From hospital dentistry to health systems: advancing special care dentistry through education, integration, and technology.

Special Care Dentistry has been defined by the populations it serves rather than by standardized frameworks, clinical pathways, and accountable care models. This population-centered framing has left the field dependent on the goodwill of individual clinicians rather than on reproducible standards. The results are wide variability in training, inconsistent care delivery, and persistent exclusion of medically complex, disabled, and frail patients from oral health systems not designed to serve them. We argue that this absence of systematization is a patient safety problem, and hospital dentistry offers a practical framework for addressing it that the field has not fully engaged. Hospital-based dental practice has developed the interprofessional competencies, documentation standards, and referral protocols that SCD requires but has not yet codified. The American Association of Hospital Dentistry holds the institutional experience to serve as an intellectual steward for the field's transformation. Our central hypothesis is that embedding SCD within the educational infrastructure of hospital dentistry, and aligning it with competency-based, value-driven, and interprofessional frameworks, represents a testable pathway toward more coherent and equitable care for populations with complex needs. We draw on evidence across workforce development, care delivery, and health policy to identify gaps in current systems and proof of concept from hospital-based models. The stakes are clear: without a systems-level response, SCD will continue to function as an accommodation rather than a discipline, and the populations it is meant to serve will continue to bear the consequences.