caregivers in the examination room while they waited for a medical provider. The PHDHP performed a verbal oral health risk assessment and provided oral health instruction, including the oral effects of any systemic conditions or medication usage, and oral hygiene education. She then discussed oral concerns with the medical provider and helped schedule dental appointments for patients who had not seen a dentist within the past year or had a demonstrated dental problem. The PHDHP also discussed patient concerns, such as dental anxiety and expectations for a first dental visit, and assisted with language or transportation barriers. The objective was to provide a “warm hand-off” of the underserved patient to a dental office in order to improve outcomes for both oral and overall health. At the conclusion of the pilot program, data from insurance claim submissions in December 2015 and June 2016 were compiled and compared based on “dental care gap” reports for patients receiving medical/dental benefits from the managed care organization and submission for reimbursement of fluoride varnish applications. The managed care organization recorded a 7% increase in the number of annual dental visits within this patient population. Data also showed an average increase of 0.5% to 0.75% in the frequency of caries detection by medical providers. While the average increase was small, some clinicians experienced a 5% increase in the identification of caries. The medical providers noted that working with the PHDHP increased their awareness of the importance of oral health as it relates to systemic health. Four providers also requested dental referrals for oral health problems noted during the pilot program. Patients often reported a lack of knowledge about the importance of oral health, fear, trouble securing time off work, cost, and transportation problems as reasons for not seeking routine dental care. The PHDHP was able to address each of these concerns with the family and schedule a dental appointment for patient(s) and family members. The managed care organization also noted a 34% increase in the number of fluoride varnish applications submitted for payment among children age 6 months to 5 years during the pilot program. At the end of the pilot program, the PHDHP from the managed care organization continued her weekly visits and the practice also hired a senior PHDHP to work 20 additional hours per week. Together, the two PHDHPs have educated and facilitated dental care for more than 1,000 families. 

CONCLUSION 

The PHDHP as a dental navigator can help improve access to dental care in a cost-effective manner. The medical office experienced greater patient satisfaction, increased collaboration between medical and dental professionals, effective addressing of family concerns and fears, and increased fluoride varnish applications during the pilot program. The PHDHP dental navigator provides additional professional opportunities for dental hygienists and may be well designed for clinicians who are unable to continue clinical practice due to physical limitations. The cost of the PHDHP was covered by the increase in the dental bonus earned by the practice from the managed care organization and payments for the application of fluoride varnish and patient and family counseling. As a collaborative team, PHDHPs, medical providers, dentists, and patients can work together to provide oral health education and care in a timely, cost-effective manner. 

 

References

  1. The Pennsylvania Code. 33.205b. Practice as a Public Health Dental Hygiene Practitioner. Available at: pacode.com/secure/data/049/chapter33/s33.205b.html. Accessed September 23, 2016.
  2. Bailit H, D'Adamo J. State case studies: Improving access to dental care for the underserved. J Public Health Dent. 2012;72:221–234.
  3. Pennsylvania State Board of Dentistry. Application for Certification as a Public Health Dental Hygiene Practitioner. Available at: dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Dentistry/Documents/Applications%20and%20Forms/
    Initial%20Applications/IDHApp%20DH%20Public%20Health%20Practitioner.pdf. Accessed September 23, 2016.
 
 

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2016;3(10):46-47. 

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