September 14, 2020
By David Burger
Little Falls, N.Y. — An emergency department referral model is finding success in rural upstate New York, in part because it features a winning trifecta of health care providers — a Community Dental Health Coordinator, an emergency department physician and an oral and maxillofacial surgeon — instilled with the belief that connecting patients to dental care is an essential service.
“The community dental health coordinators have completely changed how dental care is delivered in underserved communities,” said Dr. Laurence Pfeiffer, M.D., an oral and maxillofacial surgeon at Bassett Medical Center. “This novel pilot program has evolved into a revolutionary outreach initiative. The CDHCs help reach the most in need and get them connected with dental providers. This model of proactive care has been shown to reduce health care costs by keeping patients out of the emergency department and in the dental practices where they are much better served.”
CDHC leads the way
Dawn Helstrom, a dental hygienist employed by Bassett, is the CDHC who has been heading up the emergency department referral program since her graduation from the Tempe, Arizona-based Rio Salado Community College’s CDHC program in 2019.
Ms. Helstrom, who is about to complete her fourth decade as a hygienist, had an interest in helping the situation of preventable dental needs where individuals were “overusing the ED perhaps unnecessarily,” she said.
“Most were because in my area those clients were underserved and lacked a dental home,” Ms. Helstrom said. “I felt I could assist these individuals by navigating them through our complex beneficiary health system. As a hygienist, I felt I had the networking capabilities to empower them to help themselves, as well as the community as a whole.”
When Lewis Britton, M.D., director of emergency services at Little Falls Hospital, an affiliate of Bassett, met Ms. Helstrom by chance at a community picnic, they got to talking about ways to enhance access to outpatient services in their rural region. Their goal: to improve overall health care and reduce unnecessary emergency department visits.
“When she began telling me about her interest in launching a CDHC program, I thought that Little Falls Hospital would be the ideal site,” Dr. Britton said. “Despite being an essential component of primary care and preventive medicine, dental care is often overlooked.”
Dr. Britton said that dental complaints are a common reason people visit his team at the emergency department.
“The ED is far from the ideal setting to provide dental care,” he said. “Although we are trained to handle dental emergencies, we have limited equipment and expertise to manage the more frequent, chronic dental issues patients often present to the emergency department with. Finding a way to help these patients obtain outpatient dental services was a priority for us.”
Triad of care
The area was ripe for a program, Dr. Pfeiffer said, which explains why he jumped at the chance to assist Ms. Helstrom to address the escalating problems of emergency department visits for dental care.
“The challenges that affect the patient population we treat are multifactorial,” he said. “These include a low provider-to-patient ratio, inadequate number of providers who accept specific insurance plans, lack of dental knowledge, lack of transportation, geographic barriers, weather barriers, drug abuse, tobacco abuse, lack of dietary education, lack of child care and overall poverty.”
The way Ms. Helstrom works to mitigate the problem is a long and winding but ultimately fruitful road. Dr. Britton and his ER nurse managers keep records of all dental-related emergency department visits. Those who do not have established dental care are referred to Ms. Helstrom. She then reviews the medical record to determine what follow-up is necessary and helps make appropriate arrangements for the patients.
As part of her commitment to the program, Ms. Helstrom personally called and traveled in person to dental offices in the region to speak with dental providers and office management. With this information, she was able to assemble an up-to-date list of dental providers with special attention to those who take new patients.
A dental home is the goal.
Dr. Pfeiffer is a firm believer in dentist and physician teamwork.
“The dental clinic has a great working relationship with our emergency care providers and we are able to address these dental emergencies seamlessly,” he said. “Along with dental patient management, our hospital system took the initiative to play an active role in stopping the opioid epidemic affecting the nation and, on a smaller scale, our rural community. The dental department provided education and hands-on training to the emergency department providers on how to treat the acute dental patient and dental nerve block administration. After the hands-on orientation many of our emergency room providers became proficient in delivering effective dental nerve blocks to patients presenting with acute dental pain and prescribing non-opioid analgesics.”
Although the program is relatively new, Dr. Pfeiffer hailed its early results, as he treats dental infections, facial trauma, nonrestorable teeth, severe pain and suspicious lesions that initially presented at the emergency department.
“If there are less dental-related emergency department visits, then it’s a success,” he said. “Dental care should not first present through the emergency department or via primary care physician. Proper dental care should take place with a dental provider in the dental setting.”
In 2006, the ADA set up a task force to determine how to best meet the needs of dentally underserved rural, urban and American Indian communities. Later, in 2009, the ADA established the Community Dental Health Coordinator pilot program as one component in the effort to break through the barriers that prevent people from receiving regular dental care and enjoying optimal oral health.
In October 2010, the first class of 10 CDHC students completed training in Tempe, Arizona, and Norman, Oklahoma, and began working in tribal clinics, urban and rural Federally Qualified Health Centers, Indian Health Service facilities and other settings.
The ADA is currently providing technical assistance to 18 educational institutions with more than 600 graduates over the years, and 45 states have either a CDHC school program, a graduate of the program or a student in the program.
For more information about the ADA’s CDHC program, visit ADA.org and search for CHDC in the search engine.