Download Oral health is integral to overall health and well

Oral Health Workforce
Needs Assessment
(DRAFT document for review—MHWAC)
I.
Overview
Oral health is integral to overall health and well-being. Poor oral health is association with
conditions of tooth decay and periodontal disease. Evidence also shows that poor oral health
reflects general health conditions, and can exacerbate conditions such as heart disease, stroke,
diabetes, pre-term and low weight births and respiratory diseases.
II.
The Workforce
Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment of diseases,
disorders and/or conditions of the oral cavity, maxillofacial area, and/or the adjacent and
associated structures and their impact on the human body; provided by a dentist, within the scope
of his/her education, training and experience, in accordance with the ethics of the profession and
applicable law (American Dental Association).
Dental hygienists are licensed oral healthcare professionals who have completed extensive
education and clinical preparation in preventive oral healthcare. Registered dental hygienists can
provide a wide range of services as determined by laws in each state, including: assessment of a
patient’s individual oral health condition, specific dental hygiene treatment for children,
adolescents, adults, older adults and patients who are medically compromised. Because dental
hygienists specialize in preventive oral healthcare, they educate their patients, the community
and schools on oral health and its effect on overall health. In some states, registered dental
hygienists administer local anesthesia and/or nitrous oxide (American Dental Hygienists
Association).
In 2014, the National Governors Association issued the report The Role of Dental Hygienists in
Providing Access to Oral Health Care. The report outlined the underutilization of the dental
hygiene workforce by identifying the preventive care dental hygienists are currently educated to
provide and the restrictions that limit them from doing so in public health settings.
Legislation passed in 2003 in Montana provided an opportunity for dental hygienists to provide
direct care in public health settings with a Limited Access Permit (LAP) endorsement. The
endorsement allows dental hygienists to provide preventive services, such as dental cleanings,
fluoride applications, sealants, x-rays, and preventive education in long-term care facilities,
hospitals, and specific settings for children at high-risk for cavities. Utilization of dental
hygienists in public health settings offers a preventive approach to dental care in Montana.
Dental assistants work with dentists, using a variety of technical and interpersonal skills to
conduct specific dental procedures and to help patients feel comfortable, understand their care
plans, and follow up on needed services.
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Montana’s Oral Health Workforce
The Montana Dental Association reports between 540 to 550 actively practicing dentists in their
current membership. The Montana Department of Labor Job Projections report indicates 732
licensed dental hygienists in 2013, and projects 961 dental hygienists will be needed by 2022 – a
growth rate of 31.3%.
III.
Oral Health Workforce Needs
The Montana Office of Rural Health conducts Community Health Needs Assessments with
critical access hospitals through the Community Health Services Development process (funded
by MHREF Flex Grant, MORH Funds and the Frontier Medicine Better Health Project). For the
assessments conducted since 2012, 23% of Implementation Plans prioritize needs for local dental
services. Of those that prioritize this need, only one hospital outlines a strategy to address the
need for locally desired services. Additionally, 45.7% of CHSD survey respondents from 20122014 signify they have seen a dentist within the past three years. The assessment data, overlaid
on Dental Care Shortage Areas, shows the areas of the state where critical access communities
are identifying the need for dental care as a healthcare priority.
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a. Public Health Department Assessments (to be completed)
b. National Perspective
Summaries of state and national workforce studies are included in the Appendix. Key findings
from other states include these challenges:
 Dentists report that they are unable to accept Medicaid (underserved) populations due to
low reimbursement rates
 Overall lack of oral health care professionals
 Educational programs for oral healthcare professions are lacking
 Oral health professionals are unevenly distributed (throughout the state)
These issues are clearly reflected in Montana as well.
IV.
Oral Health Workforce Strategies
National Perspective – A detailed listing of strategies from state plans and national reports is
included in the appendix. Common strategic areas are:
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Addressing reimbursements through Medicaid
Extending oral health services to address the lack of overall need
A. Utilizing physicians, advanced practice registered nurses, and
physician assistants have received the required training to deliver (and receive
payment for) dental disease preventive services during well-child exams.”4
B. Support collaborative and inter-professional medical and oral health
education and practice in order to improve the effectiveness and efficiency of care
through greater communication and coordination among providers.4
C. “If more dental hygienists practiced independently, they could
potentially provide more preventive services—a supply increase.” 3
D. (Kansas) “Create a Kansas statewide school sealant program
strategies:”
 Finalize contracts with seven regional sealant program
coordination sites
 Conduct statewide school sealant training for program sites
 Perform oral health screenings in regional sites
 Program sites contract with regional schools and prepare
communities
 Provide preventive services in schools 6
 Expanding oral health education programs (Washington State/WWAMI)
A. “Expansion of dentist education capacity was proposed in 2009 for the
University of Washington School of Dentistry through the Regional
Initiative in Dental Education (RIDE) program (designed to increase
dentist supply in rural and underserved areas), as well as for dental
hygienist and dental assistant programs”4
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B. “Continue and expand programs that promote practice in primary care
shortage areas, such as loan repayment, scholarships, and programs that
reduce barriers for volunteer and retired providers to donate services.”
Distributing oral health professionals for better access to underserved
populations through collaboration with community health clinics, rural
healthcare organizations, schools, migrant centers, Tribal Health
organizations, and other community based organizations.
Federal Programs (HRSA) that address dental health professional shortage areas include 13
legislatively authorized activities from the 3-year HRSA program:
 Loan forgiveness and repayment
 Recruitment and retention efforts
 Grants and low- or no- interest loans
 Establishment or expansion of dental residency programs
 Expansion of oral health services in shortage areas
 Placement and support of dental trainees
 Teledentistry
 Promotion of oral health professions among youth
 Faculty recruitment program7
“The connection between good oral health care and overall health at any age cannot be
overstated,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “Integrating oral health
care into primary care helps to improve access to affordable dental care in communities that
lack a sufficient number of dental providers.”7
Education and Training
Montana does not have a dental school. Currently, the state provides support for three students
to attend out of state dental schools (typically two University of Minnesota slots and one WICHE
slot. The Regional Initiatives in Dental Education (RIDE) program was proposed in 2008 with
the goal of developing a dental education program in Montana, in a collaborative effort with the
University of Washington School of Dentistry and Montana State University. The project did
not receive funding. An Associate Degree in Dental Hygiene is offered through Great Falls
College, with sixteen new students yearly. Training for dental assistants is offered at Great Falls
College and Salish Kootenai College.
In 2013, the Montana Department of Health and Human Services was awarded funding for the
Improving Oral Health in Montana Phase 2 grant from HRSA. Objectives of the grant include:
 A total of 27 UWSOD dental students, dental residents, and/or advance dentistry trainees
will have completed dental rotations in MT in the next three years.
 To develop a financial model for dental education sustainability in MT
 Interprofessional educational experiences, for dental and non-dental health professionals
will be developed in MT
 To recruit and retain 10 oral health professionals to community health centers and
rural/underserved communities in Montana Increase retention of dentists working in rural
and underserved communities
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V.
To coordinate the placement and housing of 27 dental students from the UWSOD in rural
land underserved areas, and provide a welcoming and supportive experience during the
community experience
To increase the number of Montana students from rural and underserved areas who enter
into oral health professions education programs by providing educational presentations to
over 6,000 Montana students
Next Steps and Recommendations
The Montana Healthcare Workforce Strategic Plan (November 2011) contains six strategies for
dental and oral health workforce:
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Review the RIDE proposal to determine feasibility of implementation, develop a
collaborative dental education program (Status: Currently UW providing rotations for
dental students in rural/underserved areas of Montana in collaboration with DPHHS
Grant; reviewing RIDE implementation in Spokane for lessons learned)
Identify practice models that will allow for increased access to oral health services: oral
health in family practice, CHCs, team health training and practice (interdisciplinary
education experience, mobile dental clinics (Status: Smiles for Life Curriculum to train
primary care providers in oral health; CHC recruitment, participation in UW clinical
placements; interdisciplinary education with MSU nursing students, other?)
Encourage dental student participation in rural residency and rotation programs (Status:
Riverstone dental residency slots; UW dental student rotations)
Develop unified credentialing and licensure among rural western states (Status:
unknown)
Maintain or increase financial incentives for dental/oral health providers in rural and
underserved areas (Status :?)
Design, establish and institutionalize a standard data collection gathering system to track
workforce data (Status: Workforce survey revisions by DPHHS for Primary Care Office)
Questions for MHWAC:
What strategies should be recommended for the updated plan?


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Which existing strategies are complete or in process?
Which strategies are no longer relevant?
What new strategies should be considered?
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