An interview with Dr Gitana Rederiene

Iveta Ramonaite, Dental Tribune International

Fri. 25. September 2026

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Despite growing support for integrating oral health into mainstream healthcare, structural, professional and educational barriers continue to impede this shift. In a recent article, dental hygienist and researcher Dr Gitana Rederiene, immediate past president of the European Dental Hygienists Federation, and her co-authors examined these barriers and proposed a framework for action centred on better use of the oral health workforce, prevention and system-level reform. In this interview with Dental Tribune International, Dr Rederiene discusses the potential of oral health practitioners within multidisciplinary teams and the changes needed to make oral healthcare an integral part of overall healthcare.

Dr Rederiene, what professional, organisational and educational barriers most hinder the integration of oral health into broader healthcare systems?
The barriers are closely interconnected. In professional training, many healthcare professionals outside dentistry receive limited education in oral health and may lack confidence in recognising oral disease, providing preventive advice or making an appropriate referral. At the same time, the competencies of dental hygienists, dental therapists and oral health therapists are not always fully understood or utilised. Unclear role boundaries, professional hierarchies and resistance to changing traditional responsibilities can further restrict collaboration.

From an organisational perspective, dental services are commonly located and managed separately from primary care, hospitals and community services. Patient information may be held in incompatible electronic record systems, referral pathways are often informal or absent, and financing models reward episodic treatment rather than prevention, coordination and teamwork. Even highly motivated professionals struggle to collaborate when the system does not give them the necessary time, infrastructure or reimbursement.

Education reinforces these divisions. Oral health remains limited or absent in many medical, nursing and allied health curricula, and dental education often continues within its own professional silo. Students need opportunities to learn with, from and about other professions. Interprofessional education should develop practical competencies in communication, shared decision-making, referral and coordinated care—not simply expose students to one another in the classroom.

What role can oral health practitioners play in prevention, early intervention, referral and care coordination within multidisciplinary teams?
These professionals are particularly well positioned because prevention, risk assessment, health education and continuing patient management are already central to their education and practice. Within multidisciplinary teams, they can perform oral health assessment, identify disease and risk factors, deliver preventive interventions, support behavioural change and create timely referral pathways between dental and general healthcare services.

Their contribution should extend beyond traditional dental clinics. Oral health practitioners can work in primary care centres, hospitals, schools, maternity services, diabetes and cardiovascular disease programmes, aged-care facilities, community services and home care settings. For example, they can contribute to oral health screening during child health checks, hospital admission, preoperative assessment or chronic disease reviews. They can also train and support other healthcare professionals to recognise oral health risks and include essential oral care within daily practice.

Importantly, this should not be viewed simply as task substitution or as transferring additional duties from dentists. Meaningful integration means recognising oral health practitioners as autonomous, accountable members of the healthcare team and enabling them to work to the full extent of their competence. They should participate in care planning, documentation, referrals, follow-up and evaluation—not merely provide isolated services when a problem has already developed.

Your article argues that workforce capability alone is not enough. What would meaningful integration of oral health into primary healthcare look like in practice, and what systemic changes would be needed to achieve it?
Meaningful integration would make oral health a routine component of healthcare rather than an optional addition. Oral health risk assessment, preventive advice and referral would be incorporated into primary care, chronic disease, maternity care, paediatric care, hospital and healthy-ageing pathways. Oral and general health professionals would work from shared protocols, communicate through interoperable electronic records and remain jointly accountable for continuity of care.

Funding must shift from predominantly fee-for-service treatment towards models that reward prevention, risk-based care, early intervention and coordinated, team-based care. This must include sustainable reimbursement for oral health practitioners working in primary care, community and institutional settings—not only in conventional dental practices.

“Even highly motivated professionals struggle to collaborate when the system does not give them the necessary time, infrastructure or reimbursement.”

Education must bring oral health into medical, nursing and allied health programmes and give oral health students genuine experience in multidisciplinary care. Workforce planning should also deploy professionals where population needs are greatest, including rural communities, aged care, schools and chronic disease services.

In practical terms, successful integration requires five coordinated actions: embedding oral health within routine care pathways; incorporating oral health practitioners into multidisciplinary teams; delivering risk-based prevention across the life-course; connecting services through shared data and digital infrastructure; and supporting health equity through funding, policy and accountability. Without this system-level alignment, even a highly capable workforce will remain under-used, and integration will continue to depend on small, temporary projects rather than becoming a normal part of healthcare.

What historical and structural factors have kept oral health on the margins of mainstream healthcare?
The marginalisation of oral health is rooted in the historical development of dentistry as a profession and service system separate from medicine and public health. Dentistry evolved largely around procedural, treatment-focused care often delivered through private fee-for-service models.

Over time, that separation became embedded in health policy and service design. Dental care was frequently excluded from publicly funded health coverage, and preventive oral healthcare received less investment than restorative treatment. Even the term “dental health” reinforced a narrow focus on teeth and procedures, rather than the broader concept of “oral health” as part of well-being and chronic disease management.

In the article, we therefore argued that the present situation is not due to a lack of scientific evidence or clinical relevance. It is the result of structural and professional silos that have been built into healthcare systems over many decades. Local initiatives are valuable, but isolated projects cannot overcome barriers created by regulation, financing, education and governance. These systems must change together.

What are the consequences of this separation for patients, healthcare professionals and health systems, and which populations are most affected?
For patients, separation often means missed opportunities for prevention and early diagnosis. A person may regularly access care through a general practice, pharmacy, diabetes clinic or maternity service without anyone assessing oral health risks. Conversely, an oral health professional may identify signs or risk factors associated with diabetes or cardiovascular disease, or concerns relating to nutrition or tobacco use, but lack an effective pathway for referral and follow-up. The patient is left to navigate two disconnected systems.

Fragmentation disproportionately affects people who already experience barriers to care: those with low incomes, older adults, people with chronic disease or disabilities, rural and remote communities, Indigenous populations and people receiving residential or home-based care. These groups often have the greatest need for coordinated services but the least ability to access a traditional dental clinic.

Healthcare professionals also experience duplicated work, incomplete clinical information and uncertainty about responsibility. For health systems, the result is inefficient use of the workforce, avoidable emergency visits and continued expenditure on late-stage treatment rather than prevention. Ultimately, fragmented care reinforces both health inequalities and financial inefficiency.

Editorial note:

The article, titled “From margins to mainstream: Reimagining oral health in integrated healthcare”, was published online on 21 August 2026 in Frontiers in Dental Medicine.