Survey of Medicaid Dentists Reveals “Confidence Gap” in Ability to Implement Necessary COVID-Related Changes, Consensus on Need to Redesign Oral Health Care Delivery Practices
Safety net dental practices recognize long-term changes ahead but lack confidence in adapting to these changes
The DentaQuest Partnership for Oral Health Advancement (DentaQuest Partnership) today released a report highlighting the results of a national survey of more than 37,000 predominantly Medicaid dental providers — the first research of its kind focused on the oral health safety net. The authors identified changes to how dentists provide oral health care, including prioritizing minimally invasive treatment and telehealth to limit the spread of COVID-19 and improve care and access overall. Roughly 4,000 dental providers in 35 states completed the voluntary survey.
“We’ve seen data on how dentists are navigating the pandemic, but no one has looked specifically at the oral health safety net,” said the DentaQuest Partnership President and CEO Dr. Myechia Minter-Jordan. “Medicaid dental providers are critical to ensure access to oral health care for millions of adults and children who otherwise wouldn’t have it. Understanding how Medicaid dental providers and the patients they serve have fared is the best way to ensure we can support dentists serving our most vulnerable communities.”
The COVID-19 virus is thought to spread mainly through respiratory droplets when an infected person coughs, sneezes or even talks. Because spread is more likely when people are in close contact, and because several dental procedures require high-speed tools that aerosolize respiratory droplets, the dental care setting presents an increased risk of exposure and therefore has had significant disruptions.
Nearly all of the survey respondents agree those disruptions will be long-term for dentistry moving forward. Specifically, providers expect changes to the way clinical and non-clinical staff do their work (71%) and infection control procedures (69%). More than half of providers also anticipate greater staff concerns about occupational hazards (55%) and 50% anticipate a drop in patient trust. Most respondents agree on these long-term changes, but there is a gap between what providers say they need to do to reduce risk and their level of confidence that they can implement those changes.
This confidence gap is surprising in several ways, including the fact that at least
- 10% of respondents are not confident they can implement any of the survey’s 7 factors to reduce the risk of COVID-19 infection.
- While 65% of providers agree their dental practice should reduce the spread of aerosols through the air, half (50%) were confident they could do so.
- 65% of respondents agree it’s important to perform fewer aerosol-generating procedures, but just 55% are confident they can do so.
- Ninety-four percent of dental providers agreed they should secure additional PPE but only 59% were confident in their ability to acquire enough.
Overall, the findings indicate the need for a broad strategy that refocuses dentistry’s care pathway to maintain and even improve access to care while minimizing transmission risk. “Educating providers to prioritize minimally invasive treatment options as a first line of care is one way to improve confidence,” said Dr. Sean Boynes, vice president of health improvement at the DentaQuest Partnership. “Silver diamine fluoride, temporary restorations with glass ionomers, or atraumatic restorative treatments can reduce or slow cavities — a first line of defense, as appropriate, that doesn’t require high-speed tools that generate aerosols.” Not only does this minimize infection risk, but these approaches can also ease patients’ fear of the dentist and can cost less in both dollars and time, he added.
Given known shortages, the gap indicated for personal protective equipment (PPE) is no surprise. Redesigning care delivery with teledentistry as a key element can reduce the use of PPE and also can address many of the other confidence gaps.
According to the survey, 4 in 10 providers are already leveraging telehealth platforms to increase access to care. And nearly half of providers strongly or somewhat agree telehealth tools are more important than before the pandemic for screening or evaluating patients. In fact, one-third of all providers and more than half of providers currently using telehealth believe its increased use will be long term. Providers younger than 35 years of age, those working in Medicaid-oriented practices, and those anticipating long-term changes in dentistry were particularly like to embrace telehealth platforms.
Teledentistry also reduces dental providers’ vulnerability to the impact of unpredictable patient utilization and cash flow, which can deeply affect the viability of practices in communities of the greatest need. Roughly 90% of respondents reported seeing weekly patient visit volume drop compared to pre-pandemic. Among this group of providers, the average decline in patient visits was 51%. Nearly half responded that it will take 6 months or longer for business to return to pre-pandemic volumes and 16% were unsure of when it will happen.
The DentaQuest Partnership survey reveals a strong consensus among oral health providers that dentistry cannot return to how care was delivered before the pandemic. The results also underscore the need to evaluate Medicaid and other safety net dental providers amid the challenges of this crisis. The report authors note: these providers are important because 1) they serve a high-risk population with significant unmet dental needs, and 2) their financial stability is vulnerable due to reimbursement rates that are historically lower for the populations they primarily serve. Failure to recognize the gaps and experiences across the nation will result in an even more vulnerable safety net than we already have today.
To protect and strengthen dentistry for all, but specifically for the most vulnerable, DentaQuest continues to evaluate pilot programs for scale, and the DentaQuest Partnership continues releasing free online education to raise awareness and understanding of teledentistry and value-based care. On Thursday, June 30, the DentaQuest Partnership will host a free webinar entitled Dental Care's New Normal: Provider Survey Reveals the Need to Adapt & Redesign, that will further explore the most recent survey findings.
About the DentaQuest Partnership for Oral Health Advancement
The DentaQuest Partnership for Oral Health Advancement is a nonprofit organization working to transform the broken health care system and enable better health through oral health. Through strategic grantmaking, research and care improvement initiatives, we drive meaningful change at the local, state and national levels. The DentaQuest Partnership is affiliated with DentaQuest, a leading U.S. oral health enterprise with a mission to improve the oral health of all. Find out more at www.dentaquestpartnership.org.
DentaQuest is a purpose-driven oral health care company dedicated to improving the oral health of all. We do this through Preventistry® – our all-in approach to better care, expanded access, value-based financing, and innovative solutions. We manage dental and vision benefits for 27+ million Americans and provide direct patient care through our network of more than 85 oral health centers in 5 states. We provide outcomes-based, cost-effective dental solutions for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals nationwide. And, we've invested more than $200 million in grants and programs to achieve measurably healthier communities across the country. By advancing prevention-focused oral health, we will achieve better overall health for everyone. Learn more at www.DentaQuest.com and follow us on social: Twitter @DentaQuest, Facebook www.facebook.com/DentaQuest, Instagram @Inside_DentaQuest, and LinkedIn www.linkedin.com/company/DentaQuest.