Introduction/Planning Planning
d. Will we eliminate barriers but create other problems in the community?

Try to determine where there are gaps in services so you will be filling a need and not creating unnecessary competition. You, your agency or a funding source may have priorities or limitations on who is eligible for services or who will receive services. Consider what reactions various groups in the community might have to your proposed program and meet with them to discuss these concerns. Many communities have become upset with mobile van programs that come into town and only provide screenings and preventive services. The program bills Medicaid or insurers for these services, then leaves town and doesn't connect the patients to a regular source of care. When the people do seek care in the community, providers have to repeat the exams and x-rays to arrive at a treatment plan, but may not get paid for repeating the procedures if there are time interval limitations. View a discussion of this problem from Florida. If your program is only funded to provide preventive services, make sure there are coordination and referral systems in place so people have a regular "dental home" for ongoing dental care and that services are not duplicative. View the American Academy of Pediatric Dentistry's definition of a dental home (PDF). Recent discussions that have relevance to mobile and portable systems of care are focusing more on the concept of a "health home" (see article in the Resources tab.) The Massachusetts Department of Public Health has attempted to deal with issues related to contracting for community or school-based services through their Best Practice Guidelines for Community/School Population-Based Oral Health Programs (PDF).

ASTDD has developed a policy statement and an issue brief on School-Based or School-Linked Mobile or Portable Dental Services that discuss some of the complex issues involved and support well- designed programs that provide comprehensive services or linkage to a dental home and that comply with all federal, state and community guidelines, laws and regulations. Link to

Advances in communication and digital technology are enabling more mobile and portable systems to be viable sources of comprehensive care. One solution to not having onsite supervisors, providers with a range of skills, or a variety of specialists is the use of teledentistry. Teledentistry allows the exchange of clinical information and images for purposes of diagnosis, treatment planning or consultation. This is particularly important in remote areas. Information can be stored and transmitted later or "real-time" consultation can occur. In addition, it provides a method for distance learning. View an overview of teledentistry in a white paper created by a teledentistry workgroup in Florida. References in the Resources tab and the following examples are provided: