The most common strategy for adding dental services for health centers that do not currently offer dental services is to build-out a brick and mortar dental clinic that will offer direct services. For this option, consider and adequately address the following factors:

• Space for the dental clinic: The physical location for a dental clinic must be identified. Ideally, a dental clinic would be located as close as possible to, or even embedded in, the health center primary care medical clinic. Co-location facilitates patient-centered, integrated, team-based care. When space in the same building is not feasible community locations close to the health center primary care medical clinic are desirable.

• Capital funding for the build-out, equipment and supplies:
  Financing for all aspects of dental clinic development must be identified. Depending on the selected physical space, capital funding may include building or practice purchase, remodeling of existing spaces, purchase of dental equipment and initial supply costs. The HRSA OHI funding can be used to fund minor alterations and renovations, equipment and supplies, and health information technology (HIT).

• Workforce: Staffing for the dental clinic should be identified and/or a plan for recruiting and hiring dental staff should be developed. Workforce resources are discussed more in this toolkit.

An excellent initial resource for health centers with dental programs that provides an overview of developing a program is The Safety Net Dental Clinic Manual a resource designed to assist with dental clinic development and ongoing operations.

The NNOHA Operations Manual is a useful resource for health centers who are expanding an existing dental program. There are six chapters in the NNOHA Operations Manuals:

1. Health Center Fundamentals: provides basic material on health center dental programs and relevant information to have a successful health center dental program.

2. Leadership: describes elements of dental program leadership and gives resources to assist Health Centers in running a strong practice.

3. Financials: provides a general overview of the health center financial structure for oral health programs.

4. Risk Management: discusses strategies to provide quality dental services while reducing liabilities to protect the patient and provider.

5. Workforce and Staffing: provides helpful tools and resources in addressing common workforce issues for health center dental programs.

6. Quality: provides information on how to achieve and improve quality oral health care and gives approaches to establish a relevant quality improvement plan for dental programs.

In addition to the Financials chapter of the NNOHA Operations Manual, there are many other resources that are useful in financing health center oral health services for new dental programs:

• NNOHA and Capital Link’s webinar on planning and financing dental expansion. Capital Link is a HRSA National Cooperative Agreement awardee that works with health centers and primary care associations to provide support in financial management.

• NNOHA’s webinar on Financial Management for Health Center Oral Health Programs.

• When creating a new dental program, it is essential to analyze financial impacts of different scenarios. The DentaQuest Partnership for Oral Health Advancement and National Maternal and Child Oral Health Resource Center have created an Interactive Budget-Planning Workbook to assist with these cost comparisons.

As a new health center dental program develops, health centers will consider health information technology (HIT) systems for Electronic Dental Records (EDR). With the emergence of whole-person, integrated team-based care, the selection of the EDR has become more complex. The level of desired interoperability and communication between the medical and dental electronic records has become another criteria for EDR selection, along with cost, user-friendliness, user support and other traditional factors. The HRSA OHI funding can be used to improve the interoperability of oral health and medical electronic health record systems.

Resources to assist health centers in selecting the appropriate EDR software for their new dental program include:

• Using HIT to Improve Oral Health Access and Outcomes which discusses the benefits of having an integrated dental HIT.

• A Strategic Roadmap to Achieving Meaningful Use Objective and Selecting an Integrated Electronic Health Record System to Improve Oral Health Access and Outcomes 

• Health Center Controlled Networks HCCN) provide HIT support to health centers. The NACHC Network Resource Guide provides information about HCCN support capabilities and services.

Health center dental programs must ensure that they have proper dental practice policies and protocols to ensure patient safety and quality dental services.

• The NNOHA Dental Forms Library houses various forms such as job descriptions, consent forms, dental clinic policies, patient instructions, performance evaluations, and quality assessment forms.

• To develop a high performing dental program the Characteristics of a Quality Oral Health Dental Program factsheet provides an outline of the top characteristics of a quality health center dental program.

• To prepare for Operational Site Visits (OSV) from HRSA, this presentation will provide an in-depth look at what to expect when preparing for an OSV.

• Health centers are encouraged to promote sustainable green practices across dental sites. This promising practice, Going Green in Dental discusses strategies to implement green initiatives for waste management in dental programs.

Patient safety is a priority for health center dental programs. To learn more, access the following resources:

• The Centers for Disease Control and Prevention’s (CDC)current infection prevention and control guidelines and recommendations for dental settings.

• The Organization for Safety, Asepsis and Prevention’s (OSAP) resources for patient safety in the dental office.

• NNOHA’s webinar, Infection Prevention and Control for Dental Settings defines the purpose of an infection prevention and control (IPC) program, common IPC risks, and way to prevent common IPC risks.

• HRSA’s webinar, Infection Prevention and Control in Dental Settings reviews documented transmission of infectious agents in dental settings and the implications of this information, as well as standard precautions with an emphasis on sterilization and disinfection of patient care items and devices.

• The American Dental Association’s resources on patient safety and infection control.

It is critical when establishing a new dental program that health centers consider their workforce and staffing. Workforce issues are a primary concern for health center dental programs. Consideration of the following will help ensure a successful workforce model:

• Recruitment strategies for dental providers and team members

• Retention strategies for dental providers and team members

• Training opportunities that align with the health center mission of building community capacity and/or serve as recruitment and retention strategies

In addition to the Workforce and Staffing chapter of the NNOHA Operations Manual, the following list provides other resources on workforce and staffing that will be beneficial when establishing dental services at a health center:

• The NNOHA Job Bank is an excellent resource to recruit dental providers and team members. Job postings are publicized on the NNOHA website and in the bi-weekly NNOHA Newsletters.

• In 2018, NNOHA conducted a workforce survey among its membership. The Analysis of the 2018 Member Workforce Survey includes responses from health center dental providers and leadership on topics like dental staff salary ranges, benefits, and factors that influence job satisfaction and may be used to inform health center oral health programs in their recruitment and retention strategies.

• Recruiting and retaining a health center dental workforce can be challenging. NNOHA has compiled recruitment and retention tips for health centers working to build a strong and high-quality dental workforce. It is important that health centers make their program distinct and desirable for potential dental providers. Health centers should review workforce recruitment strategies to make their health center stand out. While recruiting staff and providers, there may be many questions that arise about what it is like to work for a health center. This Health Center Dental Employment FAQ is a resource that can be shared with interested candidates.

• One strategy for recruitment is through the National Health Service Corps (NHSC). NHSC has a loan repayment and scholarship program for dental providers if they work in a NHSC-approved site in a Health Professional Shortage Area (HPSA). Health centers may recruit dental providers who have a loan repayment or scholarship with NHSC to work in their dental program. Dental providers can apply for the loan repayment program while working in a health center that meets the HPSA dental scoring requirement. This may serve as a recruitment perk. NNOHA has developed a fact sheet that outlines the different options available through NHSC.

• Volunteer dental providers are a possibility when creating a health center oral health program. NNOHA’s promising practice, Creative Staffing with Professional Volunteers discusses the strategies used to expand volunteers’ capabilities when facing budgeting issues. In addition, health centers can apply for FTCA medical malpractice coverage for a qualified Volunteer Health Professional (VHP).