Need: Dentists in Polk County, Oregon who accepted Oregon Health Plan were booked out for months, causing patients with dental needs to have to wait for an appointment or travel to an adjoining county for dental care.
Intervention: Capitol Dental Care began a Virtual Dental Home teledentistry model to bring preventive dental care to 3 elementary schools and several Head Start programs.
Results: Through this program, over 700 students have received dental care in their schools.
Polk County, Oregon, a Dental Health Professional
Shortage Area (HPSA), has few dentists who accept
patients insured with the Oregon Health Plan (Oregon's
Medicaid program). Those who do are often booked out for
months, causing patients with dental needs to have to
wait for an appointment or travel to an adjoining county
for dental care. A sense of urgency led one dental clinic
to take action.
In September of 2015, Capitol
Dental Care, Inc. (CDC) began a teledentistry pilot
project to bring preventive dental care to Polk County.
Three elementary schools in the Central School District
and several Head Start programs signed up. Many of
students came from low-income, migrant families. At the
time, only one-third of the
county's students reported having annual dental
visits and 66% were experiencing tooth decay.
Virtual Dental Home (VDH) model has allowed students
to see an oral health service integration team of
practice dental hygienists and dental assistants for
routine dental visits. Portable dental chairs are set up
in makeshift dental offices in various locations
throughout the school. The team uses teledentistry to
consult with remotely located dentists and share
photographs and radiographs through a secure server. From
there, the dentist can develop a treatment plan and
determine if a patient needs to be seen for further
This model allows students to stay in class longer,
parents don't need to take time off work, and the service
frees up space in the dental offices for more urgent
cases. The team works at each school for a 3-month period
before moving to the next school. A dental follow-up team
comes into the school several months later for students
who need follow-up care.
Capitol Dental Care's VDH model provides dental case
management for youth who need further dental care. The
service integration team sends information home with the
students or coordinates between the parents and dentist
to set up an appointment. Those in pain can see a dentist
within 48 hours. Other services offered in the school
Fluoride-releasing fillings, a procedure that doesn't
require drills or inflict pain.
Routine cleanings, including:
Since the start of this teledentistry project through
966 students have received dental care
779 Elementary students
150 through the Oregon Child Development
37 at Community Action Head Start
From 2017 to 2018:
820 students received dental care (more than one
third of these were repeat patients with the program)
53% had untreated decay
5% of students were considered dentally "healthy,"
meaning they did not need follow-up work at a dental
82% of parent consent forms were returned with 70% of
them approving their children to participate in the
95% service rate for students whose parents have
Gaining initial support from the schools and helping
them understand the importance of the dental follow-up
Restorative treatment for some students was necessary
following their initial appointments. Calls to parents to
coordinate these follow-up appointment with local
dentists were not always returned.
Limited space at the schools made it difficult to
secure spots for the portable dental offices, but each
school was able to find some space, including a stage, a
cafeteria, a nurse's office, an upper-level room
accessible only by elevator, and a corner classroom.
The VDH program was initially offered to Head Start
programs, but it was a challenge due to the young ages of
the patients, limited time for exams, and lack of parent
consent. Because of these factors, serving Polk County's
elementary schools instead became the primary focus.
Capitol Dental Care began a duplicate project in
Yamhill County with the hopes of bringing dental services
to the developmentally disabled. However, CDC had
difficulties identifying people who met these
qualifications and getting referrals from professionals
who work with them.
Because the Virtual Dental team spends 3 months at a
time working at each school, having a mutual
understanding with administration was crucial for
productivity and communication with parents. Teachers
whose principals took proactive steps to coordinate with
the CDC were more likely to adequately prepare their
children for the dental exams.
It is important to keep in mind that this VDH model
doesn't work for every dentist or dental team. Dentists
who don't have the training or experience with telehealth
may have a harder time giving a comprehensive exam to a
Provide incentives and a deadline for students to get
their dental care permission slip signed by their
Plan to meet with the entire school staff to
familiarize them with the VDH interworking and with the
service integration team.
Perform a financial outcomes assessment on your VDH
model in order to evaluate its long-term sustainability.
After replicating the project in Yamhill County, the
team realized that the training offered by the University of the Pacific
Innovations Center was a critical piece to helping a
dental team understand the importance of the program and
commit to the mission. Consider sending your dental team
to a similar training before launching the program.
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.