Table 2 Integration of oral health into primary care: Summary of oral health outcomes

Haughney et al.,

1998/UK

To develop and evaluate a model of integrated medical and dental care/Cohort study

Co-located medical and dental practices under National Health System regulation/General population

• Postal questionnaire

• Health records archive

• Number of registered joint patients

• Information discrepancies

• Joint work practices

• Number of secondary referrals

• 90% increase in the number of registered joint patients over a 3-year period

• ↓ discrepancies

• 42% ↑ in 0–5 year olds’ number of joint visits

• 24% ↑ in > 75 year olds’ number of joint visits

• ↓ need for secondary referrals (n = 41) over a 3-year period

Pronych et al.,

2010/USA

To examine the efficacy of systems approach and training nursing staff on the oral health of nursing home residents/Pilot study

Long-term care facilities (LTC)/Geriatric population

• Clinical examination

• Interviews with the oral health coordinators

• Simplified debris index (DI-S) of residents at baseline, 2, 6 and 12 month follow-up

• Success and barriers of the model

• Feedback on the oral health coordinator’s role

• Statistically significant improvement in the oral hygiene of LTC residents

Dyson et al.,

2012/ Australia

To examine the cost-effectiveness of a rural and remote networked hub-and-spokes model / Retrospective economic analysis

Fixed dental services embedded in Aboriginal Health Services/Aboriginal communities

• Services activities data

• Cost-to-value ratio

• Cost-to-value ratio average: 1.61

• Not statistically significant difference between sites, according to the Accessibility/Remoteness Index of Australia

Gerritsen et al., 2013/

Netherlands

To compare the cost and effects of integrated care versus incidental care/Observational study

Long-term care facilities/Geriatric population

• Clinical examination

• Administrative data

• Oral health status

• Cost of dental care

• Integrated care ↓ dental treatment needs

• Integrated care ↑ cost and time spent on dental care

Hom et al., 2013/USA

To evaluate the adherence to early and periodic screening, diagnosis and treatment guidelines for medical practices/

Observational study

Medical practices/Medicaid registered children

• Medicaid administrative data base

• Number of states adhering to the best oral health practices

• Number of states requiring dental referral by age 1

• 88% of states adhered to the content and timing of best oral health practices

• 33% of the states adhered to the best oral health practice by requiring referral by age 1

Kranz et al., 2014/USA

To examine the association between the type of the service provider (primary care provider/PCP, dentist) and subsequent dental-caries related treatment (CRT) and CRT payment/Retrospective study

North Carolina Medicaid / Children aged 3–5 years

• Medicaid enrollment and claim files from 2000 to 2006

• CRT

• CRT payment

• Statistically significant difference among children visiting PCPs, dentist or both in regard to CRT and CRT payments

• The dentist provider type was associated with ↑ CRT and ↑ CRT payments per year

Langelier et al., 2015/USA

Langelier, M., 2015/USA

To identify effective approaches to integrating primary care and oral health services delivery /Case studies

Federally qualified health care centers across United States /Vulnerable population groups

• Interviews and focus group discussion

• Number of dental clinics

• Number of dental personnel

• Number of dental visits

• Attendance

• Referral mechanisms

• Number of primary care providers trained

• ↑ number of dental clinics

• ↑ number in dental residents

• After 3 months, some clinics were fully booked, with 3–4 week waits for appointments

• Electronic health record interoperability

Grisanti et al., 2015/USA

To examine the performance of Federally Qualified Health Centers over 5-year period (2007–2012)/

Observational study

Community health center’s dental department /Medicaid, uninsured and privately insured patients

• Administrative records

• Oral health age-specific indicators: number of dental visits, number of received oral health services/year, number of received preventive interventions/year, percentage of preventive measures, number/percentage of preventive visits

• 87% ↑ in the total number of patients who received at least one dental visit over 5-year period

• About 50% ↑ in the total number of patients who received preventive interventions

• 27% ↑ comprehensive exam

• 97% ↑ in number of patients having preventive interventions

• No increase in Medicaid patients having a dental procedure

• 56% ↑ in restorative procedures for 65 +

• 140% ↑ in preventive services

DiMarco et al., 2016/USA

To test the feasibility of integrating primary preventive interventions into the practice of nurses, registered dieticians and students

Sites of the Supplemental Nutrition Program for women, children and infants/Low income preschool children

• Dental screening and administrative records

• Parent/Guardian oral health survey

• Number of preventive fluoride varnishes and education sessions

• Oral force diversity, capacity and flexibility

• Interprofessional collaboration

• Fluoride varnish applied to 40% of children in order to reduce the number of cavities by 25%

• Enhanced education of 40% of women and mothers at both sites

• Establishing a dental home for 75% of children

• Expanded the scope of practice of RD, RN, NP

• Enhanced cross training opportunities