Healthcare professionals collaboratively building a bridge of teeth to represent integrated oral health.

Bridging the Gap: How Integrated Oral Health Can Revolutionize Primary Care

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Kai Mendoza in Health & Wellness October 2026 • 4 min read.

"Explore perceptions of healthcare teams in Quebec, Canada, and the potential of integrating oral health into primary care for better patient outcomes."


In recent years, there's been a growing push to integrate oral health into primary care. The idea is simple: by bringing dental and medical services together, we can improve overall patient health and access to care. However, new models of integration are not successful unless they adapt to each health system's local context.

A groundbreaking study explored the perceptions of primary health care teams in Quebec, Canada, regarding the integration of oral health into their practice. Through qualitative research, including in-depth interviews and focus groups, the study identified key challenges and opportunities in making integrated oral health a reality.

This article delves into the findings of that study, revealing how healthcare providers and managers view the integration of oral health, the barriers they face, and the enablers that can pave the way for a more comprehensive and patient-centered approach to healthcare.

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Oral Health Data and Integration

The CDC’s Oral Health Data Dashboard was last reviewed on March 12, 2025, and its data resources support exploration at national, state, and county levels. Indian Health Service summary estimates are treated as a state when available, while IHS area-specific data are not shown. The WHO’s oral health data portal describes a requested action plan with measurable targets for oral health progress by 2030. A report on preparing care teams says partnerships, tools, and resources are needed to build shared understanding and strengthen primary care clinicians’ oral health knowledge and skills.

Milestones in Integration

The Oral Health Milestones timeline is designed to help students and professionals understand events that have shaped the field; each entry presents a date, background information, and the milestone’s impact. A 2021 report on the Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) documents the project’s implementation, findings, integration strategies, and technical-assistance activities and feedback. A separate best-practice report presents integration as important and effective, and says its suggested strategies draw on health outcomes attributed to integration. A review protocol identifies preventive interventions, screening, counseling, fluoride varnish delivery, referral pathways, and integrated care models as eligible subjects for evaluating integration.

The Missing Piece: Oral Health in Primary Care

Healthcare professionals collaboratively building a bridge of teeth to represent integrated oral health.

Many healthcare professionals in the study felt that oral health services were notably absent or insufficient within publicly funded primary care. This gap leaves many patients, especially vulnerable populations like the elderly and those with intellectual or physical impairments, without adequate access to dental care.

For example, study participants shared concerns about the difficulties in referring older patients needing extractions to hospitals, highlighting a lack of dental support within their primary care settings. For many, this absence isn't just an inconvenience; it's a critical missing piece in providing holistic care.

  • Lack of awareness among parents about children's oral health.
  • Trauma or pain related to teeth/oral mucosa.
  • Oral health problems stemming from rare or genetic diseases.
  • Lack of general anesthesia services for children with special needs.
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Recent Evidence and Study Designs

A learning collaborative recruited 17 primary and oral health care teams for biweekly virtual calls over three months. In Denmark, a qualitative study conducted 13 focus group discussions in two municipalities as part of the Lifelong Oral Health research project: nine groups involved aged-care staff and four involved managers from aged-care and dental-care settings. A scoping review of healthcare workers’ experiences with primary healthcare integration reports that most included studies were published in the last 12 years, with a sharp increase in the last five. The WHO Global Oral Health Status Report reviews recent data on major oral diseases, risk factors, health-system challenges, and opportunities for reform.

Persistent Barriers and Evidence Gaps

A qualitative study of primary-care teams identifies lack of dental coverage through medical insurance and the limited number of dentists in the public sector as continuing problems for meeting priority populations’ oral-health needs. One study also notes that it did not include patients’ perspectives on integrating oral health into primary care, leaving that viewpoint unrepresented in its findings. Research on barriers and facilitators describes integration challenges across multiple domains and levels, while a separate paper synthesizes evidence on the effectiveness of integration strategies. Together, these sources point to implementation constraints and evidence questions that need attention.

For the elderly, particularly those in long-term care facilities, the demand for integrated oral health services is rising. An increase in patients with multiple health issues, impaired physical and mental health, and evolving oral health needs underscores the urgency of addressing this gap.

Making Integration a Reality: A Path Forward

The study’s findings underscore that primary health care teams in Quebec recognize the critical need for integrated oral health services. To bridge this gap, implementation of governance policies, prioritization of educational and management measures, and fostering inter-professional collaboration are essential.

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A Broader Primary-Care Role

A review argues that integrating oral health into primary health care can support affordable and accessible care, noting that oral health remains neglected in many countries. It aims to synthesize evidence for a primary oral-healthcare approach. A 2024 JAMA Internal Medicine viewpoint discusses dentists providing some primary health-care services as part of interdisciplinary teams, potentially easing clinicians’ burden. These sources frame integration as both a way to bring oral health into broader care and an opportunity to rethink team roles.

Expanding Access Through Integration

A report on innovations in oral health and primary-care integration presents approaches for connecting the two fields. It describes the intended benefit as giving more people access to dental care and advancing health equity in the U.S. healthcare system. The source characterizes these efforts as mechanisms and scopes of integration, rather than providing specific outcome figures in the supplied description.

Global Need and Health-System Context

A Nature Index topic page reports that a systematic review of oral-health system strengthening in fragile and conflict-affected states highlighted innovative models for integrating dental services into primary care. A separate article says the prevalence of oral diseases is anticipated to rise and describes improved oral health as a critical, unmet global health need. It calls for greater emphasis on integrative medicine and research to better understand oral-systemic connections. The sources therefore situate integration within both health-system strengthening and a broader research need.

Whole-Person Care in Practice

A case study and impact report, “Partners in Progress: Pursuing Medical-Dental Integration in Ohio,” explores a pilot program integrating oral health into pediatric primary care. An NYU case-study resource kit describes clinical cases illustrating links between oral and overall health and the role of collaboration across professions and settings in whole-person care. Separately, a recent trial demonstrated the effectiveness of a primary-care-based multilevel intervention to increase dental attendance among Medicaid-insured children ages 3 to 6; the related study estimates the intervention’s cost and workflow impact for real-world practices. These examples connect team-based integration with practical care experiences and implementation considerations.

By addressing the barriers and leveraging the enablers identified in this research, healthcare systems can move towards a more integrated, comprehensive, and patient-centered approach to care. This includes

Ultimately, integrating oral health into primary care isn't just about better teeth; it's about improving overall health, access, and equity for all.

What the Quebec team interviews reveal

Participants identified barriers across practical and system-wide levels. This indicates that integration was not only a matter of individual professionals’ willingness; infrastructure, resources, and policy also shaped how feasible it seemed.[1]

Limits of the Quebec study findings

  • Participants emphasized the need for integration but did not specify how to build it into their existing practice.[1]
  • The authors note that limited insurance coverage and a small public-sector dental workforce remain obstacles for priority groups.[1]
  • The authors say additional studies should examine providers’ perspectives and different levels of integration in primary care.[1]

Interviews and focus groups with Quebec primary care teams

PopulationQuebec primary health care team providers and managers[2]
Sample size91 participants[2]
SettingRural and urban health care centers in Quebec[2]
Main outcomePerceptions of Quebec primary health care teams on integrating oral health into primary care[2]
Times cited26[2]

How later work frames integration

A scoping review describes integration facilitators such as supportive policies, allocated resources, interdisciplinary education, collaboration, local leadership, and geographic proximity; these are themes in that review, not a direct comparison with the Quebec study.[3]

A later paper on dental education argues that training for dental students and allied workers, alongside mixed-methods research, can contribute to integrated approaches; it presents a broader perspective rather than a finding from the Quebec teams.[4]

Later work on Danish aged-care staff describes limited oral-care knowledge and training as obstacles in that setting, while a study of community nurses identifies interprofessional collaboration as a facilitator for older people’s oral care. These findings concern different populations and settings from the Quebec primary-care study.[5] [6]

A 2021 study of First Nations and Métis early-childhood oral health says community-based integration may be feasible with attention to information and roles, extending discussion to a distinct community context.[7]

Questions the Quebec findings leave open

  • What practical arrangements would make oral-health integration workable in teams that did not propose a specific mechanism?[1]
  • How might information systems, tools, guidelines, equipment, and remuneration arrangements affect implementation in different care settings?[1]

Sources

  1. How primary health care teams perceive the integration of oral health care into their practice: A qualitative study (Europe PMC, 2018)
  2. How primary health care teams perceive the integration of oral health care into their practice: A qualitative study (Public Library of Science (PLoS), 2018)
  3. Barriers and facilitators in the integration of oral health into primary care: a scoping review (pmc.ncbi.nlm.nih.gov)
  4. COVID-19: Perspective of a Dean of Dentistry (2020)
  5. Co‐Existence of Divergent Oral Care Approaches in Danish Aged Care: A Qualitative Study (2026)
  6. ‘Whose role is it anyway?’ Experiences of community nurses in the delivery and support of oral health care for older people living at home: a grounded theory study (2023)
  7. First Nations and Metis peoples’ access and equity challenges with early childhood oral health: a qualitative study (2021)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1371/journal.pone.0205465, Alternate LINK

Title: How Primary Health Care Teams Perceive The Integration Of Oral Health Care Into Their Practice: A Qualitative Study

Subject: Multidisciplinary

Journal: PLOS ONE

Publisher: Public Library of Science (PLoS)

Authors: Hermina Harnagea, Lise Lamothe, Yves Couturier, Elham Emami

Published: 2018-10-12

Everything You Need To Know

1

What does it mean to integrate oral health into primary care?

Integrating oral health into primary care means merging dental and medical services to improve overall patient health and increase access to care. This approach addresses the critical gap where oral health services are often absent or insufficient, especially for vulnerable populations like the elderly and those with disabilities. The implementation of governance policies, prioritization of educational and management measures, and fostering inter-professional collaboration are essential to make this integration a reality.

2

Why is the integration of oral health in primary care so important?

The primary significance of integrating oral health in primary care lies in its potential to transform healthcare by addressing critical gaps and improving patient outcomes. Healthcare professionals in Quebec recognize the critical need for integrated oral health services, as it allows for a more comprehensive, patient-centered approach. This integration is especially important for populations like the elderly, who often have multiple health issues and evolving oral health needs, and for children with special needs who may require general anesthesia for dental procedures.

3

What are the main challenges faced by healthcare professionals regarding oral health integration?

The key challenges identified by healthcare professionals in Quebec include the lack of oral health services within publicly funded primary care. This absence makes it difficult to provide holistic care, as it hinders access to dental care, particularly for vulnerable populations. For instance, difficulties in referring older patients for dental procedures, such as extractions, underscore the existing gap. Another factor is the lack of awareness among parents about children's oral health and the need for better access to general anesthesia services for children with special needs.

4

What are the potential implications of not integrating oral health services?

The implications of not integrating oral health into primary care are significant. Many patients, particularly vulnerable populations, lack adequate access to dental care, leading to potential health complications. The absence of integrated services can result in untreated oral health problems, such as trauma or pain related to teeth or oral mucosa. In Quebec, the lack of integrated services leads to difficulties in referring patients for dental care, which is especially true for the elderly, which also increases the urgency of addressing the gap in care.

5

What are the proposed solutions to achieve the integration of oral health into primary care?

To make integrated oral health a reality, several solutions have been identified. These include implementing governance policies, prioritizing educational and management measures, and fostering inter-professional collaboration. These solutions involve bringing dental and medical services together to ensure a more comprehensive, patient-centered approach to healthcare. Healthcare providers in Quebec are aware of the critical need for integrated oral health services to bridge existing gaps and improve overall patient outcomes.

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