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Start by assessing the following factors to determine if starting a dental program or expanding an existing dental program is feasible to meet an organizational need and/or increase access to dental services for the health center service population.

• Level of need for dental services in the health center service area population: HRSA health center grantees are required to provide preventive dental services either directly, through a formal written contract/agreement, or through an established arrangement.Health centers may also elect to provide additional dental services beyond the required preventive dental services. Signs of a need for dental services include inappropriate emergency room utilization for non-traumatic dental needs by health center patients, demand for dental services by the health center primary care population and/or community demand.

Health centers already operating on-site dental services, may have insufficient capacity to meet the dental needs of the service area population. Signs of insufficient program capacity include:

• Long wait times for dental appointments

• Inability to complete recommended treatment plans

• High rates of drop-in emergency visits with multiple return visits for the same condition

• Low rates of appointment compliance

• Decreased satisfaction by health center patients and staff with the dental program

• Level of access to community dental providers for the health center population: If the health center is located in a community with an adequate network of dental providers that accept Medicaid beneficiaries and offer payment options to low-income patients so that the health center service area population has adequate access to dental services, then the health center should evaluate the network of dental providers in proximity to the service area to determine the best site(s) for expansion.

• Level of organizational confidence to provide dental services sustainably: The cost of providing dental care compared to primary care can lead to long-term fiscal challenges if not managed. Health centers considering starting a dental program, should have a business plan with estimates of both the capital costs of a dental clinic build-out and the expenses and anticipated payer mix and revenues for the dental program. Health centers with data that shows they will be able to operate and fiscally manage an on-site dental program sustainably should consider proceeding with implementing a dental program. Health centers with existing dental programs that are not, at minimum, revenue neutral, should proceed with caution if considering additional expansions.