The dental care system in the US, like the overall health care system, is steeped in inequities. People of color, Tribal communities, people with disabilities, LGBTQ+ people, and other marginalized groups face steeper access to care barriers and worse oral health outcomes as a result. One reason for this is that people rarely get a choice in the type of dental care they receive. For most people, dental care consists of being in a dentist’s office or clinic and receiving “traditional” dental procedures, like drilling and filling cavities, root canals, and pulling teeth, at the direction of their provider. Black patients, in particular, are more likely to receive recommendations for invasive treatment rather than services that could allow them to keep their teeth and prevent tooth decay in the future.
Minimally-Invasive Care Presents Opportunity to Center Peoples’ Needs
However, non-surgical options for catching and treating dental problems early are often possible. Known as "minimally-invasive care” (MIC), these procedures include topical medicines that can prevent or treat cavities, as well as other alternatives to drilling and filling and even prescription products that can be bought over the counter. MIC can be provided in a variety of health care or community settings, like primary care offices, nursing homes, schools, and health fairs. It can also be offered by medical providers like pediatricians and nurses, oral health providers like dental therapists and hygienists, as well as pharmacists and community health workers.
Collectively, MIC can help treat oral health problems early, before more invasive, painful, and costly care is needed. It also allows patients to have a choice in the care they receive, improving patient experience and interrupting implicit bias. You can read more about what MIC is, how it fits in with other ways of improving access to care, and health equity implications in our new brief Toward Patient-Centered Oral Health: Improving Dental Care and Patient Experience Using “Minimally-Invasive” Care.
What can advocates do?
At the heart of MIC is providing options to patients to allow them to choose the care that is best for them. Advocates interested in MIC should first and foremost engage with their communities to figure out what people need and want out of MIC and their interactions with the oral health system, more broadly. Other policy considerations for advancing MIC in the context of health justice include:
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Get this on the radar of coalitions focused on health justice. Coalitions focused on advancing the movement for health justice are a great place to consider MIC. Even if oral health is not a central or specific focus, improving access to dental care, and especially care that is patient directed and equitably accessible is key to health equity.
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Advocate for policy solutions that make MIC possible. MIC works best as part of coordinated efforts to advance health equity. It will be most effective in the context of other systems changes, including:
- Advancing universal, comprehensive coverage: To access various MIC procedures and get the benefits of early care, prevention, and choice, people need these procedures to be covered by their insurance. This can be facilitated by expanding Medicaid adult dental benefits, adding a dental benefit to Medicare, and ensuring oral health is incorporated into any and all efforts at universal coverage.
- Expanding where care can be provided: To expand access, care needs to be available outside traditional dental offices and clinics. This can be facilitated by making COVID-era teledentistry policies permanent and authorizing an array of providers to practice in community settings like schools, nursing homes, and health fairs.
- Expanding who can provide care: To ensure enough providers are available to offer the care patients need and want, medical and oral health providers must be authorized to provide comprehensive care and work together in a coordinated way. This can be facilitated by expanding dental hygienists’ scope of practice, authorizing dental therapists, and allowing medical providers to offer basic oral health care. States should also consider the role that non-clinical providers like community health workers can play in facilitating the delivery of less invasive care.
Communities care deeply about their oral health, particularly in marginalized communities who are hurt most by the lack of responsiveness of the health system today. Building power for the health justice movement requires being accountable to these communities. MIC can play a role in centering health justice by ensuring people have a voice and choice in the health care they receive and can set the stage for longer-term structural changes in how, where, and by whom care is provided.