Title : Novel interdisciplinary approach integrating oral health care into primary care for patients with severe mental illness and substance use disorder
Abstract:
Adults with severe mental illness (SMI) and substance use disorder (SUD) face disproportionate oral health challenges, in part due to challenges with access as well as low health literacy. To better understand these disparities, we conducted a quality-improvement project at Medicine in Psychiatry Services (MIPS), an enhanced primary care clinic that specializes in treatment of roughly 2,000 patients with SMI and/or SUD. The three month survey showed that of the surveyed 265 patients only 49% reported brushing their teeth twice daily, compared with 74% of U.S. adults, and 8% of respondents under age 65 were edentulous, versus 2% nationally.
To tackle this severe disparity we launched a quality improvement initiative in August 2026 that included an interdisciplinary approach between our office and Golisano Specialty Care Clinic, a dental program of Eastman Dental that specializes in providing care to complex patients. A flow was incorporated into the check-in process to capture patients without a dentist. These patients received a one-minute education of oral care as well as a fluoride varnish application by a pre-dental student intern either before or after meeting their medical provider. The intern then coordinated a referral to Golisano Specialty Care for those that were interested in establishing care with a dentist. The intern will follow up with the patient six months after for a reapplication of the varnish as well as to see if dental appointment was completed. Preliminary experience with the first six patients demonstrated strong acceptance of both fluoride varnish application and dental referral. Patients and caregivers provided positive feedback regarding the convenience and accessibility? of receiving oral health services and coordination within the primary care setting. This positive response to a streamlined service in a population well established to be at high risk for dental and medical morbidities suggests a promising way to improve their overall health. Further work will involve the presence of dental residents regularly in the office to further help patients become comfortable in care of their oral health.
