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Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop (2023)

Chapter: 2 Learning from Interprofessional Oral Health Models of Education

« Previous: 1 Introduction
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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2

Learning from Interprofessional Oral Health Models of Education

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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The first session of the workshop included a stage-setting presentation on integrating oral health into overall health from Keith Mays of the School of Dentistry at the University of Minnesota. The session was moderated by Lemmietta McNeilly from the American Speech-Language-Hearing Association. Their remarks were followed by a roundtable discussion on the oral health roles of different health professions, which was facilitated by Robert Weyant from the University of Pittsburgh. The panel featured Hugh Silk from University of Massachusetts Chan Medical School, Lisa Mallonee from Texas A&M School of Dentistry, Jane Ziegler from Rutgers University, Rosemary Hemmings from the Oregon Health & Science University (OHSU) School of Dentistry, McNeilly, Judith Haber of the College of Nursing at New York University, Daniel McNeil of the University of Florida, and Colleen Lampron of AFL Enterprises, LLC. Discussants spoke about a collaborative approach to oral health care models, how to make health education more integrative, and how to prepare professionals, conceptually and in practice, to integrate oral health into overall health.

INTEGRATING ORAL HEALTH INTO OVERALL HEALTH

In his presentation on the importance of integrating oral health into overall health, Mays also spoke about current issues in oral health education and practice as well as the importance of visual storytelling in health care. Showing a collection of images that he described as commonly associated with the concept of “health care”—stethoscopes, white coats, syringes, bandages, and the heart—he pointed out that they did not include the mouth or oral health.

Mays spoke with the audience about the importance of advocating for dentists to be part of the overall health care team. “Oral health is just as important as overall health, and . . . oral health contributes to overall health,” he said.

Mays also addressed the adverse oral health impacts of health professional shortage areas (HPSAs). As Figure 2-1 illustrates, according to data compiled by the Health Resources and Services Administration, access to oral health care is negatively affected by shortages in care providers. Across the United States, as of October 2022, there was a shortage of nearly 12,000 oral health care providers (HRSA, 2023). This shortage, Mays

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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FIGURE 2-1 Data on health care provider and facility shortages across provider types.
*HPSAs (health professional shortage areas) are geographic areas, populations, or facilities with a shortage of primary, dental, or mental health care providers (HRSA, 2023). See https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation for details.
SOURCE: Presented by Keith Mays, November 3, 2022. https://data.hrsa.gov/topics/health-workforce/shortage-areas (accessed April 20, 2022).
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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said, affects access to care, and it is often lower-income Americans, who struggle to find providers who accept their insurance, who are negatively affected the most.

Mays then offered an example of the potentially devastating and deadly consequences of barriers to oral health care by telling the tragic story of Deamonte Driver, a young boy from Baltimore who died due to a dental illness. Driver suffered from an abscessed tooth, and his mother was unable to find affordable dental care for him. Lacking this basic dental care, Driver’s abscess spread to a brain infection, which tragically took his life at only 12 years old. Driver’s death was completely preventable, Mays emphasized, and was caused by a lack of insurance, a shortage of providers, and insufficient access to care. Mays used this example to highlight the reality of untreated dental health problems as a critical public health issue. He noted that, in addition to premature death, lack of access to oral health care can also increase disease burden and adversely affect work productivity, mental health, and overall quality of life. Mays showed statistics demonstrating the oral health care disparity, which indicated that in a single year, 108 million people do not visit a dentist, as compared with 27 million who did not see a primary care physician (Vujicic and Fosse, 2022). Mays concluded that an opportunity exists to address gaps in care access through an integrated, collaborative model of care. For example, barriers to accessing care could be reduced by geographically co-locating medical and dental offices, Mays proposed.

Mays also pointed to the challenges related to Medicaid coverage of oral health care as a major barrier to oral health and dental care access. While Mays noted that Medicaid expansion and the Children’s Health Insurance Program have provided major improvements in oral health care access for low-income children, he said there is a need for continued improvement in these programs, especially with how they reimburse providers for dental exams.

Mays described the findings of a pilot study involving patients within a University of Minnesota dental clinic that examined those social determinants of health that affect access to oral health promotion, prevention, and care, noting that unemployment stood out as a major driver of unmet need (see Figure 2-2). In highlighting this, Mays reinforced the importance of a community-centered approach to oral health that considers the social determinants of health and social inequities as barriers to care. Mays discussed the differences between “oral health” and “dental health,” explaining that oral health is more holistic, inclusive, and able to address the social drivers of health inequities. “It’s not just about the tooth, it’s about the patient’s overall health,” he said. “It’s also about the patient’s life, and . . . social determinants of health play a big role in our patient’s care and their overall health.” Mays agreed that it is important to educate and train dental

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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FIGURE 2-2 How specific social determinants of health affect access to oral health care, based on a survey of 175 participants at the University of Minnesota School of Dentistry.
SOURCE: Presented by Keith Mays, November 3, 2022.
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

students to screen for social determinants, encouraging them to look at the whole patient and not just the mouth.

In response to a question from McNeilly on how to better prepare the health care workforce to fulfill the needs of collaborative practice between oral health and medical care, Mays emphasized the importance of lifelong learning and professional education. He suggested that dentists view themselves as health care providers and simultaneously consider their patients’ oral health and its connection to other health issues, such as cardiovascular disease or diabetes risk. Mays pointed to the COVID-19 pandemic as an example of the potential for health professionals to be trained to expand the types of care they provide; for example, since the middle of the pandemic pharmacists and community health workers have been administering vaccinations. This type of cross training could be important to oral health, Mays said, with dentists understanding themselves as part of the whole health care team. He also emphasized the potential to reduce overall health care costs through collaborative care.

For a successful transition to a new model of education and care, Mays suggested taking small steps, a theme that was also echoed later in the workshop by Lisa Mallonee, Julian Fisher, and Isabel Garcia. Overhauling the health care system to better integrate oral health and serve marginalized populations will be a major undertaking, he said, and he suggested a path forward in which change can happen with one small, impactful, and approachable step at a time. In closing, Mays described a program in which his dental students worked with a community obstetrics and gynecology clinic. Dental providers established relationships with patients, and early oral health care to newborns and to expectant mothers throughout their pregnancies. This model of care was extremely successful, he said, and it illustrates the potential of a holistic and prevention-focused approach, which hopefully will be followed by other systems of care in the future.

THE ORAL HEALTH ROLES OF DIFFERENT HEALTH PROFESSIONS: A ROUNDTABLE DISCUSSION

Robert Weyant with the University of Pittsburgh School of Dentistry introduced a conversation centered around the critical question of how oral health can be more fully integrated into overall health, both conceptually and operationally. He spoke of oral health as a multi-dimensional concept, involving physical, psychological, emotional, and social domains. Oral health, Weyant said, is subjective and dynamic, and it is essential to eating, speaking, smiling, and socializing without pain, discomfort, or embarrassment. Unfortunately, Weyant added, oral diseases remain some of the most prevalent chronic diseases, despite the fact that they are largely preventable and persist in a socially patterned way, concentrating their

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

impact on socially marginalized populations. He detailed the findings from the National Institutes of Health’s Oral Health in America (NIDCR, 2021) report, which reported that half of U.S. children do not receive dental care due to social, economic, or geographic obstacles. The report also found that half of adolescents experience decay and that nearly one in five adults experience moderate to high dental fear or anxiety. This anxiety acts as a barrier to seeking care and can also affect a parent’s willingness to seek dental care for their children. Furthermore, Weyant said, there are additional barriers to care for certain populations, such as older adults, people with disabilities, people with cognitive impairments, people living in rural communities that lack dental services, and those living in care facilities who require team-based care. He also spoke of oral health during pregnancy, saying that harmful oral health patterns during pregnancy are linked to serious adverse health outcomes for both mother and baby.

Before engaging in discussions with the panel, Weyant presented key data that illustrated the need for improvements to U.S. oral health care practice. Like Mays, Weyant spoke of the barrier created by funding challenges, especially the lack of dental providers that accept Medicaid insurance. However, he said, the major insurance issue in dental health care is a lack of dental insurance at all, with 66 million Americans holding no dental insurance in 2018, twice the medical un-insurance rate (NIDCR, 2021). The costs of the resulting lack of care are immense; U.S. productivity losses due to oral health issues were estimated to exceed $45 billion in 2015, putting the United States highest among 195 countries. Emergency room visits for non-traumatic dental care needs average $1,000 per visit and cost the medical system $1.6 billion each year. All of these statistics, Weyant said, serve as evidence of the need to integrate oral health more fully into general health care.

Expanding on points previously made by Mays, Weyant pointed to policy challenges that exacerbate chronic access to care challenges among lower-income individuals. Later speakers, including Daniel McNeil from the University of Florida, Colleen Lampron with AFL Enterprises, LLC, and Michael Glick from the Center for Integrative Oral Health at the University of Pennsylvania, discussed topics including policy barriers and reinforcing the importance of oral health educators and leaders being actively involved in policy development and advocacy. For example, Weyant said that research shows cost to be the biggest barrier to routine dental care in the United States and that the way dental care is financed can be addressed through policy change. Therefore, Glick suggested, oral health professionals interested in broad improvements in oral health care in the United States should be prepared to engage with policy makers. Weyant added that a person-centered approach to care, when serving patients with multiple comorbid health conditions, including common oral diseases, will

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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require change at all levels. Specifically, he called for reform in policy, care financing, health care education, care delivery, workforce development, and professional collaboration.

Weyant concluded his introductory remarks by celebrating recent improvements in the field. He noted in particular the increase in the application of fluoride varnishes in primary medical care settings, changes in billing to allow for reimbursement in these new settings, and expanded Medicaid coverage for dental care for children. In the future, Weyant said, he hopes to see dental coverage incorporated into Medicare to better serve the oral health needs of U.S. seniors.

Next, Weyant facilitated a discussion with a panel of health professionals and educators representing medicine, public health, nutrition/dietetics, nursing, and psychology about the oral health roles of different health professions and how they can work across disciplines to promote oral health. Weyant began the conversation by highlighting the severity of the lack of oral health promotion and prevention in some communities in the United States. He then asked Mallonee and Ziegler, who are dietitians, to give their thoughts on the role of nutrition in oral and overall health.

Nutrition for Optimizing Oral Health

Mallonee spoke about the critical role of nutrition in optimizing oral health. She noted the importance of understanding the health of the mouth as being connected to the health of the body. She also talked about the role of nutrition professionals, such as dietitians, in working collaboratively as part of the oral health care team. It’s important, Mallonee said, for dietitians to know if a client has tooth or mouth pain. Mallonee also addressed the social determinants of health as they pertain to oral health, nutrition, and the dietary recommendations made by dietitians. The word to consider, she said, is “accessibility.” For example, does a patient live in a food desert? If so, what control does the patient have over his or her food choices and how can a practitioner acknowledge and help to address these challenges? Additionally, Mallonee spoke of the value in understanding a patient’s level of health literacy and taking the time with each patient to explain how food choices affect oral health. Plainly stated, she said, “the same foods that cause cavities are the ones that put [excess] weight on our bodies.” Mallonee spoke about the importance of addressing health through many levels, including policy, commenting that people with limited incomes often make food choices based on cost, and the most affordable foods are often also the most calorie dense and the least nutritious.

Reiterating a point made by Mallonee, Ziegler said that oral health and

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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nutritional health are intimately linked and that oral diseases can affect the health and nutritional status of a patient. She emphasized the need for interprofessional education, saying that ideally all health professionals should feel confident looking in their patients’ mouths and referring abnormal findings to oral health professionals. She also spoke of the association between certain oral organisms and serious systemic health conditions, such as endocarditis and joint and bone infections. She talked about the two-way relationship between oral disease and overall health, noting, for example, that treatment of diabetes often improves symptoms of periodontal disease and that, conversely, the treatment of periodontal disease can improve blood glucose levels. Finally, Ziegler urged increased collaboration between medical and dental schools and among all health professionals.

Integrating Oral and Overall Health

Weyant posed a question about the role of nursing in oral health to Haber, who spoke about her work integrating oral health and overall health while leading the national Oral Health Nursing Education Practice program (AAN, 2021). The initiative provides grant funding to train nurses to support oral health and promotes systemic change in nursing by integrating oral health into overall health and establishing the promotion of oral health as a best practice in clinical settings. She said that because nurses are involved in all aspects of health care, they “bear witness to the impact of both acute and chronic community-based health problems, and the impact of oral health on overall health.” Because of this, Haber emphasized, nurses are critically positioned to witness the impact of poor oral health on overall health and to positively affect outcomes. Noting the day’s theme of pregnancy and infancy as critical windows for oral health, Haber added that the integration of oral health into overall health would ideally begin during pregnancy or preconception, with education focused on oral health literacy that can be passed down from mother to child. Finally, Haber spoke of the importance of having adequate data on oral health care, with robust documentation that can be shared across providers, such as an “interoperable electronic health record” as a means to improving care and elevating oral health. In closing, Haber underscored the importance of “making sure that oral health is on the health care scorecard.”

Turning to the realm of primary care, Weyant posed a question to Silk, a primary care provider, about the role of primary care providers in oral health. Saying that more than 100 million people each year do not see a dentist but do see a primary health care provider, Silk suggested that these people would greatly benefit from better integration and coordination between primary care and oral health. However, he also mentioned the millions of other people who see neither a doctor nor a dentist each year and

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

stressed the benefits of considering the role of social structures and communities in access to care. Silk spoke of his work establishing the Center for Integration of Primary Care and Oral Health, which included creating core competencies for all heath care provider training. Through this center, Silk worked to launch the One Hundred Million Mouths Campaign (CIPCOH, 2023), an oral health campaign in all 50 states that engages medical schools, physician assistant schools, and residency programs to train the next generation of health care professionals to understand the mouth as a part of the body. Silk explained that fluoride varnishes are applied to children in primary care doctors’ offices in Massachusetts as a result of the service being added to the routine standard of care for children enrolled in Medicaid, making doctors accountable for providing the service. This accountability measure helps to ensure that the Medicaid population, a group at particular risk for tooth decay, can benefit from access to the preventive service. Silk closed by assuring attendees that the tools to accomplish care integration already exist, but commitments to change are needed across states, towns, and institutions.

The Role of Social Workers in Oral Health Education

Weyant then spoke with Hemmings, a social worker, about the role of social workers in oral health and in the education of health professionals. Hemmings responded that social workers are well suited for this collaborative process because they are trained to view health through a broad, holistic framework. In her job at the Oregon Health and Science University School of Dentistry, Hemmings works with dental students and social work interns, focusing their studies on the social determinants of health. She encourages the students to get involved in legislative advocacy, noting, like previous speakers, the role of policy in improving health care. Through her work, Hemmings encourages future dentists to consider how the social determinants of health will affect their patients, including, for example, through access to transportation. She also trains dental students to recognize when a patient may need a referral for mental or emotional health care. She commented on the importance of dentists being able to recognize when a patient may be in crisis, how to approach such a patient, how to screen patients for substance use disorders, and when to refer them for additional support. Learning these lessons, Hemmings said, helps dental students begin to understand that the mouth is part of the body and that patients’ oral health is significantly affected by other areas of their lives. It reframes patient care as the treatment of the whole person and teaches dental students that while they do not need to be an expert in the lived experiences of others, they do need to know how to approach and understand their patients and know where to refer them.

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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The Role of Psychology in Oral Health

Weyant asked McNeil about the role of psychology in oral health. McNeil, a psychologist, began by saying that psychology and the social sciences are inextricably intertwined with all aspects of oral health. Behaviors, perceptions, beliefs, attitudes, and cognitive factors all play important roles in oral health outcomes, he said; this includes the behaviors and attitudes of patients and caregivers as well as the behaviors and beliefs present in society and throughout the health care system. Psychology plays a role throughout the various areas of oral health, McNeil said, from dental hygiene to public policy to research. Psychology can be used in addressing mental health issues involved in oral health, such as dental fear and anxiety, he said, and there are numerous applications for psychology in interprofessional oral health care and education, including training on communication and interaction skills, understanding inequities, respectful and effective patient communication, and skills for interacting with public health, public policy, and other professionals that affect the quality of oral health care. McNeil mentioned that he is currently working on a project training oral health providers to use psychological tools to work with young children and their caregivers. The psychologically based tools address negative health behaviors and create patient-centered approaches to motivate positive change. McNeil identified giving oral health professionals the skills to care for patients who are in pain or are afraid of dental care as another crucial aspect of psychology training, as 15 percent of the population has dental fear or anxiety. At the same time, according to the Centers for Disease Control and Prevention, more than 40 percent of adults reported having mouth pain in the last year (CDC, 2022; Milgrom et al., 2010). Thus it is not rare for patients to experience mouth pain but also be anxious or fearful about getting treatment; it takes special skill, McNeil said, to effectively and compassionately work with patients who are in this acute mental state, and psychology can help provide effective tools to prepare oral health professionals for this delicate and difficult work. Holistic oral health care, McNeil said, would consider the emotional needs of the patient and promote positive health behaviors such as brushing and flossing, tobacco avoidance, and the use of mouthguards during athletic activities. In closing his dialogue with McNeil, Weyant noted his agreement that psychology plays an important role in oral health care and the importance of considering how patients’ beliefs and attitudes affect their behaviors and how those behaviors, in turn, affect their oral health.

Weyant asked McNeilly, a speech-language pathologist, about the intersection of oral health and speech pathology. McNeilly began by noting that there is an important link between the two fields because any time people speak, they use their mouths. She also noted that speech pathologists

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

already perform mouth exams, making them well positioned to observe any issues in the mouth, consider whether or not the patient actively sees a dentist, and make the appropriate referrals. McNeilly spoke about the importance of interprofessional education and collaborative learning, suggesting that all health professionals would benefit from training programs, clinics, and internship experiences that enroll students and professionals from different disciplines in the same programs. She addressed the concerns of some health professionals who do not want to be perceived as operating outside their field or scope but echoed the sentiments of her fellow speakers when she said that dentists do not “own the mouth,” nor does any other profession. All health practitioners should be willing to work collaboratively, build relationships, cross-train, and share skills across their various areas of expertise, she said. McNeilly also highlighted the importance of the early childhood window, remarking that if a 1-year-old child visits a speech language pathologist but has not yet seen a dentist, there could be a mechanism that triggers a referral to a dentist.

The Role of Public Health in Oral Health

Shifting focus to the field of public health, Weyant asked Lampron, a public health professional, about the role of public health in oral health. Lampron noted that the three core functions of public health are assessment, policy development, and assurance. Through this lens, public health recognizes the multifaceted nature of disease and focuses on addressing the individual, environmental, and social factors that contribute to better health outcomes. Public health also works to address health through a systemic framework, and to that end Lampron suggested envisioning what a new system that has been reimagined to improve health outcomes might look like. Considering the system more broadly, she said, allows for a better understanding of the current state of affairs, development of policies that improve outcomes, and monitoring of those outcomes to ensure continued achievement of desired results. She then described the interconnected nature of health care delivery and oral health equity (Figure 2-3).

What would health care delivery look like, Lampron asked, if everyone received the necessary support to attain their full health potential? Critical to this reimagining is addressing barriers in access to care and redesigning the oral health care model to focus on prevention; Lampron suggested that public health professionals could work with policy makers to ensure the financing and coverage of evidence-based services. For example, there has been some evidence to suggest that telehealth positively affects oral health, and Lampron said that coverage of telehealth for oral health care could play a large role in removing barriers to care access for those who struggle to get to the dentist. She also suggested that dental hygienists could spend more

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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FIGURE 2-3 A visual depiction of an interconnected health care system designed for oral health equity.
SOURCE: Presented by Colleen Lampron, November 3, 2022.
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

time working in community settings to deliver preventive oral health care services to populations that are often left out of the current dental health care delivery model.

Barriers and Facilitators to Interprofessional Collaboration in Oral Health

Weyant engaged the panel in a discussion about the barriers and facilitators to interprofessional collaboration in oral health. Hemmings began the discussion by saying that her background as a social worker provided her with a holistic lens with which to think about educating dental and social work students about social determinants, equity, and social justice. Her approach focuses on advocacy in educating students in the health professions on how the mouth is an integral part of whole-person care, and how the mouth projects negative impacts of social determinants. She also highlighted the importance of re-training veteran professionals as well as implementing collaborative education within the schools of medicine and dentistry. Haber said that one major barrier to interprofessional collaboration on oral health is a lack of knowledge and awareness about oral health in general, which implies that more integrative training is needed, starting with students having robust oral health clinical exposure during their education and training. She also suggested that it would likely be beneficial if faculty in health care programs received integrative and collaborative continuing professional education, and she said it would be valuable to integrate oral health metrics into primary health care standards, as this would require primary care doctors to take notice of oral health.

Continuing the discussion, Hemmings added that addressing the social determinants of health will be key to overcoming barriers and that special attention should be given to retraining dentists who have been in the field for decades but have not received training on a holistic perspective to oral health. Noting that medical school curricula evolve regularly, Silk commented that this creates opportunities to incorporate oral health into different programs. He recalled that just 5 years ago social determinants of health were seamlessly woven into medical training and suggested that the same could be done with oral health training. Silk said that oral health should not be the focus of any single class, but instead should be integrated throughout every lecture, such that the mouth is truly understood as part of the body. He spoke of successful past applications of this practice, such as foot exams and behavioral health exams becoming routine parts of primary care. The tools already exist to make these changes happen, he said, and the key will be to get people in the field excited to begin the work.

Mallonee agreed with Silk that dentistry should be worked into the overall health care curriculum in small, integrated pieces. She also suggested that dental hygienists and dentists could be trained to feel more comfortable

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

addressing the role of diet in their patients’ oral health and that they could use more education and training to feel better equipped to do so. McNeil added that the field of psychology offers a model for integrated training. For example, he said, motivational interviewing is a tool from psychology that is integrated into other health professions and used extensively. In the same way, he said, pieces of oral health could be integrated into psychology programs, physical therapy programs, and other systems of care, and those areas of care could be integrated into oral health care in a bidirectional manner. Ziegler added that current health care students have an inherent understanding of the need for collaborative interprofessional care, but many established practitioners remain uncomfortable working outside of their own areas of expertise and addressing oral health. She suggested that a major focus should be on empowering current professionals to feel comfortable working on oral health and making referrals. Continuing the discussion about barriers and facilitators, Lampron chimed in that data remain one of the biggest barriers but can also be one of the greatest opportunities. For example, diabetes collaboratives with joint funding may lack the sort of accurate tracking information necessary for a provider to determine whether a medical patient had also had a dental visit. She said that when practitioners have meaningful patient data at their disposal, they are more able to make useful referrals and work collaboratively. This is especially important, she said, when it comes to at-risk subpopulations, such as pregnant women or people with diabetes. In a similar vein, Haber commented that a lack of electronic health records that cross between primary care and oral health care is a current barrier, and that such interdisciplinary records could be a major facilitator for interprofessional collaboration.

Willgerodt concluded the session by asking the panelists for their thoughts on expanding the role of dental hygienists in order to integrate them into primary care offices as dental therapists. Silk responded that having a dental hygienist in a medical office is beneficial and helps medical professionals increase their engagement with oral health practices such as fluoride varnishes. He said that with a dental hygienist in the room, learning about oral health practices can occur more fluidly, “through osmosis.” McNeil added that the University of Florida currently has its first-year dental students work with students from other health professions to gain exposure to these areas. This early integration is beneficial and important to their future ability to work collaboratively and could help enable future health care practices that are more fully integrated between oral health and medical care. Willgerodt relayed a participant comment suggesting that if state regulations allowed trainees from one health profession to be supervised by providers from other health professions, it would be valuable to offer interprofessional education in which dental hygienists and dental therapists were educated together with other health care professions in hospitals and community centers.

Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×

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Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
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Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
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Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
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Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
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Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
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Page 10
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 11
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 12
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 13
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 14
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 15
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 16
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 17
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 18
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 19
Suggested Citation:"2 Learning from Interprofessional Oral Health Models of Education." National Academies of Sciences, Engineering, and Medicine. 2023. Sharing and Exchanging Ideas and Experiences on Community-Engaged Approaches to Oral Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/27100.
×
Page 20
Next: 3 Envisioning a New Education Model: Oral Health Promotion of the Mind, Mouth, and Body »
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Despite the integral contribution of oral health to general health status, it continues to be treated as a marginalized and less important practice of health care. Minimizing its importance begins with how U.S. dental professionals are educated. The National Academies Global Forum on Innovation in Health Professional Education held a public workshop in November 2022 to discuss definitions of community-engaged oral health and its application within, between, and across health professions. Discussions emphasized lifelong learning, the social determinants of health and community engagement, and the development of innovative approaches and models for oral health workforce education and training in a global context. This Proceedings of a Workshop summarizes the discussions held during the workshop.

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