Partnership Launches Three-Domain Framework for Oral Healthcare

Dentistry Today


The DentaQuest Partnership for Oral Health Advancement has released a report based on the work of the Community Oral Health Transformation Initiative that establishes a primary care-like structure for oral healthcare delivery, facilitates value-based payment models, and enables patients to invest in their own oral health, according to the company.

The Three Domain Framework, which involved the contributions of 120 dental organizations and leaders, lays out a clear path for providers and practices to expand access to care, improve oral health outcomes, and reduce the cost burdens associated with poor quality of life due to oral disease, DentaQuest said.

The framework gives patients and dental and medical providers the freedom to collaborate on treatment plans that work best for a given situation within the context of overall health, DentaQuest said. It also emphasizes patient and provider safety while addressing critical gaps in both patients’ access to care and providers’ financial viability, DentaQuest added.

“Oral health is directly linked to overall health, but our current system doesn’t reflect that reality. And COVID-19 has shined a bright spotlight on this flaw,” said Dr. Sean Boynes, vice president of health improvement for the DentaQuest Partnership for Oral Health Advancement.

“The Three Domain Framework outlines a new approach for oral health, one that focuses on prevention and healthy outcomes, facilitates value-based payment models, and will help address deep disparities in care and access. We are grateful to the many contributors who are working together to put our oral health system on a new and better path. This is the future of dentistry,” Boynes said.

The three domains can be adopted in any order, meaning the care team can determine where to begin. Providers can safely begin shifting their models of dentistry by starting in a domain that supports their unique needs and those of their patients, DentaQuest said.

The first domain involves advances in teledentistry. The pandemic has increased interest in and use of teledentistry, DentaQuest said, but widespread adoption requires new treatment codes and rethinking the flow of care for a variety of dental visits.

This domain focuses on the identification, development, and adoption of telehealth strategies and builds an accessible evidence-based virtual delivery approach specific to oral health that can enhance disease prevention and whole-person health.

The second domain focuses on the prioritization of minimally invasive care (MIC). The pandemic sparked interest in MIC, DentaQuest said, as providers sought treatment methods like sealants and silver diamine fluoride that limit aerosols and the spread of COVID-19.

MIC also can reverse or slow early disease stages using a program of anticipatory guidance and collaborative decision-making with patients, DentaQuest said. This domain prioritizes the use of MIC for oral health management and maintenance.

The third domain outlines an integrated care approach personalized for each patient, using risk stratification, care coordination, specialty referrals, and predictive analytics that can prolong the health of the mouth from the tissue to the bone.

Poor systemic health can lead to deterioration of oral health, and poor oral health can lead to systemic health complications, DentaQuest said. This domain addresses both sides, DentaQuest continued, relying on evidence-based practices to enhance a person’s overall health.

In the months ahead, the DentaQuest Partnership and other framework contributors said they will work to engage a broader set of oral healthcare providers, payors, and stakeholders to pilot and implement elements of each of the domains.

“A strong, sustainable health system is built on prevention, value, and equity,” said Dr. David Krol, vice president for health initiatives at the Child Health and Development Institute of Connecticut.

“The Three Domain Framework, with its primary care approach, patient-centered focus, and evidence-based foundation, provides the framework for increased alignment of the dental and medical communities in our shared quest for improved health outcomes for all,” Krol said.

Partners in developing the Three Domain Framework include:

  • The American Academy of Pediatrics
  • The ADA
  • The American Dental Education Association
  • The American Dental Hygiene Association
  • The American Institute of Dental Public Health
  • America’s ToothFairy, National Children’s Oral Health Foundation
  • The Association of State and Territorial Dental Directors
  • The Hispanic Dental Association
  • The Medicaid Medicare CHIP Dental Services Association
  • The National Association of Community Health Centers
  • The National Dental Association
  • The Oral Health Nursing Education and Practice Initiative
  • The Partnership for Integrating Oral Health Care into Primary Care

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