Building a healthier future by training for teamwork across medicine and dentistry

By the CDHP team

This post was authored by Lauren M. Feldman, DMD, who is the Predoctoral Director and a Clinical Assistant Professor at the New York University College of Dentistry, where her research focuses on engaging students and faculty in interprofessional collaborative care.

Dental care is one of the greatest unmet child health needs in the nation. Given longstanding inequities, this disparity particularly impacts communities of color and low-income families. Exacerbating this divide are weak processes for communication, coordination, and referral between medical and dental providers. Each year an estimated 108 million Americans see a physician but not a dentist, and an estimated 27 million see a dentist but do not have a medical visit. The ongoing separation of medicine and dentistry means these millions of people miss key opportunities to access prevention, early referral, and treatment. But there are effective strategies that can breakdown these silos to help children and adults get the oral health care they need. Interprofessional education (IPE) is one proven pathway to improve medical-dental integration.

There are effective strategies that can breakdown these silos to help children and adults get the oral health care they need. Interprofessional education is one proven pathway.

IPE involves educators and learners from 2 or more health professions fostering a collaborative learning environment. The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional team behaviors and competence. Empowering students to recognize their unique expertise, and the interplay of culture, power, and hierarchy within the health team, is necessary for effective communication, conflict resolution, and positive working relationships. The accrediting bodies for health provider training programs in both medicine and dentistry have recognized the importance of IPE, now including it as a standard component of educational programs. When professionals work effectively as a team, communicate productively and understand each other’s roles, they provide higher quality health care. Incorporating IPE in health care training programs, ideally throughout the full length of a curriculum, prepares providers to breakdown silos and enter an integrated workforce ready to meet the holistic needs of their patients. 

In 2005, Smiles for Life: A National Oral Health Curriculum was developed to help non-dental health professionals incorporate oral health promotion in training programs. Currently in its 3rd edition, the curriculum is endorsed by several national health care organizations. It’s also widely used, bringing oral health outside the dental setting and into the minds of primary care providers. Similarly, Drs. Erin Hartnett and Judi Haber, both of New York University’s (NYU) Rory Meyers College of Nursing, adapted the physical examination curriculum for its students to more routinely and consistently put "the mouth back in the head." This push toward changing habits among primary care professionals, in addition to simulated IPE sessions, is necessary to create systemic change.

NYU aims to produce graduates prepared to become allies and leaders in the integration of oral and overall, or systemic, health. Here are some examples:

  • A registered dietitian nutritionist student
    at a pediatric dental clinic.

    NYU’s Department of Pediatric Dentistry has a five-year grant funded by the U.S. Health Resources and Services Administration to equip dental students by weaving IPE throughout the four-year curriculum, building on both simulated and real-life clinical experiences. Clinical experiences onsite in the pediatric dental clinic and in local Head Start programs and elementary schools incorporate nursing students and those training to become registered dietitian nutritionists (RDN) to provide collaborative care.
  • NYU Rory Meyers College of Nursing’s annual Teaching Oral-Systemic Health (TOSH) Program has an interprofessional team of nursing, medical, dental, pharmacy, and midwifery students complete an in-person patient exam and case study.
  • NYU Rory Meyers College of Nursing’s Interprofessional Pediatric Oral Health Clerkship pairs nursing, medical, and dental students with pediatric dental and medical resident facilitators to provide collaborative care to children in Bellevue’s Pediatric Outpatient Clinic.

These collaborations highlight the strong link between nutrition, general, and oral health. In addition, they teach students how to communicate with other health professionals and to work as a healthcare team in multiple settings. Preliminary results of integrating dietetic and dental students in the pediatric dental clinic show that after collaborative care, students report improved attitudes toward IPE competencies, with the greatest improvements in their ability to:

  • Work effectively with team members from other health professions to enhance care
  • Identify and describe their abilities to contribute to the collaborative team
  • Use a team approach to assess a person’s health situation

Data shows that the interprofessional approach is also working well for people receiving care. In a pilot study of people receiving collaborative care from dental and dietetic students in the pediatric dental clinic, 100% of patients found the nutritional counseling they received to be helpful and appropriate to the setting. For the interprofessional team, feedback sessions with faculty and continuous, diverse exposure to interprofessional collaboration pushes students to think of innovative ways to address oral and general health for the children, adults, and communities they serve. 

The addition of interprofessional education at NYU improves care provided to an underserved patient population. It provides graduates the skills needed to deliver care that centers patients and to integrate oral and systemic health. Acquiring these fundamental skills lays the groundwork for primary care providers in both medicine and dentistry to practice, lead, and transform how healthcare is delivered, improving the health of kids and families. The world of healthcare delivery is changing and IPE is necessary for that change. No single health profession can tackle the health disparities facing our nation, but the collaborative work of providers across disciplines can help close those gaps.

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