Integrating Oral Health, Primary Care, and Health Literacy:
Considerations for Health Professional Practice, Education and Policy
Commissioned by the Roundtable on Health Literacy, Health and Medicine Division, the
National Academies of Sciences, Engineering, and Medicine
Kathryn A. Atchison, D.D.S., M.P.H.
Professor
University of California Los Angeles, School of Dentistry and Fielding School of Public Health
Los Angeles, California
R. Gary Rozier, D.D.S., M.P.H.
Research Professor, Department of Health Policy and Management
University of North Carolina at Chapel Hill, Gillings School of Global Public Health
Chapel Hill, North Carolina.
Jane A. Weintraub, D.D.S., M.P.H.,
Alumni Distinguished Professor
University of North Carolina at Chapel Hill, School of Dentistry
Chapel Hill, North Carolina.
The responsibility for the content of this article rests with the authors and does not necessarily
represent the views of their institutions or the National Academies of Sciences, Engineering, and
Medicine.
1
PREPUBLICATION COPY: UNCORRECTED PROOFS
, Table of Contents
Acknowledgements ......................................................................................... 4
Executive Summary ........................................................................................ 5
1. INTRODUCTION AND OVERVIEW OF METHODS ................................................... 10
Introduction ................................................................................................... 10
Purpose of environmental scan discussion paper .......................................... 18
Overview of methods .................................................................................... 19
Organization of report ................................................................................... 23
References and Source Documents ............................................................... 24
Figure 1-1 ...................................................................................................... 22
2. CURRENT PRACTICES AND GUIDELINES FOR THE
CLINICAL INTEGRATION OF MEDICINE AND DENTISTRY .................................. 29
Background ................................................................................................... 29
Methods ......................................................................................................... 30
Results ........................................................................................................... 32
Discussion ..................................................................................................... 36
References and Source Documents ............................................................... 41
Tables ............................................................................................................ 49
3. PRACTICES DEMONSTRATING INTEGRATION OF
ORAL HEALTH AND PRIMARY CARE........................................................................ 61
Background ................................................................................................... 61
Methods ......................................................................................................... 63
Results ........................................................................................................... 69
Discussion ..................................................................................................... 78
References and Source Documents ............................................................... 82
Tables ............................................................................................................ 87
Figure 3-1 ...................................................................................................... 68
4. INTEGRATION OF ORAL HEALTH CONTENT INTO
HEALTH PROFESSION EDUCATION AND CONTINUING EDUCATION ............... 93
Introduction ................................................................................................... 93
Methods ......................................................................................................... 97
Results: Education ......................................................................................... 99
Results: Continuing Education .................................................................... 123
Discussion ................................................................................................... 143
References and Source Documents ............................................................. 149
Tables .......................................................................................................... 157
2
PREPUBLICATION COPY: UNCORRECTED PROOFS
,5. OVERVIEW OF FOUR CASE STUDIES ......................................................................167
Introduction .................................................................................................167
Methods .......................................................................................................167
Results .........................................................................................................168
Table 5-1 .....................................................................................................175
Case Study 1: Into the Mouths of Babes, North Carolina ..........................177
Case Study 2: HealthPartners, Minnesota ..................................................196
Case Study 3: Grace Health, Michigan ......................................................208
Case Study 4: Transform Oregon – Willamette Dental Group in
collaboration with InterCommunity Health Network Coordinated
Care Organization, Oregon ............................................................. 222
6. RECOMMENDATIONS AND DISCUSSION ...............................................................241
Integration Framework and Terminology ...................................................241
Activities to Promote Integration and Health Literacy Practices ................242
Research and Reporting ..............................................................................246
Summary .....................................................................................................251
References and Source Documents .............................................................252
3
PREPUBLICATION COPY: UNCORRECTED PROOFS
, ACKNOWLEDGEMENTS
The paper’s vision, limitations, and focus were provided by the National Academies of Science,
Engineering, and Medicine Roundtable on Health Literacy. The authors would like to thank the
project officer, Lyla Hernandez and Melissa French for their guidance throughout the study. We
would also like to thank Committee Members Laurie Francis, David Gesko, Alice Horowitz,
Lindsey Robinson, Bernard Rosof, Michael Villaire, Winston Wong for the productive
discussion clarifying the scope of the environmental scan and for reviewing and giving input on
the draft document.
The authors acknowledge the creativity of Mr. Brian Lozano in designing Figures 1-1 and 3-1
and the technical assistance and editing support of Ms. Leslie Hanson at University of California,
Los Angeles School of Dentistry. We further acknowledge the support of Ms. Kathleen McGraw,
Dentistry Librarian, UNC Health Sciences Library for her assistance in search criteria and
project-sharing technology. We acknowledge UCLA students Imran Ahmed and Sogole
Tabatabaiepur for their support with literature search criteria for locating promising leads for the
environmental scan.
The authors appreciate the very generous support of all of the individuals and institutions who
participated in the Case Studies and those who discussed their integration initiatives at their
institutions.
4
PREPUBLICATION COPY: UNCORRECTED PROOFS
Considerations for Health Professional Practice, Education and Policy
Commissioned by the Roundtable on Health Literacy, Health and Medicine Division, the
National Academies of Sciences, Engineering, and Medicine
Kathryn A. Atchison, D.D.S., M.P.H.
Professor
University of California Los Angeles, School of Dentistry and Fielding School of Public Health
Los Angeles, California
R. Gary Rozier, D.D.S., M.P.H.
Research Professor, Department of Health Policy and Management
University of North Carolina at Chapel Hill, Gillings School of Global Public Health
Chapel Hill, North Carolina.
Jane A. Weintraub, D.D.S., M.P.H.,
Alumni Distinguished Professor
University of North Carolina at Chapel Hill, School of Dentistry
Chapel Hill, North Carolina.
The responsibility for the content of this article rests with the authors and does not necessarily
represent the views of their institutions or the National Academies of Sciences, Engineering, and
Medicine.
1
PREPUBLICATION COPY: UNCORRECTED PROOFS
, Table of Contents
Acknowledgements ......................................................................................... 4
Executive Summary ........................................................................................ 5
1. INTRODUCTION AND OVERVIEW OF METHODS ................................................... 10
Introduction ................................................................................................... 10
Purpose of environmental scan discussion paper .......................................... 18
Overview of methods .................................................................................... 19
Organization of report ................................................................................... 23
References and Source Documents ............................................................... 24
Figure 1-1 ...................................................................................................... 22
2. CURRENT PRACTICES AND GUIDELINES FOR THE
CLINICAL INTEGRATION OF MEDICINE AND DENTISTRY .................................. 29
Background ................................................................................................... 29
Methods ......................................................................................................... 30
Results ........................................................................................................... 32
Discussion ..................................................................................................... 36
References and Source Documents ............................................................... 41
Tables ............................................................................................................ 49
3. PRACTICES DEMONSTRATING INTEGRATION OF
ORAL HEALTH AND PRIMARY CARE........................................................................ 61
Background ................................................................................................... 61
Methods ......................................................................................................... 63
Results ........................................................................................................... 69
Discussion ..................................................................................................... 78
References and Source Documents ............................................................... 82
Tables ............................................................................................................ 87
Figure 3-1 ...................................................................................................... 68
4. INTEGRATION OF ORAL HEALTH CONTENT INTO
HEALTH PROFESSION EDUCATION AND CONTINUING EDUCATION ............... 93
Introduction ................................................................................................... 93
Methods ......................................................................................................... 97
Results: Education ......................................................................................... 99
Results: Continuing Education .................................................................... 123
Discussion ................................................................................................... 143
References and Source Documents ............................................................. 149
Tables .......................................................................................................... 157
2
PREPUBLICATION COPY: UNCORRECTED PROOFS
,5. OVERVIEW OF FOUR CASE STUDIES ......................................................................167
Introduction .................................................................................................167
Methods .......................................................................................................167
Results .........................................................................................................168
Table 5-1 .....................................................................................................175
Case Study 1: Into the Mouths of Babes, North Carolina ..........................177
Case Study 2: HealthPartners, Minnesota ..................................................196
Case Study 3: Grace Health, Michigan ......................................................208
Case Study 4: Transform Oregon – Willamette Dental Group in
collaboration with InterCommunity Health Network Coordinated
Care Organization, Oregon ............................................................. 222
6. RECOMMENDATIONS AND DISCUSSION ...............................................................241
Integration Framework and Terminology ...................................................241
Activities to Promote Integration and Health Literacy Practices ................242
Research and Reporting ..............................................................................246
Summary .....................................................................................................251
References and Source Documents .............................................................252
3
PREPUBLICATION COPY: UNCORRECTED PROOFS
, ACKNOWLEDGEMENTS
The paper’s vision, limitations, and focus were provided by the National Academies of Science,
Engineering, and Medicine Roundtable on Health Literacy. The authors would like to thank the
project officer, Lyla Hernandez and Melissa French for their guidance throughout the study. We
would also like to thank Committee Members Laurie Francis, David Gesko, Alice Horowitz,
Lindsey Robinson, Bernard Rosof, Michael Villaire, Winston Wong for the productive
discussion clarifying the scope of the environmental scan and for reviewing and giving input on
the draft document.
The authors acknowledge the creativity of Mr. Brian Lozano in designing Figures 1-1 and 3-1
and the technical assistance and editing support of Ms. Leslie Hanson at University of California,
Los Angeles School of Dentistry. We further acknowledge the support of Ms. Kathleen McGraw,
Dentistry Librarian, UNC Health Sciences Library for her assistance in search criteria and
project-sharing technology. We acknowledge UCLA students Imran Ahmed and Sogole
Tabatabaiepur for their support with literature search criteria for locating promising leads for the
environmental scan.
The authors appreciate the very generous support of all of the individuals and institutions who
participated in the Case Studies and those who discussed their integration initiatives at their
institutions.
4
PREPUBLICATION COPY: UNCORRECTED PROOFS
