DSO Addresses Social Determinants of Health (SDOH) to Improve Dental Health Equity in Children

Social Determinants of Health (SDOH) are the non-medical factors that influence health outcomes. SDOH include the conditions people are born into, grow up around, and work and live in over the course of a lifetime. Each of these factors, whether social, environmental or economic, affect a person’s health. Research shows the lower a person’s socioeconomic status, the worse their health.

SDOH have a significant impact on the health and wellbeing of children, particularly in terms of oral health:

The burden of oral disease is disproportionately greater for children of low socioeconomic status.¹
It is estimated that 23% of preschool age children suffer from dental caries and that dental caries are almost twice as likely to affect those living in poverty or minority populations.²
Access to education and healthcare along with public health policies all play a role in children’s oral health.³
Poor oral health can lead to pain, problems with eating, speaking, and learning, as well as an increased risk for developing more serious health conditions and diseases. It can also affect the development of self-esteem and social relationships.⁴
In addition to the emotional toll it takes on a child’s ability to learn, communicate and thrive socially, there are also financial costs associated with delayed dental care. In 2014, 2.43 million visits to the emergency department (ED) for dental conditions cost the U.S. $1.6 billion and an average of $971 for each child visit.⁵

There are a number of factors that can contribute to these disparities. These include limited access to oral health services, reduced insurance coverage for preventive treatments and restorative procedures, and lack of knowledge about proper oral healthcare.

Benevis, a non-branded DSO focused on delivering life-changing oral care and orthodontics to underserved communities, recently published a whitepaper on the painful price of absent oral care and developed a strategy to help address the lack of access to care for the underserved.

Schedule flexibility and enhancements

Research shows that patients highly value convenience and access, with one survey finding that healthcare consumers ranked convenience and location as most important following cost and another found convenience and access to care as the most important factors in their decision-making about where to receive care.

To provide access to more patients, Benevis plans to prioritize patient schedules by extending dental practice hours to include increased weekday evenings and Saturday appointments as the organization continues to expand access to care. Adjustments will phase in gradually across Benevis’ 120 offices in 13 states and Washington, D.C.

With a sharp focus on convenience and access to care, Benevis conducted a pilot in May 2023 across its 120 office locations to review appointment availability and scheduling requests. Team members explored expanded weekday evening and Saturday hours, both of which were met with approval and adoption by the Benevis’ patient population. Following the addition of the expanded dental practice hours, Benevis patient appointments show rates increased by 5-10% on Saturdays and shifted weekdays (10 a.m. to 7 p.m.). Through the adjusted hours, Benevis offices were able to serve up to 25% more patients per day.

“We often see patients come to appointments in their work uniforms or bring their whole family after school or when the bus route comes close to our offices. Those visual reminders show us that our patients are juggling all kinds of lifestyle demands when they come into our care, and it reminds us to be flexible so they are better suited to turn to us for all of their oral healthcare needs on a regular basis,” said Dr. Jane Whang, regional director of clinical for the east region at Benevis. “Exploring and implementing extended patient appointment times will help set up our patients for better oral care in Benevis dental homes throughout their lifetimes.”

Appointment cancellations are one of the biggest scheduling barriers for any dental practice. No show rates are even more prevalent in disadvantaged, unserved populations, where individuals may struggle with inflexible work schedules, family obligations, or transportation issues. Reminder or follow up appointment calls can also be a challenge due to frequent moves and related address or phone number changes.

“We know that some of our patients struggle to make and keep appointments during traditional business hours because of home, school, work, and family commitments,” said Kyle Knopik, vice president of business intelligence and strategy at Benevis. “Providing options that better meet our patients’ schedules will help them maintain preventative care visits and be seen more quickly when other issues arise, contributing to better overall oral health outcomes.”

To accommodate their scheduling change and begin leaning into short-term shifts with more flexible hours for patients, Benevis offices will use data from the pilots to determine which locations can accommodate the expanded hours.

Long term, Benevis is planning its workforce to meet the schedule needs of patients by recruiting office staff and clinicians to support the new model and offer flexible work schedules to those interested in working extended evening hours and Saturdays.

Diversity in workforce

Making a greater effort to diversify the existing workforce of dental professionals to better support the demographics of underserved, minority children could also help to improve oral healthcare for our disadvantaged population.

Less than 4% of U.S. dentists are Black, while 21% of Benevis dentists are Black.⁶
33% of Benevis dentists are women from a minority group.

To date, Benevis has increased care availability by adding more than 100 new dentists to its practices, giving more patients an opportunity to receive care, particularly those who are covered by Medicaid and/or Children’s Health Insurance Programs (CHIP), which makes up over 80% of Benevis patients currently. Benevis expects to increase doctor capacity by around 30% in the communities it currently serves by the end of 2023. To learn more about careers at Benevis, click here.

Goal: Increased access to dental care

In addition to the strides at Benevis, the importance of tackling SDOH disparities is increasingly being recognized by governments and other stakeholders who are taking proactive steps to reduce them through improved access to services. While addressing this issue is complex, a number of initiatives have been launched to help reduce dental health disparities in children:

The Centers for Disease Control and Prevention (CDC) has developed the Oral Health Strategic Plan to identify evidence-based strategies that will improve access to oral healthcare and education.
CDC’s Healthy People 2030 initiative outlines specific goals and objectives to reduce disparities in access to oral healthcare and improve outcomes.
At the state level, some initiatives include increasing funding for dental clinics that serve low-income children, providing preventive services such as fluoride
treatments, and creating school-based programs that provide screenings and education.⁷ Other initiatives focus on increasing awareness of the importance of good oral health and providing access to affordable dental care.
Another approach that received attention in the early 2000s involves policy that requires states to provide certification of a dental screening, examination or assessment for school entry. As of 2019, thirteen states and the District of Columbia require parents or caregivers to provide a dental certificate for school-aged children. Although helpful, this policy has been challenging for states to enforce. Add to that a shortage of Medicaid dental providers, and
policymakers are hesitant to require screenings and exams.
In 2022, the American Dental Association announced a new Health Equity Action Team integrated oral healthcare into primary care practices can help break down barriers and improve access to oral healthcare. One example may include administering an oral health or caries assessment during a child’s medical well check visit.
School sealant programs

By addressing SDOH and oral health disparities in children early on, society can help ensure that children have the opportunity to maintain good oral hygiene and health to increase their chances of reaching their full potential in life.

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Source: Benevis, Whitepaper

References:
1 – World Health Organization (WHO). Social determinants of health. WHO website. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. Accessed March 23, 2023.

2 – Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. U.S. Department of Health and Human Services.

3 – American Academy of Pediatric Dentistry. The State of Little Teeth. https://www.aapd.org/assets/1/7/state_of_little_teeth_final.pdf, Accessed March 27, 2023.

4 – Källestål C, Dahlgren L, Stenlund H. Oral health behavior and self-esteem in Swedish adolescents over four years. J Adolesc Health. 2006 May;38(5):583-90. doi: 10.1016/j.jadohealth.2005.05.021. PMID: 16635771.

5- National Institutes of Health. Oral Health in America: Advances and Challenges. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2021

6 – American Dental Association (ADA) Health Policy Institute. Racial and Ethnic Mix of the Dentist
Workforce in the U.S. https://www.ada.org/-/media/project/ada-organization/ada/ada.org/files/resources/research/hpi/hpigraphic_0221_1.pdf?
rev=1829a4f788c14974a1ac89ff1e288c0f&hash=A27C6AD199EB6FCAB15DB069BAF0CC85.
Accessed March 27, 2023.

7 – Centers for Disease Control and Prevention. Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion. Oral Health Programs. CDC website. https://www.cdc.gov/oralhealth/funded_programs/index.htm. Accessed March 27, 2023.

8 – -Vujicic, Marko, et al. Dentists in Medicaid: Who are they, where do they locate, how do they practice? Health Policy Institute. Webinar. https://us02web.zoom.us/rec/play/0gTOStINoHNi6HA-%20mTb_%20POA6euHCnOOxbHlXfsRJBPbTUvmVVsQYax6kDgjwYwEa3we1MiCTrI1BO4w.%20lGN8
EBpimH5IT9dT? startTime=1663257629000&_x_%20zm_%20rtaid=F7waaRzeQgmb7M3V4bgwUA.1663685529414.8 3cc7a4950a03c3d1c65a38848f43280&_x_zm_rhtaid=987. Published September 15, 2022. Accessed March 27, 2023.

9 -Phipps KR, Ricks TL, Mork NP, and Lozon TL. The oral health of American Indian and Alaska Native children aged 1-5 years: results of the 2018-19 IHS oral health survey. Indian Health Service data brief. Rockville, MD: Indian Health Service. 2019.