Hospital affiliated full-scope dental services: A patient interest-based feasibility study
Dental disease is ubiquitous around the world. In the US, 42% of adults have periodontal disease,1 a percentage that increases with age.2 Approximately 25% of US adults have at least one untreated carious lesion.3 More than half of children have had carious lesions in their deciduous teeth. Similarly, more than half of adolescents have had carious lesions in their permanent teeth.4
One’s quality of life5 and life itself can be compromised by dental disease.6 Even physicians, who are historically underappreciative of the ramifications of chronically poor oral health, are now realizing this fact.7
The reasons potential patients do not access dental care are unsurprising, such as cost and anxiety.8 Other more nuanced factors can be involved and have been reviewed in Dental Economics9 and elsewhere regularly.10
Not uncommonly, hospital emergency rooms have morphed into the primary dental care option for patients who do not have a regular practitioner. Hundreds of thousands of patients a year present to hospitals for nonemergent conditions that would be more optimally be treated in dental offices.11 Annual fees for dental services in hospitals are billions of dollars, exponentially greater than in dental offices for the same procedures.12
Accessible dental care survey results
In an effort to determine patients’ perceptions of what might be a reasonable way to access dental services more regularly, the dental department (not a full-scope practice) at University Medical Center (UMC) in Las Vegas, Nevada queried 456 random patients admitted for nondental inpatient services in May 2024.
The patients were asked: “If UMC established a full-scope dental service, would you be interested in utilizing that for routine dental care?”
The number and percentage of categorial responses were:
- Yes—185 (41%)
- Probably—57 (12.5%)
- Maybe—56 (12%)
- Probably not—48 (10.5%)
- No—110 (24%)
Nearly two-thirds of the patients queried said they would give serious consideration to using traditional office-based dental services that were associated with the hospital.
Establishing an active dental service affiliated with a hospital is generally not a straightforward proposition, for several reasons. For instance, consider the dueling accreditation bodies. The Joint Commission (JC) is the primary entity certifying hospitals.13 In dentistry, the Commission on Dental Accreditation (CODA) is the standard evaluator.14 There are several entities that bridge the gap somewhat, such as the Accreditation Association for Ambulatory Health Care (AAAHC)15 and the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF or Quad A).16 At the state level, dentistry is regulated by dental boards while medicine is overseen by medical boards.
Separation and reuniting of medicine and dentistry
All this has evolved from the fact that dentistry was dubbed a "mechanical trade" and accepted as a course of study at the University of Maryland School of Medicine in 1837. Physician applicant Chapin Harris subsequently founded the Baltimore College of Dental Surgery in 1840, the world’s first dental school.17 Ironically, it was a dentist, Horace Wells, who discovered (first observed and made known) anesthesiology in 1844, proving dentistry was not solely about teeth.18,19 But the die was cast and we’ve had different professions, dentistry and medicine, with innumerable similarities ever since.
The numerically significant population in this study had the demonstrated means to afford elective hospital care. Virtually all individuals in this group will ultimately require dental care and thus may be of interest to hospitals, third-party payors interested in avoiding unnecessary health-care costs, hospital credentialed, affiliated, or community-based dentists.
Although a difficult task, hospital-based dental services have been created before. With a reasonable structure, the provision of dental services via a hospital imprimatur has been wildly successful by any measure.20 Most importantly, our patients want that option.
The author acknowledges the valuable assistance of Leanne Hansen and Justin Green.
Editor's note: This article appeared in the November/December 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
References
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