Oral Health Toolkit

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Rural Oral Health ToolkitWelcome to the Rural Oral Health Toolkit. The Toolkit is designed to help you identify and

implement an oral health program. It also provides you with resources and best practices.

The toolkit is made up of several modules. Each concentrateson different aspects of oral health programs. Modules also

include resources for you to use in developing a program for

your area.

About the Community Health Gateway and its

Evidence-Based Toolkits

The Community Health Gateway showcases program

approaches that you can adapt to fit your community and thepeople you serve, allowing you to:

Research approaches to featured community health programs Discover what works and why Learn about common obstacles Connect with program experts Evaluate you program to show impact

This toolkit was developed by the NORC Walsh Center for Rural Health Analysis in

collaboration with the Rural Assistance Center.

Funding for this toolkit was provided by the Office of Rural Health Policy (ORHP), Health

Resources and Services Administration.

For the most current version of thetoolkit, please view the toolkit

online:http://www.raconline.org/

communityhealth/oral-health/

If you need assistance withdownloading or accessing the

resources listed in this toolkit,

please contact us:

http://www.raconline.org/contact/
http://www.raconline.org/communityhealth/oral-health/http://www.raconline.org/communityhealth/oral-health/http://www.raconline.org/communityhealth/oral-health/http://www.raconline.org/contact/http://www.raconline.org/contact/http://www.raconline.org/contact/http://www.raconline.org/communityhealth/oral-health/http://www.raconline.org/communityhealth/oral-health/


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Rural Assistance Centerwww.raconline.org

TABLE OF CONTENTS

Module 1: Oral Health in Rural Communities

An overview of oral health in rural communities.

Module 2: Rural Oral Health Program Models

Oral health program models and ways to adapt these programs to meet your communitys needs.

Module 3: Implementation of Rural Oral Health ProgramsResources that support the implementation of oral health programs.

Module 4: Planning for Sustainability

Strategies to ensure the sustainability of your oral health program.

Module 5: Evaluating Rural Oral Health ProgramsA framework for evaluation, methods and considerations, and metrics for oral health programs.

Module 6: Dissemination of Rural Oral Health Resources and Promising Practices

Methods for disseminating results from your oral health program.

Module 7: Program Clearinghouse

Examples of oral health programs that have been implemented in rural communities.


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MODULE 1:ORAL HEALTH IN RURAL COMMUNITIESOral health is a critical component of health and well-being. Poor oral health is related to a range

of diseases in adults and children. Routine oral health care examinations and services can help to

prevent disease and also identify other conditions. Despite the importance of oral health anddevelopments in knowledge and practice in this area, oral health disparities exist in rural

communities related to access to care, utilization of services, and outcomes. This module

provides an overview of oral health in rural America.

In this module

The State of Oral Health in Rural America Barriers to Oral Health Care in Rural Communities Rural Oral Health Program Partners Other Considerations in Light of the Affordable Care Act

The State of Oral Health in Rural America

Oral health is a critical component of health and well-being. Poor oral health is related to a range

of diseases and disorders in adults and children. The Surgeon Generalsreport on oral health

noted that:

You cannot be healthy without oral health. Oral health andgeneral health should not be

interpreted as separate entities. Oral health is a critical component of health and must be

included in the provision of health care and the design of community programs.

Despite the importance of oral health and developments in knowledge and practice in this area,

oral health disparities exist in rural communities. Disparities are evident in oral health access,

utilization, and health outcomes in rural America.

To address these disparities, rural communities are developing oral health programs that are

responsive to the specific needs of their populations. Rural oral health programs are designed to:

Increase access to oral health care Provide oral health care services Increase utilization of services Improve oral health outcomes Improve oral health literacy Reduce barriers to accessing care Raise awareness about oral health Adapt and implement promising and evidence-based approaches Build networks of oral health partners in communities
http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htmhttp://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htmhttp://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htmhttp://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htm


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RESOURCES TOLEARNMORE

Oral Health in America: A Report to the Surgeon General

http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htmReport

Alerts Americans to the full meaning of oral health and its importance to general health and well-

being.Organization: National Institutes of Health, National Institute of Dental and CraniofacialResearch

Date: 2000

Advancing Oral Health in America: Summary

http://www.nap.edu/catalog.php?record_id=13086

Discusses the challenges facing the current oral health system, the connection between oral

health and overall health, and how to improve oral health care. Chapters 2 and 3 discuss the oralhealth system in rural settings.

Report

Organization: Institute of MedicineDate: 2011

The State of Rural Oral Health: A Literature Review

http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfLiterature Review

Detailed literature review of rural health issues associated with the Healthy People 2010 focus

area on oral health.Organization: Rural Healthy People 2010

Authors: P. Fos and L. Hutchison

Date: 2003

Meeting Oral Health Care Needs in America

http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-

883263BC28ABA0A4Policy Brief

This policy brief provides background information on rural oral disparities and gives

recommendations for how to improve rural oral disparities on a national, state and local level. Italso includes a section on suggested dental training programs.

Organization: National Rural Health Association

Date: 04/2005
http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htmhttp://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htmhttp://www.nap.edu/catalog.php?record_id=13086http://www.nap.edu/catalog.php?record_id=13086http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.nap.edu/catalog.php?record_id=13086http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/TOC.htm


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Shortage Designation: Health Profession Shortage Areas & Medically Underserved

Areas/Populations

http://hrsa.gov/shortage/Website

This website includes information about Health Profession Shortage Areas, including dental

HPSAs, and Medically Underserved Areas/Populations by County, State, and Zip code.Organization: Health Resources and Services AdministrationAuthor: N/A

Date: N/A

Structural Cavities in Rural Dental Health

http://www.dailyyonder.com/silent-epidemic-dentistry/2012/03/22/3824

Article

This article describes oral health disparities in rural areas.Organization: Daily Yonder

Author: Chuck Shuford

Date: 03/2012

Barriers to Oral Health Care in Rural Communities

Rural populations face a range of barriers that affect access to oral health care, including:

Low provider-to-population ratios Inadequate number of dentists who accept Medicaid and the Childrens Health Insurance

Program or who have discounted fee schedules

Insufficient or lack of dental insurance benefits Lack of transportation Lack of child care Insufficient levels or lack of access to water fluoridation Lack of awareness about oral health Geographic barriers to care Poverty Cultural barriers and stigma
http://hrsa.gov/shortage/http://www.dailyyonder.com/silent-epidemic-dentistry/2012/03/22/3824http://www.dailyyonder.com/silent-epidemic-dentistry/2012/03/22/3824http://hrsa.gov/shortage/


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Access to Oral Health Services for Low-Income PeoplePolicy Barriers and Opportunities for

Intervention for the Robert Wood Johnson Foundationhttp://www.oralhealthamerica.org/pdf/NCSLReport.pdf

Policy Brief

This policy brief discusses oral health care policy barriers and solutions.Authors: Shelly Gehshan, Tara StrawOrganizations: National Conference of State Legislatures

Date: 10/2002

Meeting Oral Health Care Needs in America

http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-

883263BC28ABA0A4

Policy BriefThis policy brief provides background information on rural oral disparities and gives

recommendations for how to improve rural oral disparities on a national, state and local level. It

also includes a section on suggested dental training programs.Organization: National Rural Health AssociationDate: 04/2005

Oral Health among Low-Income Rural Families: Implications for Policy and Programshttp://www.csrees.usda.gov/nea/food/pdfs/oral_health.pdf

Policy Brief

This policy brief discusses barriers to oral health care.Organization: Department of Family Studies at University of Maryland

Date: 02/2007

The State of Rural Oral Health: A Literature Reviewhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdf

Literature Review

This is a literature of rural oral health.Detailed literature review of rural health issues associated with the Healthy People 2010 focus

area on oral health.

Organization: Rural Healthy People 2010Authors: Pete Fos and Linnae Hutchison

Date: 2003

Rural Oral Health Program Partners

Many rural oral health programs have the support of local health departments, community

clinics, social service organizations, and schools, among other organizations. These relationships

can help rural oral health programs to:

Identify appropriate program partners and volunteers Identify individuals who are in need services and conduct effective outreach
http://www.oralhealthamerica.org/pdf/NCSLReport.pdfhttp://www.oralhealthamerica.org/pdf/NCSLReport.pdfhttp://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.csrees.usda.gov/nea/food/pdfs/oral_health.pdfhttp://www.csrees.usda.gov/nea/food/pdfs/oral_health.pdfhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.csrees.usda.gov/nea/food/pdfs/oral_health.pdfhttp://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.ruralhealthweb.org/index.cfm?objectid=3FA06195-1185-6B66-883263BC28ABA0A4http://www.oralhealthamerica.org/pdf/NCSLReport.pdf


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Understand the barriers to oral health care and identify solutions Leverage resources Refer individuals to other providers and social supports

RESOURCES TOLEARNMOREA Guide for Developing and Enhancing Community Oral Health Programs

http://www.aacdp.com/guide/Community Guide

This guide is designed to help local public health agencies to develop, integrate, expand or

enhance community oral health programs. It provides information on mobilizing communitysupport, assessing needs and existing resources, planning the program, implementing the

program, evaluating the program and participating in policy development and research.

Organization: American Association for Community Dental Programs (AACDP)

Increasing Access to Dental Care in Medicaid: Targeted Programs for Four Populations

http://nashp.org/sites/default/files/Dental_Reimbursements.pdf?q=files/Dental_Reimbursements.pdfPolicy Briefing

This report describes strategies that states have used to address the oral health needs of young

children, pregnant women, people with developmental disabilities and people in rural areas.Organization: National Academy for State Health Policy

Author: Andrew Snyder

Date: 03/2009

Other Considerations in Light of the Affordable Care Act

The Affordable Care Act contains provisions on oral health care coverage and prevention thatmay affect the design and implementation of future rural oral health programs. Section 1302 of

the Affordable Care Actrequires pediatric dental benefitsto be included in the essential health

benefits package. Adult dental benefits are not part of the essential health benefits package.

Other activities that have been authorized by the Affordable Care Act include the development ofa national strategy to coordinate and promote disease prevention, wellness and public health

programs and the development of an evidence-based public education campaign that focuses on

early childhood caries, prevention, and oral health care of pregnant women and at-riskpopulations.
http://www.aacdp.com/guide/http://www.aacdp.com/guide/http://nashp.org/sites/default/files/Dental_Reimbursements.pdf?q=files/Dental_Reimbursements.pdfhttp://nashp.org/sites/default/files/Dental_Reimbursements.pdf?q=files/Dental_Reimbursements.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf#page=46http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf#page=46http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf#page=46http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf#page=46http://nashp.org/sites/default/files/Dental_Reimbursements.pdf?q=files/Dental_Reimbursements.pdfhttp://nashp.org/sites/default/files/Dental_Reimbursements.pdf?q=files/Dental_Reimbursements.pdfhttp://www.aacdp.com/guide/


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Oral Health and the Affordable Care Act: Only Part Way to the Finish Line

http://www.allhealth.org/publications/Oral_Health_Issue_Brief_116.pdfIssue Brief

This brief discusses oral health care access for both adults and children in the U.S. within the

context of the Affordable Care Act.Organization: Alliance for Health ReformDate: 10/2012

Childrens Oral Healthhttp://www.ncsl.org/issues-research/health/childrens-oral-health-policy-issues-overview.aspx

Website

This website examines oral health through the Affordable Care Act, Medicaid and CHIP, Access

to Services, Workforce Issues, and Prevention and Awareness.Organization: National Conference of State Legislatures

Date: 3/2012

Healthcare Reform and Oral Healthhttp://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/

Fact Sheet

This fact sheet summarizes the oral health provisions in the Affordable Care Act.Organization: Oral Health Watch

Date: 2010

Prevention Provisions in the Affordable Care Act

http://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF84-

1010EA1304A4/0/FinalPreventionACAWeb.pdf

Issue BriefThis issue brief summarizes the state of public health in the United States and describes the

major provisions of the Affordable Care Act that address prevention.

Organization: American Public Health AssociationAuthor: G. Shearer

Date: 10/2010

Patient Protection and Affordable Care Act

http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf

Law

Date: 2010
http://www.allhealth.org/publications/Oral_Health_Issue_Brief_116.pdfhttp://www.allhealth.org/publications/Oral_Health_Issue_Brief_116.pdfhttp://www.ncsl.org/issues-research/health/childrens-oral-health-policy-issues-overview.aspxhttp://www.ncsl.org/issues-research/health/childrens-oral-health-policy-issues-overview.aspxhttp://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/http://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF84-1010EA1304A4/0/FinalPreventionACAWeb.pdfhttp://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF84-1010EA1304A4/0/FinalPreventionACAWeb.pdfhttp://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF84-1010EA1304A4/0/FinalPreventionACAWeb.pdfhttp://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdfhttp://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdfhttp://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdfhttp://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF84-1010EA1304A4/0/FinalPreventionACAWeb.pdfhttp://www.apha.org/NR/rdonlyres/763D7507-2CC3-4828-AF84-1010EA1304A4/0/FinalPreventionACAWeb.pdfhttp://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/http://www.ncsl.org/issues-research/health/childrens-oral-health-policy-issues-overview.aspxhttp://www.allhealth.org/publications/Oral_Health_Issue_Brief_116.pdf


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HealthCare.Gov

http://www.healthcare.gov/

WebsiteHealthCare.gov is the first central database of health coverage options, combining information

about public programs with information on more than 8,000 private insurance products.

HealthCare.gov is a federal government website managed by the U.S. Department of Health &Human Services.Organization: U.S. Department of Health and Human Services

Office of Intergovernmental and External Affairs Initiativeshttp://www.hhs.gov/iea/initiatives/index.html

Website

This website includes news and updates about the work the U.S. Department of Health and

Human Services is performing across the country, Affordable Care Act bulletins, andinformation about how the Affordable Care Act affects your community.

Organization: U.S. Department of Health and Human Services

Center for Consumer Information and Insurance Oversight

http://cciio.cms.gov/index.html

Website

The Center for Consumer Information and Insurance Oversight (CCIIO) of the Centers forMedicare & Medicaid Services is charged with helping implement many provisions of the

Affordable Care Act. CCIIO oversees the implementation of the provisions related to private

health insurance.Organization: Center for Consumer Information and Insurance Oversight
http://www.healthcare.gov/http://www.healthcare.gov/http://www.hhs.gov/iea/initiatives/index.htmlhttp://www.hhs.gov/iea/initiatives/index.htmlhttp://cciio.cms.gov/index.htmlhttp://cciio.cms.gov/index.htmlhttp://cciio.cms.gov/index.htmlhttp://www.hhs.gov/iea/initiatives/index.htmlhttp://www.healthcare.gov/


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MODULE 2:RURAL ORAL HEALTH PROGRAM MODELSThis section provides resources about different rural oral health program models.

Different Models

Rural communities are implementing different oral health program models. The program models

are not mutually exclusive. Some programs may apply a combination of these approaches.

Workforce ModelWorkforce models focus on recruiting and retaining dental professionals in rural areas.

Allied Health Professional Model

The allied health professionals model focuses on the different roles that these professionalsprovide dental care, education, and referral, screening and support services.

Access to Medicaid Model

The access to Medicaid model focuses on expanding access to Medicaid through community-based strategies.

Outreach and Education Model

Rural communities are developing community-based outreach and education programs to expand

access to oral health care.

Oral Health Primary Care Integration Model

Rural communities are using different strategies to integrate oral health and primary care.

School-Based Model

Rural communities are implementing school-based oral health programs that provide fluoridevarnish and dental sealants.

Dental Clinic Model

Rural oral health programs are developing dental clinics that provide safety net care to

individuals in order to increase access to care and reduce reliance on emergency services.

Mobile Dental Services Model

The mobile dental services model focuses on providing access to dental care, preventive healthcare, and chronic disease screening and management services.

Dental Home ModelRural communities are designing dental homes for adults and children. The dental home modelemphasizes wellness through improved oral health status, increased collaboration among

providers, and the promotion of health education.

Eligibility and Enrollment ModelRural communities are using eligibility and enrollment models to expand access to oral health

services.


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Community Fluoridation Model

Community water fluoridation is a public health intervention used to prevent tooth decay.

Also in this Module

Guidelines for Rural Oral Health Programs Populations Served Adapting Programs to Serve Your Community

Workforce Model

Recruiting and retaining dentists to practice in rural areas can be challenging because of feweravailable local training programs for dental hygienists and assistants, lower private and public

health insurance reimbursement rates for services and fewer employment opportunities for thedentists spouse. In order to increase access to care, rural communities are using workforce

models to recruit and retain dentists.

Rural workforce approaches include:

Encouraging students from rural communities to choose dental careers by developingprograms that introduce students to the dental profession

Offering incentive programs to dental professionals who serve rural populations,including tuition reimbursement and loan forgiveness programs

Introducing pediatric residents to area dentists interested in recruiting graduates for theirpractices

Creating linkages between dental schools and rural dental clinics to increase the numberof dental student graduates completing a portion of their training in a rural community

IMPLEMENTATI ON CONSID ERATIONS

The Patient Protection and Affordable Care Act contains oral health workforce and training

provisions that may present new opportunities for future rural oral health workforce programs.

Specifically, the Affordable Care Act contains provisions to establish:

Programs to train or employ alternative dental health care providers New opportunities for training dentists A dental faculty loan repayment program for faculty engaged in primary care dentistry

who train rural dentists

New primary care residency programs, including dental programs Funding for graduate dental education


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Healthcare Reform and Oral Health

http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/Fact Sheet

This fact sheet summarizes the oral health provisions in the Affordable Care Act.

Organization: Oral Health WatchDate: 2010

Access to Oral Health Care Services: Workforce Development http://www.astdd.org/access-to-oral-health-care-services-workforce-development/Report

This report describes a public health strategy, assesses the strength of evidence on the

effectiveness of the strategy, and uses practice examples to illustrate successful implementation.

Organization: Association of State & Territorial Dental DirectorsDate: 5/2011

State and Community Best Practice Approach Examples: Workforce Developmenthttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%

20Development

Collection of Program ExamplesThe Association of State and Territorial Dental Directors provides state and community best

practice approach examples on workforce development.

Organization: Association of State and Territorial Dental Directors

Oral Health Workforce in Wisconsin

http://worh.org/files/OralHealthWorkforce04-10.pdf

Power Point PresentationThis presentation discusses the disparities in oral health among rural populations in Wisconsin

and slide 28 provides recommendations related to the oral health work force.

Organization: Rural Health Development Council, Wisconsin Department of Health ServicesAuthor: Lisa Bell

Date: 04/2010

Allied Health Professional Model

Allied health professionals support rural oral health programs by providing oral health care

services, including education, referral, screening and support services. According to theAssociation of Schools of Allied Health Professions, allied health professionals are individuals

who are involved with the delivery of health or related services pertaining to the identification,

evaluation and prevention of diseases and disorders. Allied health professionals include dental

hygienists, dental assistants, health educators, and dental laboratory technicians.

Some states have proposed the creation of a new allied health professional training program for

mid-level dental providers called dental therapists to perform certain procedures. Dental
http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/http://www.astdd.org/access-to-oral-health-care-services-workforce-development/http://www.astdd.org/access-to-oral-health-care-services-workforce-development/http://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://worh.org/files/OralHealthWorkforce04-10.pdfhttp://worh.org/files/OralHealthWorkforce04-10.pdfhttp://worh.org/files/OralHealthWorkforce04-10.pdfhttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://www.astdd.org/state-and-community-practice-examples/&bpareport=Access%20to%20Oral%20Health%20Care%20Services:%20Workforce%20Developmenthttp://www.astdd.org/access-to-oral-health-care-services-workforce-development/http://www.oralhealthwatch.org/policy-center/healthcare-reform-and-oral-health/


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therapists have practiced in countries such as New Zealand, Canada, Hong Kong and Thailand.

Dental therapists also practice in the United States. The Alaska Native Tribal Health Consortium

introduced dental therapists to care for Alaska Natives in tribal villages in 2005. In 2009,Minnesota authorized the training and practice of dental therapists.


Allied health professionals may support school-based programs (seeSchool Based Model),

mobile dental services programs (seeMobile Dental Services Model), dental clinic programs(seeDental Clinic Model), and dental home programs (seeDental Home Model).


Dental Therapists: Background and Updates on Implementation

http://www.dentalboard.state.mn.us/Default.aspx?tabid=1165

Website

Information and documents related to dental therapist licensure.Organization: Minnesota Board of Dentistry

Author: N/ADate: N/A

A Review of the Global Literature on Dental Therapistshttp://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapis

t%20literature%20review.pdf

Literature Review

This document reviews the different ways that countries around the world use dental therapists inthe oral health workforce.

Organization: W.K. Kellogg FoundationAuthor: David Nash, Jay Friedman and Kavita Mathu-MujuDate: 04/2012

American Dental Hygienists Association

http://www.adha.org/This website provides information about the American Dental Hygienists Association and other

resources about oral health.

Organization: American Dental Hygienists Association

American Dental Assistants Association

http://www.dentalassistant.org/This website provides information about the American Dental Assistants Associationand the American Dental Assistants Association Foundation.

Organization: American Dental Assistants Association
http://www.dentalboard.state.mn.us/Default.aspx?tabid=1165http://www.dentalboard.state.mn.us/Default.aspx?tabid=1165http://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapist%20literature%20review.pdfhttp://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapist%20literature%20review.pdfhttp://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapist%20literature%20review.pdfhttp://www.adha.org/http://www.adha.org/http://www.dentalassistant.org/http://www.dentalassistant.org/http://www.dentalassistant.org/http://www.adha.org/http://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapist%20literature%20review.pdfhttp://www.wkkf.org/~/media/97a0e38a926443bf81491c09dca6a7ea/nash%20dental%20therapist%20literature%20review.pdfhttp://www.dentalboard.state.mn.us/Default.aspx?tabid=1165


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American Dental Education Association

http://www.adea.org/

ADEA is the premier association serving the dental education community. Dental education is abroad and varied field that educates individuals as general dentists, specialists, dental hygienists,

dental assistants, and dental laboratory technicians.

Organization: American Dental Education Association

The Association of Schools of Allied Health Professions

http://www.asahp.org/

This website provides information about the Association of Schools of Allied Health Professionsas well as links to other relevant websites.

Organization: The Association of Schools of Allied Health Professions

Access to Medicaid Model

Dental coverage for children has expanded over the years through the Childrens HealthInsurance Program, improvements in state Medicaid programs, pediatric dentistry training, anddental management organizations. However, some rural communities do not have adequate

access to dentists who accept Medicaid for adults. Rural oral health programs are working to

expand access to Medicaid through community-based strategies.


Few rural communities are implementing this model because it is challenging to expand accessto Medicaid using community-based strategies.


Medicaid Travel of Pediatric Dental Teams, Alaska Department of Health and Social Services,

Department of Public Healthhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf

Program Example

This is a best practice approach report.

Organization: Association of State and Territorial Dental DirectorsDate: January 2005

Into the Mouth of Babes

http://www.ncdhhs.gov/dph/oralhealth/partners/IMB.htm

Program ExampleThe Into the Mouths of Babes is a program that reimburses physicians for providing preventive

dental services to children 0 to 3 years of age.Organization: North Carolina Department of Health and Human Services
http://www.adea.org/http://www.adea.org/http://www.asahp.org/http://www.asahp.org/http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://www.ncdhhs.gov/dph/oralhealth/partners/IMB.htmhttp://www.ncdhhs.gov/dph/oralhealth/partners/IMB.htmhttp://www.ncdhhs.gov/dph/oralhealth/partners/IMB.htmhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://www.asahp.org/http://www.adea.org/


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Children and Oral Health: Assessing Needs, Coverage, and Access

Describes the current state of children's oral health status and access to dental care.

Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured

Date: 06/2012

The Current and Future Role and Impact of Medicaid in Rural HealthOutlines and describes the current Medicaid program and its importance to rural America. Also

discusses rural implications of program expansion, including whether and how states choose to

implement changes.

Sponsoring organization: Rural Policy Research Institute Rural Health Panel

Date: 09/2012

view details

Medicaid and Rural America

http://files.cfra.org/pdf/Medicaid.pdf

Issue briefThis issue brief is part of a larger series that examines health care issues in rural America.

Organization: Center for Rural Affairs

Date: February 2012

Outreach and Education Model

Rural communities are developing outreach and education programs that use curricula, tools, and

media to increase community member knowledge and awareness of oral health. Community

outreach and education programs may occur in dental clinics as well (seeDental Clinic Model).Rural oral health programs that focus on outreach and education may partner with Area Health

Education Centers, local health departments, schools, day care centers, tribes, and Head Start

programs. Examples of rural oral health outreach and education activities include:

Hosting a dental booth at a community health fair Identifying champions providers in peer groups to increase awareness of oral health

care challenges in their communities

Working with community health workers to conduct education on oral health self-care and preventive care in order to reduce emergency department visits

Providing teachers with access to ongoing technical assistance on pediatric oral healthissues

Educating providers about the importance of oral examinations of infants and toddlers Conducting outreach to hard-to-reach populations such as migrant farm workers Working with the Women, Infants, and Children and Head Start programs to include

a dental education component
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7681-04.pdfhttp://kaiserfamilyfoundation.files.wordpress.com/2013/01/7681-04.pdfhttp://www.rupri.org/Forms/HealthPanel_Medicaid_Sept2012.pdfhttp://www.rupri.org/Forms/HealthPanel_Medicaid_Sept2012.pdfhttp://www.raconline.org/publications/documents/8908/http://www.raconline.org/publications/documents/8908/http://files.cfra.org/pdf/Medicaid.pdfhttp://files.cfra.org/pdf/Medicaid.pdfhttp://files.cfra.org/pdf/Medicaid.pdfhttp://www.raconline.org/publications/documents/8908/http://www.rupri.org/Forms/HealthPanel_Medicaid_Sept2012.pdfhttp://kaiserfamilyfoundation.files.wordpress.com/2013/01/7681-04.pdf


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Rural oral health programs use culturally appropriate outreach and education strategies.

Educational materials may be translated into different languages. Outreach may occur atchurches, stores, and community centers.


The State of Oral Rural Health

http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdfReport

This document gives an overview of oral health problems in the U.S and highlights five rural

health programs and that are using outreach and education models for improving access to dental

care for rural populations.Organization: Texas A&M Health and Science Center

Author: Pete Fos and Linnae Hutchison

Date: 2003

Oral Health Education Materials for Children

http://www.dphhs.mt.gov/publichealth/oralhealth/

ResourceThis website provides oral health education materials for children in first through fifth grade.

Click on "Oral Health Education" to display the links to specific materials.

Author: Montana Department of Public Health and Human ServicesOral Health Program

Community Health Access Project Pathways Model

http://www.innovations.ahrq.gov/content.aspx?id=2040

Summary

The Community Health Access Project implemented the Pathways Model, which employscommunity health workers who connect at-risk individuals to evidence-based care through the

use of individualized care pathways designed to produce healthy outcomes. While this programdid not focus on oral health education, it could be adapted to focus on oral health.

Author: Agency for Healthcare Research and Quality, U.S. Department of Health and Human

Services

Zero Out Early Childhood Tooth Decay: An Early Head Start Dental Health Initiative

http://www.sph.unc.edu/zoe/

FactsheetThis project is designed to Zero Out all Early (ZOE) childhood tooth decay in children enrolled

in Early Head Start programs in North Carolina. It builds on previous efforts in medical anddental offices to reduce tooth decay and is funded by a 5-year grant (2008 to 2013) from the

National Institutes of Health.Organization: University of North Carolina Gillings School of Global Public Health

Date: N/A
http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdfhttp://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdfhttp://www.dphhs.mt.gov/publichealth/oralhealth/http://www.dphhs.mt.gov/publichealth/oralhealth/http://www.innovations.ahrq.gov/content.aspx?id=2040http://www.innovations.ahrq.gov/content.aspx?id=2040http://www.sph.unc.edu/zoe/http://www.sph.unc.edu/zoe/http://www.sph.unc.edu/zoe/http://www.innovations.ahrq.gov/content.aspx?id=2040http://www.dphhs.mt.gov/publichealth/oralhealth/http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdf


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Smiles for Life: A National Oral Health Curriculum

http://www.smilesforlifeoralhealth.org/

Smiles for Life is a national comprehensive oral health curriculum. This curriculum is designedto enhance the role of primary care clinicians in the promotion of oral health for all age groups

through the development and dissemination of high-quality educational resources. The

curriculum contains educational modules for physicians, nurses, and physician assistants.Organization: Society of Teachers of Family Medicine Group on Oral Health, DentaQuestFoundation, Washington Dental Service Foundation, Connecticut Health Foundation

Into the Mouths of Babes Toolkithttp://www.ncdhhs.gov/dph/oralhealth/partners/IMB-toolkit.htm

Toolkit

TheInto the Mouths of Babes program trains medical providers to deliver preventive oral health

services to high-risk children.Organization: North Carolina Department of Health and Human Services

Oral Health-Primary Care Integration Model

Rural communities are using different strategies to integrate oral health and primary care:

Improving communication between dental and primary care providers Creating interdisciplinary teams where mid-level medical and dental hygienists work

alongside primary care physicians to provide oral health screenings, guidance, and other

services and referrals (SeeAllied Health Professional Model).

Establish referral partnerships between dental clinics and primary care practitioners (SeeDental Home Model).

Using school-based models for dental assessment that refer children to a source ofprimary care (seeSchool-Based Model).

The health commons approach has been used to integrate oral health and primary care foruninsured, low-income rural populations. Health commons sites are primary care safety net

practices that include medical, dental, behavioral, public health and social services. This

approach has been used in New Mexico to pool resources from different public and privatestakeholders in the community.


Partnerships play an important role in the implementation of this model.
http://www.smilesforlifeoralhealth.org/http://www.smilesforlifeoralhealth.org/http://www.ncdhhs.gov/dph/oralhealth/partners/IMB-toolkit.htmhttp://www.ncdhhs.gov/dph/oralhealth/partners/IMB-toolkit.htmhttp://www.ncdhhs.gov/dph/oralhealth/partners/IMB-toolkit.htmhttp://www.smilesforlifeoralhealth.org/


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A Health Commons Approach to Oral Health for Low-Income Populations in a Rural State

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447375/Peer Reviewed Journal Article

This article describes the incorporation of oral health services into a health commons primary

care model.Organization: American Journal of Public Health, Vol. 92, No.1Authors: Stephen Beetstra, Daniel Derksen, Marguerite Ro, Wayne Powell, Donald Fry, ArthurKaufmanDate: January 2002

The State of Rural Oral Health: A Literature Reviewhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfLiterature ReviewThe health commons approach is discussed in the section on proposed solutions.

Organization: Rural Healthy People 2010

Authors: Pete Fos and Linnae HutchisonDate: N/A

School-based Model

Rural communities are implementing school-based oral health programs that provide fluoridevarnish and dental sealants. In school-based dental programs, dentists, dental hygienists, and

community health workers deliver preventive dental services.

A rural oral health program in South Dakota utilizes dental hygienists to perform screenings,fluoride varnish, dental sealants, oral health education to students, and if needed, refer patients to

local dentists that have agreed to treat more complex cases. Dental hygiene students and theirprofessors travel to rural school sites to deliver services.

Another program in rural Montana utilizes a community health advisor to deliver fluoride

varnishes to school children during dental screenings. Also, a program in rural Louisiana is

educating medical and allied health professionals about how to apply fluoride varnish in schools.

School-based programs offer an opportunity to introduce dental hygiene students to the needs of

rural populations, and can increase the rural oral health workforce in the long-term (seeWorkforce Models).


Oral health programs implementing school-based models must obtain the appropriate

permissions from parents and school administrators to work with school-aged children. A school

nurse or school counselor may serve as an outreach coordinator that can assist the dentist incoordinating the program. Rural oral health programs implementing school-based models may

have support from community stakeholders, such as the health department, state office of rural

health, universities, and state dental and dental hygienists associations.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447375/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447375/http://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.srph.tamhsc.edu/centers/rhp2010/10Volume2oralhealth.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447375/


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ENROLLMENTFORMS ANDMANUALS

School Based-Dental Program Information and Enrollment Form

http://www.choptankhealth.org/service%20docs/CC-SBDP-enrollment%20form.pdfForm

This is a letter template for enrolling in a school-based dental program.

Organization: Choptank Community Health SystemDate: May 2011

School-based Fluoride Varnish Program Manual

http://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-Based-

Fluoride-Varnish.pdf

ManualThis manual was prepared for the purpose of sharing lessons learned and productive practices

arising from development, testing and launching a program of providing school-based oral healthpreventive services for children. These consisted of providing basic oral health assessments,

creating and testing a Community Health Advisor model for fluoride varnish application, and

ensuring follow-up referrals and care for children with urgent needs.

Author: Anderson Center for Dental CareDate: 2010

Seal America: The Prevention Intervention, Second Edition, Revisedhttp://www.mchoralhealth.org/seal/

ManualGuide for health professionals who want to implement a school-based dental sealant program.

Includes step-by-step instructions covering staffing, equipment, funding, program evaluation andmore.

Author:Nancy Carter, R.D.H., M.P.H.

Date: 2011

MOREINFORMATION ABOUTSCHOOL -BASEDPROGRAMS

Preventing Dental Caries: School-Based or -Linked Sealant Delivery Programs

http://www.thecommunityguide.org/oral/schoolsealants.html

Summary of FindingsThese programs provide direct delivery of dental sealants to children in school-based or school-

linked settings. The Community Preventive Services Task Force recommends school-based and

school-linked dental sealant delivery programs based on strong evidence of effectiveness in

preventing or reducing tooth decay among children.Community Preventive Services Task Force

Date: 2002
http://www.choptankhealth.org/service%20docs/CC-SBDP-enrollment%20form.pdfhttp://www.choptankhealth.org/service%20docs/CC-SBDP-enrollment%20form.pdfhttp://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-Based-Fluoride-Varnish.pdfhttp://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-Based-Fluoride-Varnish.pdfhttp://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-Based-Fluoride-Varnish.pdfhttp://www.mchoralhealth.org/seal/http://www.mchoralhealth.org/seal/http://www.thecommunityguide.org/oral/schoolsealants.htmlhttp://www.thecommunityguide.org/oral/schoolsealants.htmlhttp://www.thecommunityguide.org/oral/schoolsealants.htmlhttp://www.mchoralhealth.org/seal/http://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-Based-Fluoride-Varnish.pdfhttp://www.oralhealthaccess.org/resources/documents/2010-10-06-Prgrm-Manual-School-Based-Fluoride-Varnish.pdfhttp://www.choptankhealth.org/service%20docs/CC-SBDP-enrollment%20form.pdf


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School-Based Dental Sealant Programs

http://www.cdc.gov/oralhealth/topics/dental_sealant_programs.htm#3

WebsiteProvides information about the evidence supporting school-based sealant programs, as well as

recommendations for implementation.

Organization: Centers for Disease Control and Prevention

Use of Fluoride: School-based Fluoride Mouthrinse and Supplement Programs

http://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplement-

programs-introduction/

Report


This Best Practice Approach Report describes a public health strategy, assesses the strength of

evidence on the effectiveness of the strategy, and uses practice examples to illustrate successfulimplementation.

Date: June 2011

Eastern Plains Oral Health Initiative

http://www.cahec.org/community/oral_health.php

Program Example

The Eastern Plains Oral Health Initiative promotes the health of school children in seven frontierareas of Colorado by employing a school-based dental sealant program and educating

parents/caregivers about the importance of preventive oral health practices for their children.

Organization: Centennial Area Health Education Center

MOREINFORMATION ABOUTCLINICAL RECOMMENDATIONS FORFLUORIDEVARNI SH

Professionally Applied Topical Fluoride: Evidence-Based Clinical Recommendationshttp://jada.ada.org/content/137/8/1151.full

Evidence reviewThis is a summary of evidence-based clinical recommendations developed by an expert panel

established by the American Dental Association Council on Scientific Affairs that evaluated the

collective body of scientific evidence on the effectiveness of professionally applied topical

fluoride for caries prevention.Author: American Dental Association Council on Scientific Affairs

Date: 2006

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htmReport

The recommendations in this report guide dental and other health-care providers, public healthofficials, policy makers, and the public in the use of fluoride to achieve maximum protection

against dental caries while using resources efficiently and reducing the likelihood of enamel

fluorosis.Author: Centers for Disease Control and Prevention

Date: August 2001
http://www.cdc.gov/oralhealth/topics/dental_sealant_programs.htm#3http://www.cdc.gov/oralhealth/topics/dental_sealant_programs.htm#3http://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplement-programs-introduction/http://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplement-programs-introduction/http://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplement-programs-introduction/http://www.cahec.org/community/oral_health.phphttp://www.cahec.org/community/oral_health.phphttp://jada.ada.org/content/137/8/1151.fullhttp://jada.ada.org/content/137/8/1151.fullhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htmhttp://jada.ada.org/content/137/8/1151.fullhttp://www.cahec.org/community/oral_health.phphttp://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplement-programs-introduction/http://www.astdd.org/use-of-fluoride-school-based-fluoride-mouthrinse-and-supplement-programs-introduction/http://www.cdc.gov/oralhealth/topics/dental_sealant_programs.htm#3


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Fluoride Varnish for Preventing Dental Caries in Children and Adolescents

http://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-in-children-and-adolescents

Summary

The review of trials found that fluoride varnish can substantially reduce tooth decay in both milkteeth and permanent teeth.Organization: Cochrane Database of Systematic Reviews

Authors: Marinho VCC, Higgins JPT, Logan S, Sheiham A

Date: January 2009

Dental Clinic Model

Rural oral health programs are developing dental clinics that provide safety net care toindividuals. Some rural communities are leveraging existing dental clinics, while others are

seeking funds to build new free-standing clinics or open clinics within a local medical center. Inone rural program that participates in an oral health consortium, four dental clinics operate in apartnersbuilding at no cost.

Rural oral health programs offer preventive, restorative, surgical and rehabilitation services to

patients, such as:

Dental hygiene (cleaning, scaling, polishing) Oral cancer screening Dental X-rays Dental sealants Fluoride varnish Fillings Root canal therapy Crowns Tooth extraction Dentures Treatment of gum disease

In addition to these services, dental clinics may offer education on oral hygiene, self-care and

wellness maintenance. Rural dental clinics may also provide services for expecting mothers and

mothers with infants, such as information about newborn hygiene and bottle-feeding, sample

dental products, dental wipes, and treatment schedules.

In some dental clinics, dentists or dental students offer their services free of charge. Other dental

clinics may accept Medicaid or use a sliding fee scale. Some dental clinics offer only emergencydental services, and such services are offered at reduced rates.
http://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-in-children-and-adolescentshttp://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-in-children-and-adolescentshttp://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-in-children-and-adolescentshttp://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-in-children-and-adolescentshttp://summaries.cochrane.org/CD002279/fluoride-varnishes-for-preventing-dental-caries-in-children-and-adolescents


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Rural dental clinics are staffed in different ways. Some programs recruit dentists to provide

dental care to patients on a rotational schedule, sharing the responsibility across providers. Otherprograms work with dental residents to provide free dental care. Programs also offer multi-day

portable clinic events staffed by dental and medical professionals and community member

volunteers.

Rural oral health programs have established patient advisory groups to guide their projects in

order to identify and understand the needs of their priority population. In some cases, food,transportation and modest compensation are offered to advisory group members to improveparticipation.


American Dental Association Center for Evidence-based Dentistry

http://ebd.ada.org/about.aspx

WebsiteThe Center for Evidence-based Dentistry provides a database of systematic reviews on all oral

health topics, synopses of the key elements of systematic reviews, clinical recommendations and

guidelines, and links to other many outside resources including tutorials, glossaries, anddatabases.

Organization: American Dental Association

Dental Support Center

http://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspx

The purpose of the Dental Support Center (DSC) is to improve access to quality clinical and

preventative services for the Indian Health Service Beneficiaries. The website contains patient

educational resources and templates that could be used in other clinics.Organization: United South and Eastern Tribes, Inc.

Mission of Mercy

https://www.amissionofmercy.org/aboutus/

Program ExampleSince 1994, Mission of Mercy has been providing free healthcare, free dental care and free

prescription medications to the uninsured and underinsured.

Organization: Mission of Mercy

The Calhoun County Dentists Partnership: A Hands-Up, Not a Hand-Out

http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=40

Journal ArticleThis article describes the Calhoun County Dentists Partnership that provides dental care to

patients in exchange for community service at local nonprofit organizations.

Citation: Journal of the Michigan Dental Association, Issue 94, Vol. 3, p. 38-41Author: Sharon Emery

Date: March 2012
http://ebd.ada.org/about.aspxhttp://ebd.ada.org/about.aspxhttp://ebd.ada.org/ClinicalRecommendations.aspxhttp://ebd.ada.org/Resources.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspxhttps://www.amissionofmercy.org/aboutus/https://www.amissionofmercy.org/aboutus/http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=40http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=40http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=40http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=40http://www.smilemichigan.com/Portals/pro/Journals/March%202012/index.html?pageNumber=40https://www.amissionofmercy.org/aboutus/http://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspxhttp://ebd.ada.org/Resources.aspxhttp://ebd.ada.org/ClinicalRecommendations.aspxhttp://ebd.ada.org/about.aspx


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School-based Oral Health Screening Materials

http://www.dphhs.mt.gov/publichealth/oralhealth/Resource

This website provides oral health screening resources including basic screening survey manuals

and video, screening form, parental consent letter, among other resources.Author: Montana Department of Public Health and Human ServicesOral Health Program

How to Start a Dental Clinic

http://www.nnoha.org/practicemanagement/startclinic.htmlResource

This is a resource that provides information on starting a dental clinic.

Organization: National Network for Oral Health Access

Date: N/A

Dental Forms Library

http://www.nnoha.org/dentallibrary.htmlForms

The National Network for Oral Health Access Dental Forms Library is a collection of forms in

use by safety-net oral health programs across the country. These sites are sharing their forms to

allow other programs to have a reference in developing their own material.Organization: National Network for Oral Health Access

2011-12 Definitions, Oral Health Policies, Clinical Guidelineshttp://www.aapd.org/policies/

The American Academy of Pediatric Dentistry (AAPD) Reference Manual is divided into five

sections: (1) definitions; (2) oral health policies; (3) clinical guidelines; (4) endorsements; and

(5) resources. Oral health policies are statements relating to AAPD positions on various publichealth issues. Clinical guidelines are practice recommendations designed to assist the dental

provider in making decisions concerning direct patient care.

Organization: American Academy of Pediatric DentistryDate: 2011

Oral Health Disparities Collaborative Implementation Manualhttp://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&or

ig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manu

al.pdf%C2%A0

Shares experiences and lessons learned from health centers that participated in the 2005 HRSAOral Health Disparities Collaborative Pilot. Organization: The Health Resources and Services

Administration, U.S. Department of Health and Human Services

Date: June 2008
http://www.dphhs.mt.gov/publichealth/oralhealth/http://www.dphhs.mt.gov/publichealth/oralhealth/http://www.nnoha.org/practicemanagement/startclinic.htmlhttp://www.nnoha.org/practicemanagement/startclinic.htmlhttp://www.nnoha.org/dentallibrary.htmlhttp://www.nnoha.org/dentallibrary.htmlhttp://www.aapd.org/policies/http://www.aapd.org/policies/http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.aapd.org/policies/http://www.nnoha.org/dentallibrary.htmlhttp://www.nnoha.org/practicemanagement/startclinic.htmlhttp://www.dphhs.mt.gov/publichealth/oralhealth/


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Mobile Dental Services Model

Rural communities deliver dental services through mobile dental vans or portable dental clinics

in population centers, schools, or hard-to-reach areas. A mobile dental van may include dental

operatories; X-ray facilities; a sterilization system; and computer for processing claims, updating

medical records, and scheduling appointments. The mobile dental services model focuses onproviding access to dental care, preventive health care, and chronic disease screening and

management services for underserved residents of isolated communities. Mobile dental services

models offer access to care for residents that would otherwise have to travel a long distance toreach a dentist.

Services offered by mobile dental programs may include providing dental exams, providingeducation, and delivering dental sealants. Root canals and oral surgery are two services not often

provided by a mobile program. Mobile dental programs may also transport dental equipment to

Head Start centers, schools, and nursing facilities to enable providers to provide care on site. The

mobile dental program may submit claims to Medicaid and third party insurances. The Tioga

Mobile Dental Services program, sponsored by the Tioga County Health Department, is onemodel that has been adapted by rural communities.

IMPLEMENTATI ON CONSIDERATIONS

Relationships with community stakeholders are imperative to the success of the mobile dentalservices model. Rural programs have worked with schools and government agencies that are

vested in the program to provide the electronic, water and septic hook-ups. While the van is on

site, local dental professionals donate supplies and equipment. Community stakeholders may

also help program staff by referring clients. The mobile program may refer patients for morespecialized care to private dental practices.

Mobile dental services programs have different staff needs than other programs. For example,programs typically hire or work with a coordinator who is responsible for scheduling

appointments, determining eligibility, billing, reporting, and community outreach. Some

programs have a policy that van staff must be able to lift at least 50 pounds of portableequipment.

Finally, it is important for this program model to maintain diverse funding streams from patientfees, in-kind support from local organizations or foundations, and fundraising events.

Maintenance of the van can be expensive, given the costs associated with obtaining appropriate

licenses and winterizing the van in harsh climates.


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Medicaid Travel of Pediatric Dental Teams, Alaska Department of Health and Social Services,

Department of Public Healthhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf

Report

A best practice approach report that describes a program in Alaska that reimburses travel and perdiem expenses for pediatric dental teams in order to improve access to dental care services.Organization: Association of State and Territorial Dental Directors

Date: January 2005

Tioga Mobile Dental Services, Tioga County Health Department

http://naccho.org/topics/modelpractices/database/practice.cfm?practiceID=315

Report

This program is highlighted as a model practice in the National Association of County and CityHealth Officials best practice database.

Organization: National Association of County and City Health Officials

Medicaid Travel of Pediatric Dental Teams, Alaska Department of Health and Social Services,Department of Public Health

http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf

Program ExampleThis is a best practice approach report.


Date: January 2005

Dental Home Model

The dental home model of care is a comprehensive approach to improving oral health access forvulnerable populations by providing a regular source of care. The American Academy of

Pediatric Dentistry adopted the dental home as a policy in 2001 and defined it as the ongoing

relationship between the dentist and the patient, inclusive of all aspects of oral health caredelivered in a comprehensive, continuously accessible, coordinated, and family-centered way.

The dental home model emphasizes overall wellness through improved oral health status,

increased collaboration among providers, and the promotion of health education. Ruralcommunities are designing dental homes for both adults and children.

The Carolina Dental Home Program in North Carolina has been replicated in rural communities.

This program brings physicians and dentists together to provide dental care for children onMedicaid from birth to three years old. Rural communities have adapted the Carolina Dental

Home Program by targeting children outside of the primary care setting, such as at child care

centers and community events, and expanding the targeted age group.

Rural communities have also adapted the Michigan Community Dental Clinic program. This

network of public health clinics serves adults and children on Medicaid as well as low income,
http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://naccho.org/topics/modelpractices/database/practice.cfm?practiceID=315http://naccho.org/topics/modelpractices/database/practice.cfm?practiceID=315http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdfhttp://naccho.org/topics/modelpractices/database/practice.cfm?practiceID=315http://www.astdd.org/bestpractices/DES02001AKmedicaidtravel.pdf


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uninsured individuals. This program is striving to expand the clinic system to establish dental

homes for persons unable to obtain care in private sector settings.


The dental home model emphasizes wellness, prevention and disease management. Dental

hygienists, dental assistants, nutritionists, and health educators can play an important role insupporting dental home programs. Some dental home programs may include an outreach

component to identify people who are at greatest risk of oral disease. Dental home programs may

also offer screenings and referrals for other services and supports. Therefore, dental homerequires collaboration across other providers, agencies and organizations in the community.


Policy on the Dental Home

http://www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdf

Policy

The American Academy of Pediatric Dentistry supports the concept of a dental home for allinfants, children, adolescents, and persons with special health care needs.


Policy on Workforce Issues and Delivery of Oral Health Services in a Dental Homehttp://www.aapd.org/media/Policies_Guidelines/P_WorkforceIssues.pdf

This is the American Academy of Pediatric Dentistryspolicy that focuses on the benefits of

dental services delivered within a dentist-directed dental home.


Carolina Dental Home Programhttp://www.ncdhhs.gov/dph/oralhealth/partners/CarolinaDentalHome.htm

Program Example

The N.C. Oral Health Section, partnering with the UNC-CH Gillings School of Global Public

Health, designed this pilot program to improve access to dental care for young children. Theobjective of the Carolina Dental Home program is to identify best practices for treating and

preventing tooth decay in young children. This pilot program has been funded by Health

Resources and Services Administration (HRSA).

Michigan Community Dental Clinics

http://midental.org/about-us/WebsiteThis program helps local health departments in Michigan establish dental clinics, based on the

successfulDental Clinics Northmodel.

Date: N/A
http://www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdfhttp://www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdfhttp://www.aapd.org/media/Policies_Guidelines/P_WorkforceIssues.pdfhttp://www.aapd.org/media/Policies_Guidelines/P_WorkforceIssues.pdfhttp://www.ncdhhs.gov/dph/oralhealth/partners/CarolinaDentalHome.htmhttp://www.ncdhhs.gov/dph/oralhealth/partners/CarolinaDentalHome.htmhttp://midental.org/about-us/http://midental.org/about-us/http://www.nwhealth.org/dcn.htmlhttp://www.nwhealth.org/dcn.htmlhttp://www.nwhealth.org/dcn.htmlhttp://www.nwhealth.org/dcn.htmlhttp://midental.org/about-us/http://www.ncdhhs.gov/dph/oralhealth/partners/CarolinaDentalHome.htmhttp://www.aapd.org/media/Policies_Guidelines/P_WorkforceIssues.pdfhttp://www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdf


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Eligibility and Enrollment Model

Rural communities are using eligibility and enrollment models to expand access to oral health

services. The eligibility and enrollment model is often a component of a school-based model,

dental clinic model, or dental home model.

Some programs provide insurance counseling and enrollment assistance. For example, one rural

community works with Medicaid outreach workers to enroll eligible individuals into Medicaid.

The Medicaid outreach worker also coordinates with local offices to secure applications andrenewal forms ahead of dental visits. Another rural oral health program works with the county

health department to refer individuals to a dental home. This program has an arrangement with

local dentists to provide dental services at a reduced cost. Programs may also provideinformation and referrals to help families to access other social services that are available in the

community as well as transportation assistance.


Eligibility and enrollment models require strong partnerships in the community where patientscan be referred for services. Partners include colleges, health and social service agencies,

schools, dental societies, churches, Area Health Education Centers, and legal services

organizations.


The State of Oral Rural Health

http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdf

Report

This document gives an overview of oral health problems in the U.S. and highlights five ruralhealth programs and their models for improving access to dental care for rural populations.

Programs that incorporate eligibility and enrollment components include Miles for Smiles and

Choptank Community Health Systems Oral Health Prevention Program.Organization: Texas A&M Health and Science Center

Author: Pete Fos and Linnae Hutchison

Date: 2003

Access to Baby and Child Dentistry

http://abcd-dental.org/

Program Example

Works to increase the number of Medicaid-enrolled babies, toddlers and preschoolers whoreceive dental care in Washington state. Onestudyevaluated the program in a rural county.

Organization: A public-private partnership managed by Washington Dental Service Foundation
http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdfhttp://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdfhttp://abcd-dental.org/http://abcd-dental.org/http://www.ncbi.nlm.nih.gov/pubmed/14700089http://www.ncbi.nlm.nih.gov/pubmed/14700089http://www.ncbi.nlm.nih.gov/pubmed/14700089http://www.ncbi.nlm.nih.gov/pubmed/14700089http://abcd-dental.org/http://srph.tamhsc.edu/centers/rhp2010/10Volume1oralhealth.pdf


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Community Water Fluoridation Model

Community water fluoridation is a public health intervention to prevent tooth decay. One of the

Healthy People 2020 oral health objectives is to increase the proportion of the U.S. population

served by community water systems with optimally fluoridated water. Water fluoridation

prevents tooth decay by ensuring that teeth have frequent contact with low levels of fluoride.While there are other available sources of fluoride, studies have shown that water fluoridation

can reduce tooth decay by 25 percent over a persons lifetime. Rural populations are less likely

to have access to adequately fluoridated drinking water. Few rural oral health programs havefocused on community water fluoridation.


The local community can become the driving force to promote fluoridation and oral health.

Successful program shave active participation from professionals responsible for water policy aswell as oral health professionals. Water fluoridation programs may encounter policy, technical

and logistical challenges.


Fluoride Legislative User Information Database (FLUID)http://fluidlaw.org/

The Fluoride Legislative User Information Database (FLUID) is a comprehensive database

containing historical information on legal cases decided by U.S. courts and current informationon federal and state policies regarding community water fluoridation. Local policies that affect

significant U.S. population bases are added over time.

Water Fluoridation and Dental Health Indicators in Rural and Urban Areas of the United Stateshttp://publichealth.hsc.wvu.edu/wvrhrc/docs/2011_fluoridation_final_report.pdf

Report

Findings from this report suggest the need to improve access to adequately fluoridated publicwater for rural populations.

Organization: West Virginia Rural Health Research Center

Author: Michael Hendryx, PhD, R. Constance Weiner, DMD, Matthew Gurka, PhDDate: November 2011

Preventing Dental Caries: Community Water Fluoridation

http://www.thecommunityguide.org/oral/fluoridation.html

Summary of FindingsThe Community Preventive Services Task Force recommends community water fluoridation

based on strong evidence of effectiveness in reducing tooth decay.

Organization: Community Preventive Services Task ForceDate: 2002
http://fluidlaw.org/http://publichealth.hsc.wvu.edu/wvrhrc/docs/2011_fluoridation_final_report.pdfhttp://publichealth.hsc.wvu.edu/wvrhrc/docs/2011_fluoridation_final_report.pdfhttp://www.thecommunityguide.org/oral/fluoridation.htmlhttp://www.thecommunityguide.org/oral/fluoridation.htmlhttp://www.thecommunityguide.org/oral/fluoridation.htmlhttp://publichealth.hsc.wvu.edu/wvrhrc/docs/2011_fluoridation_final_report.pdfhttp://fluidlaw.org/


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Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm

ReportThe recommendations in this report guide dental and other health-care providers, public health

officials, policy makers, and the public in the use of fluoride to achieve maximum protection

against dental caries while using resources efficiently and reducing the likelihood of enamelfluorosis.Organization: The Centers for Disease Control and Prevention, U.S. Department of Health and

Human Services

Date: 2001

State and Community Best Practice Approach Examples: Community Water Fluoridation

http://www.astdd.org/state-and-community-practice-

examples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20FluoridationCollection of Program Examples

The Association of State and Territorial Dental Directors provides state and community best

practice approach examples on community water fluoridation.Organization: Association of State and Territorial Dental Directors

Resource Highlights:Focus on Fluoridated Community Water

http://www.mchoralhealth.org/highlights/water.htmlCollection of Resources

This collection of selected resources offers information about fluoridated community water.

Organization: National Maternal and Child Health Oral Health Resource CenterDate: September 2011

Guidelines for Rural Oral Health Programs

Rural communities are using evidence-based practices and guidelines to develop rural oral health

programs. For example, rural oral health programs that target infants and children areincorporating the American Academy of Pediatric Dentistrys recommendations and guidelinesrelated to treatment options for early childhood caries, perinatal oral health care, infant oral

health care, oral health care for the pregnant adolescent, and management of the dental patient

with special health care needs. TheAmerican Dental Association Center for Evidence-based

Dentistrywebsite may also be helpful to rural communities that are identifying clinicalrecommendations and guidelines for their oral health programs.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htmhttp://www.astdd.org/state-and-community-practice-examples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20Fluoridationhttp://www.astdd.org/state-and-community-practice-examples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20Fluoridationhttp://www.astdd.org/state-and-community-practice-examples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20Fluoridationhttp://www.mchoralhealth.org/highlights/water.htmlhttp://www.mchoralhealth.org/highlights/water.htmlhttp://ebd.ada.org/about.aspxhttp://ebd.ada.org/about.aspxhttp://ebd.ada.org/about.aspxhttp://ebd.ada.org/about.aspxhttp://ebd.ada.org/about.aspxhttp://ebd.ada.org/about.aspxhttp://www.mchoralhealth.org/highlights/water.htmlhttp://www.astdd.org/state-and-community-practice-examples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20Fluoridationhttp://www.astdd.org/state-and-community-practice-examples/?bpareport=Use%20of%20Fluoride:%20Community%20Water%20Fluoridationhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm


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American Dental Association Center for Evidence-based Dentistry

http://ebd.ada.org/ClinicalRecommendations.aspxWebsiteThe Center for Evidence-based Dentistry provides a database of systematic reviews on all oral

health topics, synopses of the key elements of systematic reviews, clinical recommendations andguidelines, and links to other many outside resources including tutorials, glossaries, anddatabases.

Organization: American Dental Association

Dental Guidelines

http://www.usetinc.org/programs/uset-thps/DentalSupportCenter/Guidlines.aspx

Guideline

This website provides an overview of the recommendations for using fluoride and dentalsealants.

Organization: United South & Eastern Tribes, Inc.

2011-12 Definitions, Oral Health Policies, Clinical Guidelineshttp://www.aapd.org/policies/

The American Academy of Pediatric Dentistry (AAPD) Reference Manual is divided into five

sections: (1) definitions; (2) oral health policies; (3) clinical guidelines; (4) endorsements; and(5) resources. Oral health policies are statements relating to AAPD positions on various public

health issues. Clinical guidelines are practice recommendations designed to assist the dental

provider in making decisions concerning direct patient care.Organization: American Academy of Pediatric Dentistry

Date: 2011

Populations Served

Rural oral health programs serve a range of different populations:

Uninsured and underinsured individuals School-age children Mothers and pregnant women Medicaid recipients Minority populations The homeless

Some rural oral health programs have conducted community health needs assessment to identify

their priority populations.
http://ebd.ada.org/ClinicalRecommendations.aspxhttp://ebd.ada.org/ClinicalRecommendations.aspxhttp://ebd.ada.org/ClinicalRecommendations.aspxhttp://ebd.ada.org/Resources.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter/Guidlines.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter/Guidlines.aspxhttp://www.aapd.org/policies/http://www.aapd.org/policies/http://www.aapd.org/policies/http://www.usetinc.org/programs/uset-thps/DentalSupportCenter/Guidlines.aspxhttp://ebd.ada.org/Resources.aspxhttp://ebd.ada.org/ClinicalRecommendations.aspxhttp://ebd.ada.org/ClinicalRecommendations.aspx


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Hard to Reach: Rural Homelessness & Health Care

http://www.nhchc.org/wp-content/uploads/2011/10/Rural-Homelessness.pdfProject Report

This report discusses homelessness in rural areas and compares its impact on health care access

and outcomes in rural areas versus urban areas.Author: Patricia A. PostDate: 01/2002

Adapting Programs to Serve Your Community

Rural communities may also take guidance and direction for oral health programs from

promising programs. One rural community developed a program that combines treatment and

education services in a dental clinic by adapting a dental disease management initiative focusedon risk-based treatment and patient education, Caries Management by Risk Assessment

(CAMBRA). Another community used theHealth Resources and Services AdministrationsHealth Disparities Collaborativeas the basis for their rural oral health program. TheUnitedSouth and Eastern Tribes Dental Support Centerprovides an organizational model and guidelines

that can be adapted to rural community attributes.

In addition to implementing promising programs, rural communities are also adapting theirprogram activities to best serve their populations. For example, when providing mobile dental

services in rural areas, a dental van can be rotated to various locations on a weekly basis rather

than a daily basis to accommodate for the longer travel distances. Additionally, a mobile dental

services program may incorporate a teledentistry component to prescreen and diagnose patientsbefore the van arrives in a particular community.

To accommodate patients schedules, some programs provide two-to-three day portable clinicaccess events at Federally Qualified Health Centers (FQHCs) and health departments. These

events are staffed by dental and medical professionals and community member volunteers, and

offer opportunities for people to access care without an appointment.


Oral Health Disparities Collaborative Implementation Manual

http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&or

ig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manu

al.pdf%C2%A0Shares experiences and lessons learned from health centers that participated in the 2005 HRSA

Oral Health Disparities Collaborative Pilot.

Organization: The Health Resources and Services Administration, U.S. Department of Healthand Human Services

Date: June 2008
http://www.nhchc.org/wp-content/uploads/2011/10/Rural-Homelessness.pdfhttp://www.nhchc.org/wp-content/uploads/2011/10/Rural-Homelessness.pdfhttp://www.ihi.org/knowledge/Pages/OtherWebsites/HealthDisparitiesCollaboratives.aspxhttp://www.ihi.org/knowledge/Pages/OtherWebsites/HealthDisparitiesCollaboratives.aspxhttp://www.ihi.org/knowledge/Pages/OtherWebsites/HealthDisparitiesCollaboratives.aspxhttp://www.ihi.org/knowledge/Pages/OtherWebsites/HealthDisparitiesCollaboratives.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspxhttp://www.usetinc.org/programs/uset-thps/DentalSupportCenter.aspxhttp://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.nnoha.org/goopages/pages_downloadgallery/download.php?filename=20606.pdf&orig_name=oral_health_implementation_manual.pdf&cdpath=/oral_health_implementation_manual.pdf%C2%A0http://www.useti

Documents

Oral Health Toolkit