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This is a finding aid. Unless otherwise noted, the materials described below are physically available in our reading room, and not digitally available through the World Wide Web. See the Duplication Policy section for more information. The following terms from Library of Congress Subject Headings suggest topics, persons, geography, etc. Clicking on a subject heading below will take you into the University Library's online catalog. William Terry Coucha white editor and publisher, was director of the University of North Carolina Press, ; director of the University of Chicago Press, ; sinceeditor and publisher with encyclopedias and commercial publishers; lived in Palo Alto, California; returned to live in Chapel Hill.

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Try out PMC Labs and tell us what you think. Learn More. Integration of oral health into primary health care holds the key to affordable and accessible health care as oral health is still a neglected component in many countries. This review aims to determine integration of oral health into primary health care and provide an evidence-based synthesis on a primary oral healthcare approach. The studies included in this review are according to the following eligibility criteria: the articles in English language, the articles published from January to Octoberand only full text article.

The search yielded articles.

Introduction

After removal of duplicates: articles screened based on title and abstract, full text articles were assessed for eligibility, and 30 full text articles were included. This review showed evidence how oral health is related to general health: focused on common risk factor approach and bidirectional relationship. There are various ways of integration, such as interprofessional education, interprofessional collaborative practice, closed-loop referral process, and various public and private partnerships, and at the same time, there are a lot of barriers in integration.

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Thus, the primary oral health care needs to be developed as an integral part of primary health care. Consequently, there is a need to increase finance, health care workforce, government support, and public—private partnership to achieve the goal of affordable and accessible health care, i.

Primary health care has been defined by the World Health Organization WHO as essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain.

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It is the first level of contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process HCP.

Oral health is considered an integral part of general health. Inthe WHO 7 th global conference has advocated the integration of dental care into primary healthcare services and reliance on the collaborative work of a diverse array of HCP. This integrative strategy rests on the premise that a cluster of modifiable risk factors such as diet and smoking contribute to oral and noncommunicable diseases together. First, at the microlevel the individual or psychological leveldental anxiety, self-identity e. Second, at the mesolevel social processes and community structuressocial support and engagement, transport availability and range of information about dental health and availability of services are potentially limiting factors, contributing to societal definitions of dental health, potential distrust of services and an individual's willingness and ability to seek dental health care.

Third, at the macrolevel overarching population-wide structures and policiesa range of factors limit access.

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The primary oral health care approach empowers health promotion and oral disease prevention and favors health equity. It includes various domains such as risk assessment, oral health evaluation, preventive intervention, communication, and education as well as interprofessional collaborative practice. Thus, the purpose of the review was to determine integration of oral health into primary health care and provide an evidence-based synthesis on a primary oral healthcare approach. The studies included in this review according to the following inclusion criteria: 1 The articles in English language, 2 The articles published from January to October and 3 Only full text article.

S1 lists the keywords and combinations of keywords as well as of MeSH terms Medical Subject Headings used in the searches. Articles were retrieved using the appropriate search strategy for each database.

Additional articles were identified by reviewing the reference lists and bibliographies of the articles obtained by database searching [ Table 1 ]. The search yielded articles identified through electronic database searching and 10 additional articles were identified through reference lists.

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After removal of duplicates: articles screened based on title and abstract, full text articles were assessed for eligibility, and 30 full text articles were included [ Figure 1 ]. For example, a primary health care unit is expected to be able to cure people using staff, procedures and drugs ; deliver vaccines with effective cold chains, immunization schedules and information systems to ensure coverage and provide reproductive health services requiring expertise in family planning methods, skills in advising people, treatment of sexually transmitted diseases and provision of effective follow up.

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Common risk factor approach: It was given by Sheiham and Watt in The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socioenvironmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific[ 5 ] [ Figure 2 ].

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Bidirectional relationship: The bidirectional relationship among oral health and other diseases and conditions provides a strong rationale for a bidirectional relationship between oral health care and primary care. Example: Diabetes and Periodontitis[ 78 ] [ Figure 3 ]. Depicts bidirectional relationship between diabetes and periodontitis Source: Grover and Luthra[ 8 ].

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Table 3 depicts the ways of Integration. These statistics have created a growing awareness of the need for early interventions. Activities to be accomplished during the rotation include creating cooperative working relationships with the relevant community, arranging oral health examination exercises in the field for data collection for class use, organizing oral health education sessions, promoting oral health, rendering oral emergency care and providing atraumatic restorative treatment care.

The most recommended oral health workforce mix includes general dentists, specialist dentists, dental therapists, dental hygienists, dental assistants, dental technologists and more recently, the Community Dental Health Coordinator CDHC. The CDHC will work under the dentist and will be responsible for the following: giving oral health education, prevention, oral health promotion, organizing clinical outreach visits and limited preparatory clinical treatment procedures to be completed by the dentist. It includes a multisector, international and long-term partnership program over three years and is a development model.

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The medical providers have numerous opportunities up to 12, well-child visits from birth to 36 months of age to see infants, toddlers, and preschoolers at frequent and regular intervals; the medical home is being leveraged to expand access to preventive oral health services for children. Basic preventive oral care includes the following:. A small contingent of medical practices in Colorado tested an innovative model where a dental hygienist was co-located in the medical practice.

The participating practices included federally qualified health center, not-for-profit practices and private pediatric medical practices and were situated in both rural and urban settings across Colorado. Depicts dental hygiene operatory in medical home Source: Braun and Cusick[ 13 ].

Telehealth enabled teams teledentistry more commonly refers to a virtual meeting between a dental hygienist and dentist. It uses the latest technology to link dental hygienists in the community with dentists at remote office sites. The goal was to have telehealth-connected dental teams, led by dental hygienists who work in communities, keeping people healthy by providing case management.

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This model had been tested in California. The American Academy of Pediatric Dentistry first issued its support of the dental home concept in after evaluating the success of the medical home policy put forth by the American Academy of Pediatrics in Establishment of a dental home begins no later than 12 months of age and includes referral to dental specialists when appropriate. Most physicians and dentists are in nonintegrated practices, integration can begin using simple agreements regarding referral and acceptance of patients. North Carolina offers an early model of such a practice with the IMB program, which began in Pediatricians provided preventive oral health services and dental referral for Medicaid-enrolled children up to age 42 months with poor access to dental care.

Physicians either employ or co-locate dental hygienists in their practice to provide preventive oral health services to children, pregnant women and patients with chronic diseases such as diabetes. ACOs have ushered in a new paradigm for health care delivery focused on prevention and efficiency via team-based care and community engagement.

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Oral Urgent Treatment OUTfor the emergency, refers to management of oral pain, infections, and trauma. This includes services targeted at the emergency relief of oral pain, management of oral infection and dental trauma. Affordable Fluoride Toothpastes is an efficient tool to create a healthy and clean oral environment.

The widespread and regular use of fluoride toothpaste in non-EME nonestablished market economy countries would have an enormous beneficial effect on the incidence of dental caries and periodontal disease. Atraumatic Restorative Treatment—It can be performed inside and outside a dental clinic, as it uses only hand instruments and a powder—liquid high-viscosity glass-ionomer.

The dimensions of integrated care are structured around the three levels where integration can take place: the macrolevel systemthe mesolevel organizational and the microlevel clinical. The macrolevel system integration : Incorporating vertical and horizontal integration can improve the provision of continuous, comprehensive and coordinated services across the entire care continuum.

Vertical integration is related to the idea that diseases are treated at different vertical levels of specialization i. This involves the integration of care across sectors, e.

Integration of oral health into primary health care: a systematic review

Contrary, horizontal integration is improving the overall health of people and populations i. Mesolevel organizational integration : Organizational integration refers to the extent that services are produced and delivered in a linked-up fashion.

Interorganizational relationships can improve quality, market share and efficiency; for example, by pooling the skills and expertise of the different organizations. Mesolevel professional integration : Professional integration refers to partnerships between professionals both within intra and between inter organizations. Microlevel clinical integration : The coordination of person-focused care in a single process across time, place, and discipline. Functional integration: Linking the micro- meso- and macrolevel. Functional integration includes the coordination of key support functions, such as financial management human resources, strategic planning, information management and quality improvement.

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Normative integration: Linking the micro- meso- and macrolevel. The development and maintenance of a common frame of reference between organisations, professional groups and individuals with respect to shared mission, vision, values and culture [ Figure 5 ]. Depicts rainbow model Source: Harnagea et al. There are various barriers in integration oral health into primary health care [ Table 4 ]. This review shows that integration of oral health into primary health care is the demand of the time.

Tools & resources

This review included only full text articles so that we can understand innovative approaches of integration of primary health care into oral health care. When no integration of oral health into primary health care: In this review, an article by Atchison reveals that in areas where there were no integration between medical and dental care providers, the patient were left to manage the challenges of seeking appropriate care. One costly result had been the seeking of dental care in hospital emergency departments ED. The majority were for nonurgent, nontraumatic dental conditions that, according to Wall and colleagues, could be better treated in community settings.

Where and why integration was successful: In this review, an article by Atchison reveals that in United States, integration was successful because of interprofessional collaborative practice. Example: Boston Medical Center Geriatric. Alternative integration approaches were also found to be as one of the integration approaches in rural states of New Mexico and Colarado. It was seen that integration through closer integration of medical and dental providers was supported by able care organizations like Kaiser Permanente Northwest through Electronic Health Records HER. Why integration was a failure: In this review, it was seen that integration fails in some places of North Carolina and California because of lack of integrated HER that prevents all health care providers from seeing a patient's common care plan and treatment status.

Consequently, there is a need to increase finance, health care workforce, government support and public—private partnership to achieve the goal of affordable and accessible health care, i. Lack of oral health policies and programs—should be incorporated in national primary health care.

Example: It can be included in Janani Sureksha Yojana scheme. Lack of resource—Multi disciplinary practice, closed loop referral system, cost sharing mechanism. Not considered as a felt need only emergency dental care approach is there—Oral health education booklets for allied health professionals and concept of dental home. National Center for Biotechnology InformationU. J Family Med Prim Care.

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