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Three Domain Approach to Transforming Oral Health Care

Even as the COVID-19 pandemic exacerbates the nation’s broken oral health care system, it has created an opportunity for the industry to move toward a new, more sustainable model centered around the patient, primary care and prevention. The DentaQuest Partnership for Oral Health Advancement has released a report - based on the work of the Community Oral Health Transformation Initiative learning community - that establishes a primary care-like structure for oral health care delivery, facilitates value-based payment models and enables patients to invest in their own oral health.

120 of the industry’s most prominent organizations and leaders contributed to the development of the Three Domain Framework, which lays out a clear path for providers and practices to expand access to care, improve health outcomes and reduce the cost burdens associated with poor quality of life due to oral disease.

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. And it emphasizes patient and provider safety while addressing critical gaps in both patients’ access to care and providers’ financial viability.

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

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.

Domain One: Advancements in Teledentistry

The pandemic has increased interest in and utilization of teledentistry, but widespread adoption requires defining new treatment codes and rethinking the flow of care for a variety of dental visits. Domain One 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.

Domain Two: Prioritization of Minimally Invasive Care

The pandemic also sparked interest in Minimally Invasive Care (MIC), as providers sought treatment methods, like sealants and silver diamine fluoride, that limit aerosols and the spread of COVID-19. MIC can reverse or slow early disease stages using a program of anticipatory guidance and collaborative decisionmaking with patients. Domain Two prioritizes the use of MIC for oral health management and maintenance.

Domain Three: Integration and Personalization of Oral Care Delivery

Domain Three 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. This domain addresses both sides of that coin, relying on evidencebased practices to enhance a person’s overall health.

Read the Three Domain Framework report.

Review the executive summary.

Watch a short video about the Three Domain Framework.

  • DentaQuest Partnership
  • Delta Dental
  • Maryland Department of Health
  • Maryland Academy of Pediatric Dentistry
    Maryland Academy of Pediatric Dentistry
  • DesignFest
  • Stulman Foundation
    Stulman Foundation
  • United Healthcare logo
    United Healthcare logo