Source: Dr. December 30, 2010 -- It's been 10 years since the U.S. surgeon general's report on oral health in America, which among other things advocated interdisciplinary training between medical and dental providers. Current research shows that primary medical care providers are still not comfortable performing basic oral health assessments, and many consider oral health outside their realm of practice.
"The time has arrived for each profession to recognize the benefit of coordinated treatment plans to better manage patients," Charles Cobb, DDS, PhD, professor emeritus at the University of Missouri-Kansas City School of Dentistry and co-author of a new study that used the theory of planned behavior to examine nurse practitioners' understanding of the link between periodontal disease and systemic health (Journal of Periodontology, December 2010, Vol. 81:12, pp. 1805-1813). The researchers surveyed  200 primary care providers about practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link and used 137 partially and fully complete questionnaires for their data analyses. Of the 137 questionnaires, 123 were completed by nurse practitioners. Dr. Cobb and colleagues found that only 22% of the respondents reported they always or routinely screen for periodontal disease. Using the theory of planned behavior -- which explains behavior as a function of intent, including such factors as attitudes, social norms, and perceived control -- they found that the likelihood of screening increased if the providers felt confident in their training (attitude), felt like it was within their scope of practice (social norm), and felt that they had control over office protocols (control). "A change in professional and peer expectations about periodontal assessments would be an important factor in improving rates of screening," said Dr. Cobb. Limited time and concerns over reimbursement were also found to be factors. Interdisciplinary/interprofessional education In a survey issued to incoming internal medicine trainees, 82% of the 115 respondents reported they never asked patients if they had been diagnosed with periodontal disease, and 90% reported not receiving any training about periodontal disease in medical school (J Periodontol, March 2010, Vol. 81:3, pp. 359-363). Nearly 70% reported that they were not comfortable "at all" doing a simple periodontal exam, 46% felt that discussing/screening for periodontal disease was outside their role as physicians, and 23% said they never referred patients to dentists. "Somehow, there must be a recognition of value to doing even a 'tongue blade' visual examination of the oral cavity to determine obvious signs of inflammation," says Dr. Cobb. "Currently, such a visual examination is not part of the routine in medicine and nursing." "While microorganisms know no such barriers, health professional education and primary care practice lags behind today's science. "What is needed are cultural changes within medicine and dentistry and practical strategies to ensure better communication between practitioners and integration, or at least coordination, of health services." Improving education Efforts are under way to address these disparities. A 2003 Institute of Medicine (IOM) report, "Health Professions Education: A Bridge to Quality," concluded that all health professionals should be educated to:
  • Provide patient-centered care
  • Work in interdisciplinary teams
  • Employ evidence-based practice
  • Apply quality improvement approaches
  • Utilize informatics
Using the IOM report as a guide, and as part of a study initiative called "New Models of Dental Education" funded by the Josiah Macy Jr. Foundation, three panels were convened to discuss the future of dental education. Panel 2 of the Macy Study, held in December 2006 and co-sponsored by the American Dental Education Association (ADEA) and the Association of American Medical Colleges (AAMC), discussed education and clinical training of both dentists and physicians (J Dent Educ, February 2008, Vol. 72:2 Suppl., pp. 73-85). The panel concluded that medical providers would best be trained in oral health using a "spiral curriculum" on oral-systemic health in five key areas: caries, periodontal disease, dental public health issues, oral cancer, and the oral-systemic health relationship. Optimally, content from each of these five areas would be interspersed throughout medical training, starting in basic science courses and then reinforced at higher educational levels and in clinical rotations. The 19th-century distinction between medicine and dentistry is becoming obsolete as the relation between oral and systemic health blurs, the Macy Panel 2 noted. To integrate new knowledge across the research literature, the panel recommended that clinicians become "sophisticated users of science and technology and avid consumers of interdisciplinary research to best implement the latest in evidence-based practice." Building on this work, the AAMC will be mounting an effort to expand and disseminate curriculum resources available to medical schools through a cooperative agreement awarded by the Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA), Dr. Mouradian noted. This award reflects a new focus on oral health within the federal government. Both HRSA and the U.S. Department of Health and Human Services have identified the integration of oral health into primary care as strategic priorities. "All this will take time and work," Dr. Mouradian said. "But without such efforts, we will be seriously hampered in our ability to address the profound oral health disparities identified by the surgeon general." The next time you visit your medical doctor ask what they know about Periodontal Disease. Encourage them to call our office and we will send them information on the systemic links to total body health. Thanks, Dr. Phyllis B. Cook 7028 Wrightsville Ave Wilmington,NC 28403 910-256-8486