Health centers that currently offer on-site dental services have various options for expanding oral health care access. One common strategy is through the expansion of on-site direct dental services. Health centers may expand on-site direct dental services through establishing new sites or by renovating/expanding existing locations. Health centers may also expand on-site direct dental services with the integration of oral health and primary care practice (IOHPCP).  For the expansion of on-site direct services, 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.

New Sites and Site Renovations

One option to expand on-site direct dental services is through the development of new sites or renovation/expansion of existing sites.

General Expansion Resources and Practice Management

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.

Financials

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.

• With any dental program, it is essential to analyze financial impacts of different scenarios. The DentalQuest 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.

Many health centers have expanded oral health access through service expansion. NNOHA’s promising practice, Increasing Oral Health through Clinic Expansion features a health center who expanded their dental clinic using the HRSA 2016 Oral Health Service Expansion funding. NNOHA’s promising practice, Expanding Scope: The Swedish Community Specialty Clinic describes a health center’s experience with expanding their scope of practice to provide advanced dental services.