Views of Dental Providers on Primary Care Coordination at Chairside

Research Aims:(1) To assess dental hygienists’ and dentists’ perspectives and experiences regarding current scope of practice and the integration of primary care activities with routine dental care; and (2) to assess the needs of hygienists and the office environment around primary care screening at chairside.

Methods:This exploratory qualitative study utilized maximum variation sampling to recruit 10 hygienists and 6 dentists from 10 urban dental offices with diverse patient mixes and volumes. A faculty dental hygienist conducted semi-structured, in-depth interviews, which were digitally recorded and transcribed verbatim. Data analysis consisted of multilevel coding based on grounded theory, resulting in emergent themes with accompanying categories.

Results: The majority of dentists and hygienists interviewed identify screening for hypertension, diabetes, and tobacco use and discussing nutrition as relevant to their dental practices, particularly for vulnerable patients. Respondents suggested that such activities are important for many of their colleagues, although the analysis suggests certain challenges, including lack of continuity, accountability, resources, and systems-level support, with opportunities for improvement regarding timeliness, efficiency, and effectiveness. Dental providers’ perspectives of patients’ reactions to discussing the aforementioned health matters underscore salient barriers to care and support increased care integration. Overwhelmingly, hygienists reported using electronic devices at chairside to obtain web-based health information, with variation in terms of accuracy, quality, and reliability.

Conclusions: Dental hygienists occupy a unique and vital role in providing trusted patient-centered primary care, and may be well-positioned to help facilitate greater integration of oral and general health care, including screening, monitoring, and care coordination.