Poor oral health in low-income communities is a wicked problem that causes many burdens on children and adults alike. There is a wide disparity in untreated tooth decay and restricted activity days for children and adults alike. Frequently cited barriers to improving the dental health disparities and achieving these target outcomes include low Medicaid reimbursement rates, unwillingness of dentists to participate in Medicaid, a shortage of dentists, unresolved oral health literacy concerns, costs of care, and a lack of transportation to and from a dental office. These barriers contribute to a lack of access to dental care in low-income neighborhoods. These outcomes can prevent families from improving their low-income status. Atlanta, Georgia is an urban area with pockets of severe health and income disparities. Charles Moore MD, David Reznik DDS, and Hope Bussenius DNP, APRN, FNP-BC have been working to alleviate health disparities on the northwest side of Atlanta for many years. Poor oral health can lead to unnecessary tooth decay, periodontal disease, plaque buildup, pain, infection, and even the quiet and deadly advancement of oral cancer. It also leads to unnecessary and expensive visits to the Emergency Department to treat pain of tooth decay and periodontal disease but not the causal conditions. Finding ways to improve oral health in low-income communities is essential to good health and helping individuals move from poverty to middle class status. It requires an interdisciplinary, collaborative effort of a diverse array of health care workers.
Through this initiative, we will expand capacity to provide oral health services to this community and to communities throughout Georgia by:
- Providing Community Needs Assessments. (3 to 6 Months)
- Increase the number of healthcare professionals in low-income areas trained to provide basic oral health care/cancer screening in low-income communities. (Ongoing in the three-year project)
- Providing program implementation evaluation. (Ongoing in the three-year project)
- Improving community knowledge about oral care issues. (Ongoing in the three years)
- Community Needs Assessment – A neighborhood environmental scan will provide a needs assessment specific to northwest Atlanta.
- Integration of oral health services into primary care.
- Train primary care registered nurses and nurse practitioners to provide basic oral examinations, cancer screening and how to administer sealants.
- Increase Capacity of Low Cost Oral HealthCare.
Increase availability of low-cost dental care: The HEALing Community Center at Neighborhood Union is located in the targeted neighborhood and an oral health program began in August and have the capacity to provide 10,000 visits per year.
School and Afterschool Programs: This program would train school nurses and nurse practitioners who work in the neighborhood schools to do an oral exam, provide oral home care instructions, place sealants, and show students how to use the OTC fluoride rinse.
Advocacy Component: The program staff of the Dental Healthcare Neighborhood would advocate for Georgia State law changes that would increase access to dental care for low-income families.
The initiation of this program would improve four oral health outcomes.
- Improve oral health and access to dental care in low-income populations
- Reduce healthcare cost
- Reduce days missed from school and work
- Improve oral health outcomes when cancer is present
Morehouse School of Medicine Public Health Program, local schools
The engagement of all of the partners in the determination of the performance measures, and the metrics for which data will be collected, will be critical. Once the design has been finalized, the Morehouse School of Medicine Public Health Program will provide qualitative data analysis techniques to ensure that data summaries and interpretations are both valid and reliable, including data reduction, data coding, and conclusion drawing and verification. The fellows and evaluation team will track all activities/outcomes in REDcap.