As the barriers separating medical and dental treatment continue to fall, it becomes increasingly important that we expand our ideas, approaches, and even language, about overall health. One of the most interesting areas of study to emerge has been research into social determinates of health, or SDOH. SDOH are becoming increasingly relevant in the healthcare space as treatment models continue to evolve to more whole patient-centered care.
SDOH are defined as “the conditions where people live, learn, work, and play that affect a wide range of health risks and outcomes.” Conditions such as being uninsured, language barriers, food insecurity, being socially isolated or lonely, access to transportation, and low income, education and literacy levels are just some of the SDOH that can impact your patient’s behaviors and lifestyle choices.
As research continues to mount regarding the impact of oral health on systemic health, these conditions, choices and options for overall healthcare are becoming more relevant to patient care. For dentistry, understanding the role that SDOH play in a patient’s ability to engage in consistent, ongoing dental care is critical to supporting their ongoing oral health, which leads to overall systemic health.
Here are a few scenarios that represent patient impacts of SDOH. They provide examples of situations you may have experienced in your practice that, now equipped with knowledge and awareness, can be identified and acted on proactively:
➤ A patient who is uninsured and low income but not eligible for assistance will likely seek emergent care, but will not engage in routine care to mitigate future events and ensure improved oral health. Combine that scenario with a limited education – less than a high school graduate and at risk for a low literacy level – and you have an individual that will struggle to cover their basic needs, much less pursue regular dental care. Are there resources available that can support you in keeping this patient engaged in their dental care in an affordable and approachable way?
➤ There may be a time in which a longtime senior patient loses a spouse and as a result, loses the person who was responsible for much of their care, including coordination of appointments and transportation to and from, as they also find themselves lonely and unable to remain social and active due to grief. Outreach to that patient could be critical in keeping them engaged in their oral health.
➤ Treating patients that present with signs of nutrition deficiencies could be an opportunity to screen for food insecurity – especially in seniors and children.
Food insecurity is defined as having limited access or an inadequate supply of nutritional foods or limited ability to acquire enough food. This drives higher levels of chronic disease diagnosis and poor disease management – as often times, basic living and/or medication costs take precedent over buying food.
Coupled with poor dental care, oral and systemic health risk is exacerbated. You can ask two simple questions in an approachable and caring manner to screen for food insecurity:
In the last 12 months, have you worried about having enough food or that your food would run out before you could buy more?
In the last 12 months, the food you bought ran out and you didn’t have the money to buy more.
If the response is sometimes or often, you can try to support the patient and their family in locating food resources and continue outreach to ensure they remain compliant with their routine dental care.
WHY SDOH ARE IMPORTANT TO DENTISTRY
As dentistry strives to become more collaborative with medicine and to deliver an integrated care approach, it is critical to correlate oral systemic health with overall wellness, and SDOH are an important part of that mission. As a champion of patient experience in healthcare for a Fortune 100 company, I’ve been witness to the impacts of SDOH and their role in limiting access to the care, programs and services needed to improve patients’ number of healthy days and quality of life. Educating practitioners about SDOH in all healthcare professions helps to create broad awareness and action plans when faced with these patient challenges. As many go without access to dental care because of these social determinants, we must identify and address these situations as we are confronted with them and collectively work to reduce health disparities to improve the health of all.
