Dental Tribune USA
DentaQuest partnership and 120 industry leaders have created a new framework for a more sustainable oral health system. (Photo: DentaQuest Partnership for Oral Health Advancement)

Three Domain Framework is the future of dentistry

By Dental Tribune USA
November 11, 2020

Even as the COVID-19 pandemic exacerbates the nation’s broken oral health care system, it has created an opportunity for the industry to move toward a new, more sustainable model centered around the patient, primary care and prevention.

The DentaQuest Partnership for Oral Health Advancement released a report in late October — based on the work of the Community Oral Health Transformation Initiative learning community — that establishes a primary care-like structure for oral health care delivery, facilitates value-based payment models and enables patients to invest in their own oral health.

One hundred twenty of the industry’s most prominent organizations and leaders contributed to the development of the Three Domain Framework, which lays out a clear path for providers and practices to expand access to care, improve health outcomes and reduce the cost burdens associated with poor quality of life because of oral disease.

The framework gives patients and dental and medical providers the freedom to collaborate on treatment plans that work best for a given situation within the context of overall health. And it emphasizes patient and provider safety while addressing critical gaps in both patients’ access to care and providers’ financial viability.

“Oral health is directly linked to overall health, but our current system doesn’t reflect that reality,” said Dr. Sean Boynes, vice president of health improvement for the DentaQuest Partnership for Oral Health Advancement. “And COVID-19 has shined a bright spotlight on this flaw. The Three Domain Framework outlines a new approach for oral health — one that focuses on prevention and healthy outcomes, facilitates value-based payment models and will help address deep disparities in care and access. We are grateful to the many contributors who are working together to put our oral health system on a new and better path. This is the future of dentistry.”

The three domains can be adopted in any order, meaning the care team can determine where to begin. Providers can safely begin shifting their models of dentistry by starting in a domain that supports their unique needs and those of their patients.

Domain One: Advancements in teledentistry

The pandemic has increased interest in and utilization of teledentistry, but widespread adoption requires defining new treatment codes and rethinking the flow of care for a variety of dental visits.

Domain One focuses on the identification, development and adoption of telehealth strategies and builds an accessible evidence-based virtual delivery approach specific to oral health that can enhance disease prevention and whole-person health.

Domain Two: Prioritization of minimally invasive care

The pandemic also sparked interest in minimally invasive care (MIC), as providers sought treatment methods, such as sealants and silver diamine fluoride, that limit aerosols and the spread of COVID-19. MIC can reverse or slow early disease stages using a program of anticipatory guidance and collaborative decision-making with patients. Domain Two prioritizes the use of MIC for oral health management and maintenance.

Domain Three: Integration and personalization of oral care delivery

Domain Three outlines an integrated care approach personalized for each patient, using risk stratification, care coordination, specialty referrals and predictive analytics that can prolong the health of the mouth from the tissue to the bone. Poor systemic health can lead to deterioration of oral health, and poor oral health can lead to systemic health complications. This domain addresses both sides of that coin, relying on evidence-based practices to enhance a person’s overall health.

In the coming months, the DentaQuest Partnership and other framework contributors will work to engage a broader set oral health care providers, payors and stakeholders to pilot and implement elements of each of the domains.

“A strong, sustainable health system is built on prevention, value and equity,” said Dr. David Krol, vice president for health initiatives at the Child Health and Development Institute of Connecticut. “The Three Domain Framework, with its primary care approach, patient-centered focus and evidence-based foundation, provides the framework for increased alignment of the dental and medical communities in our shared quest for improved health outcomes for all.”

Read the Three Domain Framework report, review an executive summary and watch a short video at

The list of national organizations contributing to the Three Domain Framework includes the following:

  • American Academy of Pediatrics
  • American Dental Association
  • American Dental Education Association
  • American Dental Hygiene Association
  • American Institute of Dental Public Health
  • America’s ToothFairy, National Children’s Oral Health Foundation
  • Association of State and Territorial Dental Directors
  • Hispanic Dental Association
  • Medicaid Medicare CHIP Dental Services Association
  • National Association of Community Health Centers
  • National Dental Association
  • National Rural Health Association
  • Oral Health Nursing Education and Practice Initiative
  • Partnership for Integrating Oral Health Care into Primary Care

About DentaQuest Partnership for Oral Health Advancement

The DentaQuest Partnership for Oral Health Advancement is a nonprofit organization working to transform the broken health care system and enable better health through oral health. Through strategic grantmaking, research and care improvement initiatives, the organization drives meaningful change at the local, state and national levels.

Find out more at

(Source: DentaQuest Partnership for Oral Health Advancement)

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