Understanding Risk Assessment and Management Strategies in Oral Health Care Delivery Systems

CAMBRA is a preventive and personalized approach to the treatment of tooth decay that allows patients and providers to understand the risk of tooth decay and take steps to minimize it. Evidence suggests that risk assessment is an effective way to provide oral health services. If properly trained, navigators can provide oral health counseling and potentially offer risk assessment, screening, and prevention services. Dentists and hygienists typically take a patient's medical history, but they rarely ask about preventive health behaviors such as flu shots, HPV vaccines, or mammograms, or about screening for diabetes or other chronic diseases.

CAMBRA involves collecting information about a patient's oral health and behavior, evaluating the balance of pathological and protective factors, and classifying the patient's risk of suffering from a disease in the future. Gauger and colleagues conducted an extensive review of integrative and collaborative care models for dentistry and primary care. The review was limited to programs that provided preventive services and had a system for comprehensive dental care, whether on-site or off-site. Clinical office referral guidelines and performance measures are being developed, and demonstration programs are beginning to provide information on the barriers that prevent successful links between primary health care and dental care.

The evolution of the dental profession has occurred in isolation from other providers and healthcare settings. Some community agencies or other providers referred at-risk children and pregnant women to participating medical and dental providers or to FQHCs. The NIIOH and ADEA have been national leaders in promoting the integration of oral health into IPE activities. The PBRN dental plays a unique role in hiring, training, and implementing practice-based research among dentists in private offices, both pay-per-service and managed care.

A validated tool created to represent the multifactorial nature of dental caries is management of tooth decay through risk assessment (CAMBRA). This tool emphasizes the balance between pathological and protective factors in the tooth decay process. Even within a healthcare network such as an FQHC, demonstration programs reported logistical difficulties due to different processes at each clinic, as well as a lack of shared EHRs in medical, behavioral, and dental offices. Scientific evidence has shown that preventing and treating tooth decay requires evaluating the patient's risk of tooth decay and then altering the complex dental biofilm and modifying oral factors to improve health.

In the United States, medical and dental care systems are largely isolated from each other, making it difficult for these culturally, financially, and educationally different health professionals to work together to provide comprehensive care to individuals. The authors recognize the National Interprofessional Initiative on Oral Health (NIIOH) and the American Dental Education Association (ADEA), as well as Denice Stewart DDS MHSA and Richard W., for their contributions and views. There is limited research on the process of dental referral to primary care, particularly the interface between primary health care and private dental offices.

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