Medical-Dental Integration: Barriers to Implementing Silver Diamine Fluoride into Primary Care Well-Child Visits

Abstract

Purpose Dental caries is the most common chronic disease in children and the US Preventive Services Task Force recommends integration of oral health assessments and minimally invasive services into primary care for early oral health prevention. The purpose of the study was to identify barriers to integrating silver diamine fluoride (SDF) into well-child visits with primary care physicians (PCPs) and non-medical professionals and to provide recommendations for future medical-dental integration (MDI) interventions.Methods This phenomenological qualitative study used a purposive sample of PCPs and non-medical professionals (n=12) and virtual semi-structured interviews for data collection. Inductive followed by deductive analysis approaches were used for thematic analysis.Results Nine themes across four domains emerged; systems level barriers within healthcare systems, educational barriers, workflow challenges, and provider perceptions. Barrier themes included approval processes within the healthcare system, billing and coding processes, lack of oral health education, training challenges, lack of workflow time, shortage of oral health providers, oral health professionals' views on SDF, as well as perceptions SDF is a novel treatment and outside the medical scope of practice. Further analysis identified 10 recommendations to assist other professionals or health systems in future MDI efforts.Conclusion This study provides insight into barriers for development and implementation of SDF integration initiatives to aid increased adoption of SDF into primary care, and MDI efforts overall. The barriers identified and recommendations offer opportunities for dental hygienists to engage in collaborative interprofessional care.

Keywords: dental caries; medical dental integration; minimally invasive dental treatment; silver diamine fluoride.