Table 1.

Integration of oral health into primary care: Summary of integrated oral health care programmes

Authors, Country/ Year	Program type/Target population	Program main strategy	Oral health care provider	Main outcomes
Bain & Goldthorpe, Canada/1972	University-initiated outreach /Aboriginal community	• Assigned full-time dentists to community’s hospital, providing dental services in nursing stations and satellites	Dentists & dental residents	• Creation of supportive environment • Demonstration of feasibility, replicability
Rozier et al., USA/2003	Statewide community clinics preventive program/Low income children 0–3 years old	• Reimbursement of non-dental care providers for preventive dental services	Paediatricians, family physicians, nurses and other health care professionals in community clinics	• ↑ trained medical professionals (88% participation rate) • Wide geographical oral health coverage • ↑ 2.8 times the number of practices with submitted claims over one-year period • ↑ follow-up visits
Wysen et al., USA/ 2004	Public-health based program /Low-income children ≤5 years old	• Empowering case management model • Co-location of dental and medical clinics • Providers cross-training • Community education and outreach	Case managers, community agency staff, physicians, public health nurses, dentists and dental hygienists	• Successful training of community care providers • ↑ numbers of screening, dental visits and oral health services • 109% ↑ in fluoride varnish applications over 10-month period
Heuer, S., USA/2007	School-linked clinics /Low income children	• Contractual partnership with a local community dental health center and employment of dental hygienists at school • Training of school nurse practitioners for screening of oral diseases	Nurse practitioners and dental hygienists	• ↑ Parents’ satisfaction • ↓ of no-show rates for dental care
Stevens et al., USA/2007	Oral health-oriented prenatal practice /Pregnant low income adolescents	• Incorporation of evidence-based oral health guidelines in prenatal care • Inclusion of dental consultations in prenatal sessions	Nurse midwives and nurse practitioners, paediatric dental consultant, obstetrician, physician, social worker and nutritional specialist	• ↑ Patients’ satisfaction
Dugdill, L. & Pine, CM., UK/ 2011 Pine CM & Dugdill L, UK/2011	Global multi-objective public-health programs in collaboration with National Dental Associations, the member associations of Federal Dental International (FDI) and Unilever Oral Care/Wide-range population groups	• Public-private partnership • Training of day care workers to deliver oral health promotion in day care centers (Philippines) • Education of future parents (Poland) • Training of dental educators (Indonesia) • Training for dentists (Nigeria)	Non-dental care providers Dentists	• Raised awareness of oral health in 1 million people from 36 countries • ↑ capacity building to deliver oral health in 36 countries • Improvement of oral health status in children over a ten-year period
Brownlee, B., USA/2012 Nycz, G., USA/ 2014 Maxey, H., USA/2015 Taflinger et al., USA/2016 Acharya, A., USA/2016 Gesko, DS., USA/2016	Patient-centered dental homes targeting various models of care: physician led model, administration-driven model, culture of integration, interprofessional collaboration, dental outreach coordinator/Low income children, pregnant women and diabetic patients	• Co-location of dental and medical care • Oral health champion modelling to provide oral health care in the primary care setting • Implementation of protocol for referral protocols • Cross-training of dentists and medical providers	Primary health care providers & clinical assistants Dental care team (dentist, dental hygienist, dental assistant, dental therapist)	• ↓ oral health risk factors for some of the models including • ↑ number of patients receiving dental care in all delivery models • Implementation of systematic and reproducible risk assessment tool for periodontal disease and oral cancer • Some programs based on physician-led models were not sustainable
Ramos-Gomez, FJ., USA/2014	University initiated program in partnership with community-based organizations	• Training of all staff involved • 3-month rotation for dental paediatric residents	Non-dental providers and dental residents	• 672 patients and 1500 visits over a 3 year period • More than 42% of the children had 2 or more visits • 138 patients were maintained caries-free and the programme prevented lesions from progressing in 51 patients
Leavitt Partners, USA/2015	Dental services integrated in accountable care organizations/ Public & private-insured population groups	• Co-location of medical and dental care • Case management • Higher reimbursement rates for care coordination via medical providers • Reimbursement of non-dental and dental care providers for preventive dental services • Contracting with dental associations to provide dental care in private and public settings • Empowering dental leadership	Dentists, care coordinators, non-dental care providers, outreach and referral team	• ↓ 55% of operating room utilization for children’s dental care under sedation • ↓ 50% of dental pain complaints • ↓ 9.1% in emergency visits over one-year period • ↑ 3.3% outpatient visits over one- year period
Wooley, S., Australia/ 2016	Community-controlled primary health care service /Aboriginal population	• Care coordination to enable two-way referrals and information exchange between staff and community	Dentist and dental consultant, nurses	• Fissure sealants and fluoride varnish to 100% of the children over a five- year period • ↓ emergency attendance rates over a five- year period • DMFT = 0 in 53.1% of 12 years old children and dmft = 0 in 16.9% of 0–4 year old children over a five-year period