Voices from the Field: Drs. Taiwo Ngo and Kehinde Obeto on the Benefits of Medical-Dental Integration

Taiwo Ngo, DDS, and Kehinde Obeto, MD, have quite a few things in common: They’re both from Lagos, Nigeria. They both moved to Ohio to pursue careers in health care. And they both now provide care for underserved populations in the Toledo area.

They’re also twins with strong family ties to health care.

“While we were in Nigeria, our dad was a pediatrician,” Obeto says. “He’s passed now, but he had his own hospital where I worked part-time before I moved to the States.”

This background helped the sisters find their calling to help people get the access to care they need.

Ngo and Obeto are now furthering that work by participating in the MORE Care™ pilot program in Ohio. MORE Care (Medical Oral Expanded Care), is an initiative of CareQuest Institute for Oral Health that aims to integrate oral health into primary care practices. The pilot program in Ohio is a collaboration between CareQuest Institute and Oral Health Ohio, a coalition of statewide partners that educate and advocate to improve the state’s oral and overall health. The initiative helps primary care practices build patient-centered referral networks with local dental providers to improve oral health and overall health within communities.

The twins personify medical-dental integration: Ngo is a dentist at Midwest Dental Center, and Obeto is a pediatrician at Nationwide Children’s Hospital. Together, they explain how participating in MORE Care and medical-dental integration are improving the care they provide for underserved populations.

Can you share a bit about the patient population you serve in Ohio?

Ngo: Access to dental or medical care is a challenge for a lot of people. Sometimes some of them don’t have the insurance, and whoever has insurance just ends up going to the emergency department if they have a toothache or abscess to get medication for pain. You find out a lot of them — even those who do have insurance —don’t use it. Some of them are afraid to go to the dentist. Some of them have had traumatic experiences in the past and only make it in to see the dentist when they feel like it’s the last resort.

They also may not have transportation to get to a dental appointment, or they have to walk, so it’s hard for them to make it there.

Can you say more about the medical side of medical-dental integration and how that looks in practice at Nationwide Children’s Hospital?

Obeto: As part of medical-dental integration, our well-child visit now has an integrated template for oral health. We look at the child’s teeth and see if there is any caries formation, and we also check to see if they’ve ever seen a dentist or if they’ve ever had fluoride varnish applied. We go through some questions like, “Do you drink bottled water?” because bottled water doesn’t have any fluoride. We ask the parents, “Do you brush their teeth twice a day?” Some parents don’t realize that kids need to have fluoride in their toothpaste. They still believe they should use baby toothpaste that has no fluoride. So, during part of the visit, we educate the parents and tell them their children’s toothpaste must have fluoride in it.

Why are pediatricians so well positioned to play an important role in oral health?

Obeto: The American Academy of Pediatrics has restated that we, as pediatricians, see kids more often than a dentist. We get to see them for their shots, and the first three years of life are when we get to see them maybe six, seven, or eight times. So, we figured it’d be a great opportunity for us to use that to integrate dental health into our practice, so we can apply fluoride varnish to protect their teeth. That way, even if they don’t get in to see a dentist, we can help prevent them from getting cavities by applying fluoride varnish and using the oral health anticipatory guidance.

And if I happen to see a patient who needs to be seen [by an oral health provider] right away, I send the referral over to the Midwest Dental Clinic. And then at the end of every week, we fax over the referrals to the dentist so she can call them. So, the office calls the patients and says, “You have a referral to see the dentist. We’re calling to make an appointment for you.” We keep a spreadsheet so we can tell who has been seen and who hasn’t been seen. If they do come in and they have a dentist already, then we refer them to their dentist so we can keep them in their dental home. The ones I refer to Dr. Ngo are the ones who don’t have a dental home.

Does medical-dental integration benefit underserved populations?

Ngo: Here in Toledo now, the number of dentists who take the Medicaid population is about 1% or 2%. A lot of dentists, pediatric dentists, will see patients with private insurance, but they will not see Medicaid patients. So medical-dental integration helps people who are enrolled in Medicaid get access to a dentist.

How does medical-dental integration promote prevention and the shift to value-based care?

Ngo: We are trying to shift the focus of volume of service to value. It’s about treating the whole picture, not just one aspect of it. And we’re trying to reduce patients’ expenses. In the long run, you find a lot of people will spend less money, and the government will spend less money, because patients will not go into the ER for one thing or another. If a patient comes to me and I realize they need medical care, or they just moved here and don’t have a regular pediatrician, I can make them a referral to Dr. Obeto at Nationwide Children’s Hospital, and they can get the problem resolved. It’s also not just a matter of taking care of the cavity, of fixing the problem you have right now. At the end of the day, you’re spending more money doing that.

The goal is to tell patients about prevention, so they don’t get the cavity in the first place. In the long run, they’re spending less money. And they’re getting the bigger picture. Now they’re thinking, “If I don’t eat as much candy or drink as much pop, then I won’t have to come in to get the shots to get a filling.”

How has MORE Care changed the way you work with your sister (and other dentists)?

Obeto: This is a formal integration even though we’ve already collaborated with each other in the past. For instance, if I have a patient who had dental caries and was in pain, and they couldn’t get in to see a dentist anywhere else, I would call Dr. Ngo and say, “Can you see this patient?” So, this is a more formalized process now, where there’s a structured framework for us to include oral health services, track referrals, and improve clinical workflows and communication.

Editor’s note: Voices from the Field is a series of blog posts that highlight individuals who are working to improve the oral health system. From providers and policymakers to advocates and patients, we provide a snapshot of the backgrounds, ideas, successes, challenges, and daily lives of people who are making oral health care more accessible, equitable, and integrated. If you know someone we should feature, please write to us at marketing@carequest.org.