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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Integration of Dental and Medical Care

Approach. Integrate dental hygienists into pediatric and prenatal medical care teams to expand access to early preventive oral health services

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Overview. Medical-dental integration (MDI) is a highly effective, systems-focused strategy for expanding access to preventive oral health services for maternal and child populations, especially those with low socioeconomic status and from racial/ethnic minority groups who encounter significant challenges to accessing traditional dental care. [1] The Wisconsin Medical Dental Integration (WI-MDI) model embeds dental hygienists (DHs) directly into pediatric and prenatal care teams, utilizing existing patient flow to provide services like caries risk assessment, fluoride varnish application, anticipatory guidance, and coordinated referral to a dental home. For Wisconsin, this model was made possible by legislative changes that expanded DH scope of practice, allowing for direct access in medical settings without dentist supervision. [1] Since 2019, the WI-MDI project has provided oral health services during over 15,000 patient visits. Similarly, the Michigan Initiative for Maternal and Infant Oral Health (MIMIOH) successfully embedded DHs in Federally Qualified Health Center (FQHC) obstetrics clinics, demonstrating success in promoting prenatal dental care. During periods of active participation, MIMIOH cohorts showed a significantly higher proportion of pregnant Medicaid-enrolled women receiving a dental visit compared to non-participating FQHCs. This MDI approach leverages the high frequency and attendance of medical visits to reach patients earlier and more often with affordable preventive dental services, thereby advancing maternal and child oral health outcomes. [1,2]

Evidence. Moderate Evidence. Strategies based on moderate evidence show a clear trend toward positive results. While these approaches are likely to be effective, further research is needed to confirm their impact. Implement with evaluation to better understand specific local effects.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Morbidity Reduction. This strategy addresses factors that can decrease the incidence or prevalence of diseases and illnesses.
  • Health Care Access for All MCH Populations.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Case Management (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of dental hygienists (DHs) newly integrated and employed full-time as members of pediatric or prenatal medical care teams. (Measures the workforce capacity expansion necessary for the integrated model)
  • Number of Federally Qualified Health Centers (FQHCs) or large health systems newly enrolling in and actively implementing the Medical Dental Integration (MDI) program model. (Measures the volume of institutional adoption and diffusion of the strategy)
  • Number of formal agreements or Memorandums of Understanding (MOUs) established between the MDI clinics and local dental providers to accept referrals. (Measures the development of the external referral network capacity)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of integrated DHs who report receiving adequate, standardized training in medical workflow collaboration, interdisciplinary communication, and patient care coordination protocols. (Measures the workforce readiness and quality of professional preparation)
  • Percent of integrated DH appointments where all core preventive services (e.g., caries risk assessment, fluoride varnish application, anticipatory guidance) are documented in the Electronic Health Record (EHR). (Measures the fidelity and comprehensiveness of service delivery)
  • Percent of obstetricians and pediatricians in participating clinics who provide a successful "warm handoff" or introduction of the integrated DH to the patient/family. (Measures the quality of medical provider buy-in and interdisciplinary teamwork)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of patient visits (pediatric well-child or prenatal) that included preventive oral health services provided by an integrated dental hygienist. (Measures the total service reach achieved through medical system utilization)
  • Number of pregnant women and children enrolled in Medicaid who are identified with an oral health need and successfully linked via care coordination to a dental home. (Measures the volume of successful linkage to ongoing comprehensive care)
  • Number of policy or legislative changes enacted at the state level that explicitly enable DHs to provide direct access services in primary care medical settings without the immediate supervision of a dentist. (Measures the resulting governmental policy change necessary for systems viability)
  • Number of parents/caregivers of children aged 0-5 years who report obtaining a dental home for their child following the MDI intervention. (Measures the successful transition to specialized dental care)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent increase in dental visit utilization among Medicaid-enrolled pregnant women or children aged 0-5 years in MDI clinics compared to baseline or non-MDI clinics. (Measures the differential impact and effectiveness of the integrated model on utilization)
  • Percent decrease in emergency department visits for dental-related pain or infection in communities served by MDI programs over a multi-year period. (Measures the impact on reducing costly, preventable acute morbidity)
  • Percent of integrated DH referrals for restorative care (e.g., identified decay) that result in a completed diagnostic or restorative dental appointment within the state-recommended timeframe. (Measures the quality and effectiveness of the closed-loop referral and case management system)
  • Percent of low-income patients or those from racial/ethnic minority groups served by the MDI clinics who report high satisfaction with the convenience and availability of the preventive dental services received. (Measures the improvement in Patient Experience outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Linden, J. E., Gundacker, C. L. U., Deinhammer, L., & Crespin, M. (2023). Medical dental integration in Wisconsin: Integrating dental hygienists into pediatric well child visits and prenatal care. J Dent Hyg JDH, 97(3), 13–20.
[2] Clark, S. J., Byrappagari, D., & Sailor, L. (2025). A pilot program to promote maternal and infant oral health through collaboration between dental and obstetric providers: Impact on dental visits during pregnancy. Maternal and Child Health Journal.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.