Oral Health Training Manual: About this Manual


Oral health is a critical component of total health for all people. Poor oral health has serious consequences, including painful, disabling, and costly oral diseases. Gum disease, in particular, is associated with diabetes, heart disease, and stroke. Pregnant women with gum disease are more likely to give birth to children prematurely and to have children of low birth weight.1,2

“[Receiving oral health care through Ryan White] changed everything. I was out and about in the community much more than I ever would have been before I had my teeth fixed. More exercise, more self-esteem, more food, more everything, really.”

— Charles, Patient at SPNS Oral Health Initiative grantee site, HIV Alliance of Eugene, OR

Many of these oral diseases may be prevented with regular dental care.3 In 2007, however, only 44.5 percent of people age 2 and older had a dental visit within the previous 12 months, a rate that has been essentially unchanged over the previous decade.4 Despite oral health’s importance, 47.2 percent of U.S. adults have some form of periodontal disease.5

The landmark Oral Health in America report by the Surgeon General makes a compelling case for the integration of oral health into overall health. The report calls out disparities in access to oral health care across the country, including socioeconomic factors, lack of transportation, presence of disability or chronic illness,
lack of dental insurance, and personal factors, such as lack of awareness and education about the importance of oral health.6

These access barriers are particularly acute for people with chronic illnesses or compromised immune systems, including people with HIV (PWH), because of the interconnection between physical health and oral health. To address unmet oral health care needs and identify strategies and treatment models, the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Special Projects of National Significance (SPNS) program launched the Innovations in Oral Health Care Initiative (Oral Health Initiative). This initiative, which ran from 2006 to 2011, funded 15 grantee sites across 12 States and 1 U.S. Territory and included hospitals, community health centers (CHCs), and AIDS service organizations (ASOs) in both urban and rural settings.

This training manual synthesizes lessons learned from this federally funded project and has important implications for addressing oral health care among PWH, one of their most frequently cited unmet needs. The objective of this training manual is to provide program-planning information. Target audiences include HIV, primary care, and dental providers interested in expanding or replicating innovative models of oral health care for PWH. This training manual consists of the following components:

  • An overview of the importance of oral health care in total patient care and specific considerations for PWH
  • A discussion of the barriers to oral health care that PWH face, A synopsis of key details of the SPNS Oral Health Initiative, its grantees, and the models of care studied
  • A survey of the best practices garnered from the SPNS Oral Health Initiative, and the potential benefits and challenges associated with each model of care discussed, along with other considerations, such as costs, logistics, and sustainability and
  • A list of helpful additional resources to further assist with the replication process and the delivery of high-quality oral health care to PWH.

This training manual is part of the Integrating HIV Innovative Practices (IHIP) project, which promotes dissemination and replication of successful models of care. Accompanying this guide are a curriculum, pocket guide, and Webinar trainings.