When dental offices were able to open back up after a shutdown at the beginning of the COVID-19 pandemic, El Centro de Corazon decided to re-vamp dental care provided to patients 3 years and under. Before the start of the COVID-19 pandemic, El Centro attempted to have patients presenting for well child exams to have a first dental home exam the same day. The process of patients seeing a dentist in a separate area of the clinic was not very successful due to many missed opportunities throughout the day due to the dentists being housed away from the medical practice. When dental services were able to be resumed in June 2020, a dentist and a dental assistant was imbedded into a pediatric medical practice.

Imbedding a dentist and a dental assistant into the pediatric practice was a fairly easy process. The dentist and dental assistant share an office space in the same area of the medical exam rooms. The office space contains a couple of computers, a table, and portable storage for the dental supplies needed for the dental visit. All the supplies needed for a dental exam and toothbrush prophy are packaged into colorful bags for quick and easy use. The pediatric toothbrush, toothpaste, gauze, bib, gloves, fluoride varnish, educational material and a toy are pre-package for quick and easy use.

The dental visit for children 3 years and under is conducted in the medical exam rooms. The dental assistant and medical assistant communicate through electronic messaging when there is availability in the medical room for the dental visit to be completed. There is an understanding between the medical and dental departments to have the dental visit completed before vaccinations. The dental exam and prophylaxis are completed on the medical exam table which is similar to a dental bench that is used in some pediatric dental practices. The dentist sometimes uses a headlamp if the lighting is inadequate in the medical exam room. If the dentist determines there is a need for radiographs, the child will then be walked to the dental area in the clinic.

If decay is noted, and Silver Diamine Fluoride (SDF) is indicated, this procedure will also be completed in the medical exam room. If a referral is needed to a pediatric dentist this information will be communicated to the parent and the pediatrician.

The integration of the medical and dental practices at El Centro has ensured our patients have a true patient centered medical home. The parents have been more receptive to having a dental exam at 6 months of age since the dentist comes into the medical exam room while waiting for the pediatrician. There is not a need for the parent to schedule a separate dental visit, visit another clinic or change rooms since both visits are conducted in the same space. The pediatric patients receive their first dental home exams at the same intervals of the well child exams at 6,9,12,15,18,24, 30, and 36 months. If a child is classified as high caries risk, and still bottle or breastfeeding, the child will be asked to come for a dental only visit at 21 and 33 months.

In 2020, during the first year of the true medical and dental integration, 1,346 first dental home exams were completed, a 78% increase from 2019. In 2021, 1,896 first dental home exams were completed. The dentist imbedded in the medical practice had approximately 2,400 dental encounters in 2021.

Having the medical and dental integration has fostered closer relationships between the medical and dental staff. The staff functions more as one central team than separate teams as before the integration. The same dentist is always in the medical practice to foster a cohesive provider/patient relationship. A decrease in early childhood caries has been noted with the combined visits as parents are less likely to miss a medical visit with vaccines than a dental only visit.