SDOH Guidelines for the Main Dental Clinic
As outlined in Healthy People 2030:
Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Examples of SDOH include safe housing, transportation, and neighborhoods; racism, discrimination, and violence; education, job opportunities, and income; access to nutritious foods and physical activity opportunities; polluted air and water; language and literacy skills.
For a more in-depth understanding of SDOH, please visit Healthy People 2030 which includes more examples of each domain as well as supporting research articles.
Oral Health Care and SDOH
According to the World Health Organization:
Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment. Oral health varies over the life course from early life to old age, is integral to general health and supports individuals in participating in society and achieving their potential.
Oral diseases encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate. Oral diseases disproportionately affect the most vulnerable and disadvantaged populations.
People of low socioeconomic status carry a higher burden of oral diseases and this association remains across the life course, from early childhood to older age, and regardless of the country's overall income level.
Oral health care is a multifaceted system that is impacted by SDOH on several levels.
At the micro level, individual effort of the patient or dentist can result in immediate impact of the patient's oral health.
On the other hand, the macro level focuses on efforts by the community, state, or even country that can result in an increased population impact; however legislation and implementation of these efforts may take significantly longer to be effective.
Here are some ways that an oral health care professional can make an impact on a patient's health on both the micro and macro levels.
Micro level: one-on-one chair side oral hygiene instructions, motivational interviewing, patient education, addressing health literacy; providing patients with a list of resources tailored to their individual needs; evidence based dental treatment
Macro level: community outreach, establishing oral health screenings and preventative care programs in community centers and/or schools; taking on leadership roles in organized dentistry; advocate for access and funding to oral health care
In the dental clinic, SDOH is addressed mainly at the micro level through patient education and oral hygiene instruction. By implementing an SDOH survey during new patient screenings along with annual follow-ups, our clinic will be able to better address our patient's needs.
Flow Chart for Implementing SDOH Survey in the Main Dental Clinic
During the initial screening appointment following the medical history review, the student dentist introduces the concept of SDOH to the patient and asks the patient the 4 questions from the SDOH Survey. Patient responses are recorded in the patient's AxiUm chart under "SDOH Survey and Follow Up" form.
The student then has a conversation with the patient about any "no" and "sometimes" responses and gives the patient a paper copy of Resources for Patients explaining the specific resources that are applicable to the patient.
At the ODTP, the student dentist follows up with the patient concerning their SDOH Survey responses and inquires about the listed resources. An additional copy of Resources for Patients can be given to the patient at that time. The student dentist then records the initial follow up under the existing "SDOH Survey and Follow Up" form.
A comprehensive follow-up should be performed annually by having the patient answer the SDOH Survey. "No" and "sometimes" responses are discussed, and the patient is given a new list of resources based on their current needs. The patient's responses are then recorded in a new "SDOH Survey and Follow Up" form.
**Supplemental: If time permitting, the student is encouraged to invite the patient to learn about available resources in their community based on their individual needs using the operatory monitor and going to Find Help. (Reference the guide below). The student dentist then either prints out the list of resources for the patient and/or emails the list to the patient's email address.
SDOH Survey to be used in the Main Dental Clinic
List of Resources for Patients
List of SDOH Resources.pdfPlease reference the guide below to learn how to use FindHelp.
Proposed AxiUm Form for SDOH Survey and Follow Up
While scripts are not intended to be memorized, they are often helpful to reference. Below is a script to aid in communicating about SDOH with patients.