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Preventative Dentistry Delivery to Children in Rural
Communities in the United States
Lauren K. Dulieu
School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
Abstract
New models in the delivery of healthcare such as mobile clinics, retail clinics, and telehealth have helped to bring care to patients who might
not otherwise receive care due to geographic limitations. Such alternatives may help to address the need for dental care in rural communities in
the United States. In addition to these solutions, dental therapists can increase the available provider base to deliver preventative dental
services to children.
Key words: Dental therapists, mobile clinic, preventative dentistry, retail clinic, teledentistry
INTRODUCTION
There are only approximately 5000 practicing pediatric dentists
in the United States.
[1]
The limited number of pediatric dentists
and their high concentration in populated areas often implies
that children living outside these areas, i.e., rural areas,
encounter barriers in access to even rudimentary and
preventative dental care. The most significant of these
barriers are the very miles of travel necessary to reach a
dental office.
[2]
Solving the problem of access for these
children should be a priority for organized dentistry because
it has been shown that early preventative dental services are
highly effective in controlling and preventing tooth decay. In
light of the provider shortage and the vast geographic areas that
need to be covered, it is crucialto consider innovative options to
care for these children. This article will review some novel
alternatives to bring preventative dental care closer to children
living in rural areas.
MOBILE DENTAL CLINICS
A mobile dental clinic (MDC) is a vehicle, usually a van,
outfitted with a complete dental operatory including a dental
chair, lights, sterilization equipment, and other equipment to
perform dental procedures. The primary goal of an MDC is to
provide care to rural communities where dental care may not be
readily accessible. Ultimately, the premise isthat, if the patient
cannot travel to the dental office, the dental office can travel to
the patient. Care providers staffing an MDC often include
dentists, hygienists, and dental students who deliver services
ranging from restorative to preventative care.
[3]
One of the most
prominent applications of MDCs is to provide care to school
children in rural locations. Vans often supply children with
dental supplies and informational brochures with oral hygiene
instructions. In addtion, children may receive oral exams,
cleanings, radiographs, fluoride varnish applications, and
sealants as preventative services. By bringing care to school
children, mobile dental clinics serve as an innovative method
for servicing rural populations in providing both preventative
and restorative care.
RETAIL CLINICS
Retail clinics allow patients to “walk in”at any time for care
because they are conveniently located and associated with the
pharmacies of major retail stores in the United States. Retail
clinics serve to bring healthcare to patients who may not have
access to a dentist due to geographic barriers. Each medical retail
clinic is staffed by physician assistants and nurse practitioners
who provide a variety of healthcare services. The scope of
practice for these providers includes the diagnosis, treatment,
Address for correspondence: Ms. Lauren Kathryn Dulieu, University of
Connecticut School of Dental Medicine, Connecticut, USA.
E-mail: dulieu@uchc.edu
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How to cite this article: Dulieu LK. Preventative dentistry delivery to
children in rural communities in the United States. Dent Hypotheses
2016;7:160-1.
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DOI:
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and prescription for common illnesses; vaccinations, treatment
of skin, and musculoskeletal conditions; routine lab tests; and
wellness services including counseling and school physical
exams. Retail clinics do not currently include dental care, but
opening these clinics to involve dental providers could increase
access and overall oral healthcare for children living in rural
areas. Since retail clinics have gained popularity in medicine and
minor health needs are met, primary care physicians will be able
to treat more medically complicated conditions.
[4]
TELEDENTISTRY
Like telephones allow people to communicate from two different
locations, teledentistry allows dentists and patients to connect
over long distances. Telehealth helps to reduce healthcare
disparities for rural populations by eliminating distance as a
barrier to care. There are currently three different categories
of teledentistry, namely, “store and forward,”“real-time
consultation,”and “remote monitoring.”
[5]
“Store and forward”
allows for exchange of clinical information between providers to
aid in treatment planning and consults. This method would be
useful to ensure that patients in rural communities maintain a
virtual record of their care from providers through mobile dental
vans or clinics. “Real-time consultation”involves video
conferencing between providers such that a provider working
in a clinic could directly consult an overseeing dentist at the
time of treatment. “Remote monitoring”allows dentists to
monitor patients in hospitals or homes situated in remote
locations. Remote conferencing would allow patients to
consult with distant practicing dentists from their own home.
With advances in technology, the development of camera
attachments for mobile phones, tablets, and other com-
munication devices could allow consulting dentists to better
assess patient needs and create treatment plans. Teledentistry
has demonstrated the value of intraoral cameras and teledentistry
in pediatrics and preventative dentistry as a means of screening
high risk children for caries.
[6]
Unfortunately, telehealth still raises
concerns from a legal perspective and licensure for both
physicians and dentists consulting with patients across state
lines. The benefit of telehealth for patients is also great for
these concerns to not be addressed in the future.
DENTAL THERAPISTS
Dental therapists provide a level of intermediate care that may
include preventative and restorative services that can benefit
patients and dentists. Unlike much of the western world, the
practice of dentistry by dental therapists in the United States
remains controversial. The American Dental Association
(ADA) opposes dental therapists performing surgical or
irreversible procedures which include drilling or extracting
teeth.
[7]
Controversy aside, it is estimated that, in the United
States, there are roughly 75 million children which equates to
approximately 15000 children for every 1 pediatric dentist.
[8]
The supply providers is inadequate to meet the demand and
dental therapists can fill this unmet need. Even though services
of dental therapists may be limited to preventative services that
include prophylaxes, fluoride varnish applications, screenings,
radiographs, sealants, and diet counseling. By taking
preventative action in early childhood, the overall dental
health and hygiene of these individuals would be signifi
cantly improved later in life. Therapists could help to triage
more complicated cases and consult with either a local dentist
overseeingthe practice or a distant dentistusing teledentistry. In
addition, dental therapists could help children become more
comfortable with a dental care provider that has the potential to
improve cooperation in the dental setting. This would lessenthe
stress on dentists and may increase care by general dentists
when pediatric dentists are not available.
DISCUSSION
A combination of mobile dental clinics, teledentistry, retail
clinics, and dental therapists could serve as one of the most
promising solutions in addressing the lack of pediatric dental
care in rural areas of the United States. Mobile dental clinics
and retail clinics through retail pharmacies (such as CVS or
Walmart) could provide the opportunity for dental care in
rural areas that may not readily have access to dental offices.
Dental therapists could then staff either mobile dental clinics
or retail clinics. Preventative services could include
preventative services such as prophylaxes, fluoride varnish,
sealants, diet counseling, and radiographs, which have all
been shown to improve the oral health of children. Finally,
teledentistry could connect dentists, dental therapists, and
patients in offices, retail clinics, or MDCs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Kerins C, Casamassimo PS, Ciesla D, Lee Y, Seale NS. A preliminary
analysis of the US dental health care system’s capacity to treat children
with special health care needs. Pediatr Dent 2011;33:107-12.
2. ADA News CDC: Children’s preventative dental care effective, use
low. Available from: http://www.ada.org/en/publications/ada-news/2014-
archive/september/cdc-childrens-preventive-dental-care-effective-use-low
[Last accessed on 2016 Aug 8].
3. Ganavadiya R, Chandrashekar B, Goel P, Hongal S, Jain M. Mobile and
portable dental services catering to the basic oral health needs of the
underserved population in developing countries: A proposed model. Ann
Med Health Sci Res 2014;4:293-304.
4. Laws M, Scott MK. The emergence of retail-based clinics in the United
States: Early observations. Health Affairs 2008;27:1293-8.
5. Jampani ND, Nutalapati R, Dontula BS, Boyapati R. Applications of
Teledentistry: A literature review and update. J Int Soc Prev Community
Dent 2011;1:37-44.
6. Kopycka-Kedzierawski DT, Billings RJ. Teledentistry in inner-city
child care centres. J Telemed Telecare 2006;12:176-81.
7. American Dental Association Statement on Accrediting Dental
Therapy Education Programs. Available from: http://www.ada.org/
en/press-room/news-releases/ 2015 −archive/august/american-dental-
association-statement-on-accrediting-dental-therapy-education-programs
[Last accessed on 2016 Aug 8].
8. Mertz E, Mouradian W. Addressing children’s oral health in the new
millennium: Trends in the dental workforce. Acad Pediatr 2009;9:433.
Dulieu: Preventative dentistry in rural communities in the U.S
Dental Hypotheses ¦ Oct-Dec 2016 ¦ Volume 7 ¦ Issue 4 161
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