a child in need. Grover stated the CDHC model is about building relationships in the community and helps to coordinate and navigate care.

Creating Dual Strategies

Speakers addressed approaches to interweaving prenatal and infant oral health care. Edelstein remarked that a dual strategy may be a medical-dental or community-dental approach. As the main disease process is overwhelmingly preventable, strategies need to be addressed by focusing on social, behavioral, and environmental determinants using the known tools of social and behavioral science. Caplin commented on the need to combine treatment with education so that patients and their parents have different expectations about oral health. For example, in some communities, Caplin stated, there is no expectation for tooth retention. By changing perceptions, especially of young mothers, their behaviors may change for the benefit of their children as well as for their future pregnancies.

Improving Outcomes

The speakers discussed the evidence that indicates that newer workforce strategies to improve access lead to improved outcomes. Edelstein commented that this evidence is not robust and often preliminary, but in individual projects they seem to demonstrate a culture change toward disease management as well as long-term improvements in caries incidence. Glassman stated that many models have not been fully implemented and therefore cannot yet be fully assessed, but they are often based on other successful models. For example, he noted the long-term experiences in integrating oral health professionals into social service systems in community settings. Newer models, he said, often add components to these previously successful models, such as expanded scopes of practice and expanded collaboration, and so expectations are for similar or even better results. Caplin commented on early assessments, such as the numbers of completed cases as well as utilization rates, which indicate early successes in some of these programs. For example, he stated that future planned analyses of OHIP include pre- and posttesting in educational interventions and post-treatment surveys of the members of the oral health team.



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