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The Silo Effect
Despite the prevalence, severity, and cost of this largely preventable disease, oral disease has not received the attention it deserves. For too long, oral healthcare has been separated from routine medical care—with some considering it discretionary. The separation of the mouth from the body has been built into the cultures of medicine and dentistry for generations by separate training programs, professional identities, payment structures, and delivery systems. As a consequence, collaboration between medicine and dentistry rarely occurs. Referrals from primary care providers to medical specialists have standard protocols for requesting either a procedure, the answer to a question, or the transfer of care with expectations for a consultation report after the patient is seen. No such standards exist for communication between medical providers and dentists. The oral healthcare delivery system, as it is currently configured, fails to reach the populations with the highest burden of oral disease resulting in significant and pervasive oral health disparities for low-income, minority, rural, and other underserved populations. For example, the prevalence of caries among poor and near-poor five-year olds (50%) is twice that of their non-poor peers. Yet in 2010, only 20% of Medicaid-enrolled children under age three received dental care; and, in one study, only 9% received preventive dental care. The Report of the U.S. Surgeon General on Oral Health, published in 2000, called for all healthcare providers to participate in oral healthcare—a call that was echoed by the Institute of Medicine in 2010 and affirmed by the Health Resources and Services Administration (HRSA) in 2014.
We see new opportunities to act on this call. The primary care delivery system is in the midst of a transformation—striving to provide more patient-centered, coordinated, and value-oriented care. A supporting element of this “transformation” is an evolving healthcare payment environment, which brings new expectations, challenges, and new opportunities for managing costs and improving health outcomes. The oral healthcare delivery system, as it is currently configured, fails to reach the populations with the highest burden of oral disease resulting in significant and pervasive oral health disparities.