Health centers may expand off-site direct dental services through the provision of care in hospital-based dental programs. Health centers can consider a hospital-based dentistry program to help provide oral health services for people with complex medical, cognitive, physical, and psychological conditions requiring additional management skills and resources. The following checklist can be used in planning for a hospital-based dental program:

• Conduct a community needs assessment.

• Create an operation and capital expense budget, identifying the cost for staffing, supplies and capital equipment. The HRSA OHI funding can be used to purchase dental equipment.

• Review HRSA’s requirements on defining scope or project and policy for requesting changes.

• Engage partners.

• Recruit, privilege, and credential staff interested in providing care in a hospital setting

• Understand the hospital environment and quality assurance/improvement activities (i.e., accrediting organization, national, state, and local health standards, etc).

• Determine equipment needs for the operating room.

• Prepare necessary forms and establish workflows needed in preparation for surgical cases (i.e., appropriate documentation, informed consent, etc.)

• Understand insurance requirements (i.e. pre-authorizations).

• Consider leveraging a case manager.

• Prepare sites for clinical care through provider and staff training and education.

• Establish an ongoing program evaluation process.

For more information on these steps, access NNOHA’s white paper on hospital-based dentistry for health centers and NNOHA’s presentation, Health Centers and Hospital-Based Dentistry. A NNOHA promising practice, Hospital-Based Early Childhood Caries Intervention discusses early childhood caries intervention through hospital-based dentistry. Another NNOHA promising practice, Establishing a Dental Clinic in a Hospital Emergency Department, features a health center’s experience in implementing a dental clinic in a local hospital as an emergency room diversion strategy for patients experiencing dental problems.

Health centers may also consider an emergency room (ER) diversion program which can include establishing a satellite site in a local hospital. The American Dental Association (ADA) has some resources on ER diversion like this fact sheet on reducing health care costs through ER diversion. They also have step-by-step guides on developing an ER diversion program. The Association of State and Territorial Dental Directors’ (ASTDD) Best Practice Approach Report, Emergency Department Referral Programs for Non-Traumatic Dental Conditions provides a description of the ER diversion strategy, guidelines and recommendations, research evidence, best practices, and examples.