Pacific Center for Equity in Oral Health Care

The Pacific Center for Special Care is now The Pacific Center for Equity in Oral Health Care!

From its founding in 1990, the Pacific Center for Special Care prioritized and launched programs to address disparities in oral health and diversification of the dental workforce. Some examples include: development of best practices and alternative delivery care models, including tele-dentistry, to care for people with special health care needs; advocacy and integration of oral health programs into the California Regional Center System; implementation of the Pipeline Program to diversify applicants to dental schools; and the first on-line program for registered dental hygienists in alternative [RDHAP].

The Pacific Center for Equity in Oral Health Care (Pacific Center) will build on this legacy by continuing to address the needs of those who require Special Care and the needs of a broader socio-economic population that has been and remains vulnerable in the wake of poor oral health literacy and limited access to oral health care. The recent onset of COVID 19 will likely have long lasting collateral damage to the already tenuous structures in place to help those most in need, access basic dental services. This health and economic crisis will also impact the future of dental education and perhaps to whom it will be available in the future, underscoring the need to continue pipeline initiatives through the Pacific Center that will diversify and enrich our educational program and our profession. The Pacific Center will address inequities in resources for oral health care and dental education and advocate for health systems and health policies that support broad inclusion of oral health care as an integral and meaningful part of the health care system, available to all.

Oral Health Courses for Caregivers and Administrators

Oral health means having a healthy mouth and that includes healthy teeth and gums, plus all the other areas inside the mouth. The Pacific Center for Special Care has produced a set of training materials explain how to support the oral health of those you provide care for, and were designed by a national advisory committee to engage two main groups:

direct caregivers: how to maintain the oral health of the people for whom they are caring
facility administrators, supervisors and trainers in long-term facilities: guidelines for creating and implementing an oral health program in an organization.

For more information, please email pacificcenter@pacific.edu.

Through a grant funded by the San Francisco Foundation, the Pacific Center for Special Care has developed a policy toolkit for improving oral health for underserved populations.

By engaging partners and stakeholders and forming workgroups, the Pacific Center will use its experience from the past several decades to develop and disseminate background materials and recommendations for legal, regulatory and reimbursement reform needed to improve oral health for underserved populations.

The toolkit will provide background for policymakers and emphasize the importance of developing community-based systems focused on health promotion, prevention, and treatment services. It will also present evidence that these systems can produce better health outcomes per dollar spent than other alternative systems of care. In addition it will provide a rationale and specific, actionable policy recommendations.

Policy Briefs

What is the Virtual Dental Home?

The Virtual Dental Home (VDH) 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.

Using the VDH system registered dental hygienists in alternative practice (RDHAP), registered dental hygienists working in public health programs (RDH) and registered dental assistants in extended functions (RDAEF) can keep people healthy in community settings by collecting diagnostic records, providing preventive procedures and interim therapeutic restorations education, 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.

How does it work?

The VDH model relies on community-based practice of specially trained dental hygienists and assistants who collect dental records and provide preventive care for patients in community settings, such as schools, Head Start preschools and nursing homes. They send that information through a secure telehealth system to a dentist at a clinic or dental office who establishes a diagnosis and creates a dental treatment plan. In addition to preventive procedures, the hygienist or assistant, if directed to do so by the dentist, may provide a type of small protective filling called an "interim therapeutic restoration" (ITR), stabilizing the tooth until the dentist determines that further treatment is required. Patients who require more complex treatment that only a dentist can provide are referred and receive assistance securing a dental appointment.

The services provided in community locations include:

Health promotion and prevention education
Dental disease risk assessment
Preventive procedures such as application of fluoride varnish, dental sealants and for dental hygienists, dental prophylaxis and periodontal scaling
Placing carious teeth in a holding pattern using interim therapeutic restorations (ITR) to stabilize patients until they can be seen by a dentist for definitive care. Placing ITRs has been approved for this project by the Office of Statewide Health Planning and Development under the Health Workforce Pilot Project application #172.
Tracking and supporting the individual's need for and compliance with recommendations for additional and follow-up dental services.

approximately two-thirds of the patients seen in a VDH were able to receive the care they needed at the community site. This is care they most likely would not have received otherwise or would have had great difficulty getting.

Benefits and Savings

Dental disease is the No. 1 chronic disease of children — more common than obesity and asthma, and it is almost entirely preventable. For children, providing access to preventive services early in their lives inhibits the initiation of dental disease and provides a lifetime of benefits. When children are free from active dental disease, they miss fewer days of schools and are better able to learn. They also enjoy the benefits of higher-quality nutrition and experience improved self-esteem.

For elders, especially those who live in a residential facility, they benefit from receiving dental services that will keep their mouths clean and pain free. In instances where more complex care is required and a trip to the dental office is scheduled, the VDH system minimizes the number of visits required, as the patients' needs have already been assessed and the dentist is prepared to provide the required treatment.

The cost of neglect is substantial to individuals and to society. By reducing barriers to preventive and basic dental care in these vulnerable populations, the VDH model can provide long-term savings by avoiding costly procedures, emergency room visits and even hospitalizations associated with advanced dental disease.