Oral health care in the 21st century: It is time for the integration of dental and medical education

Donoff, R. Bruce; Daley, George Q.

doi:10.1002/jdd.12191

Cited by 17 publications

(28 citation statements)

References 28 publications

(28 reference statements)

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“…The historic separation of medical and dental professional education in the United States (US), apparent in the siloed delivery of oral and medical health care and services, has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education (IPE) and collaboration. [1][2][3][4] This compartmentalization of care processes has also resulted in poorer overall health outcomes and higher costs for patients. 5 Those who bear the greatest burden of disease are vulnerable populations (ie, low-income individuals, ethnic minorities, immigrants, and individuals with disabilities) who may have low oral health literacy and limited access to care.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City

Laniado

Cloidt

Altonen

et al. 2021

AMEP

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Background:The siloed delivery of oral and medical health care in the United States has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education and collaboration. The aim of this study was to assess the knowledge and practice behaviors of primary care medical providers in an urban safety-net hospital regarding collaboration with dentists and integration of oral health into overall health-care delivery. Methods: A 36-item survey was designed in a web-based platform (Survey Monkey ® ) and electronically distributed in September 2020 to 181 primary care medical providers (physicians, nurses, physician assistants) within a municipal hospital in the Bronx, New York. The questionnaire included sections on demographics, current practices, oral health knowledge, and opinions regarding interprofessional collaboration. Descriptive statistics and bivariate analyses using the chi-square and Fisher's exact test were performed with a significance level of 0.05. Results: The response rate was 66% (119 respondents). The vast majority (80%) reported little or no training in oral health and 85% reported no team experience with oral health professionals. Medical providers' confidence in examining the oral cavity was positively associated with previous additional training (p = 0.001) and with team experience (p = 0.005). The two most commonly reported barriers to willingness to collaborate were lack of formal relationships with dental providers (74%) and competing priorities (69%). Conclusion: Overall, there is very limited awareness and integration of oral health into the clinical practice of medical providers at this safety-net hospital. However, those providers with previous training and team experience had greater oral health confidence. Given the critical importance of oral health to overall health, increased efforts should be directed to further educate and train medical providers and address barriers to interprofessional care.

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Section: Introductionmentioning

confidence: 99%

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City

Laniado

Cloidt

Altonen

et al. 2021

AMEP

View full text Add to dashboard Cite

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“…Investments in expensive universal EHRs will undoubtedly prove difficult as dental institutions attempt to curtail or reduce the rising cost of dental education. Despite these challenges, the promise and possibilities found within integrated dental-medical care demands that it be given high priority in dental education [ 3 , 32 ]. New strategies will most likely require non-traditional approaches, innovation and significant adjustment in the current educational model, and in particular, the clinical practicum [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Input From Practice: Reshaping Dental Education for Integrated Patient Care

MacNeil

Hilario

2021

Front. Oral. Health

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Among the primary challenges in advancing the practice of integrated primary dental and medical health care is the appropriate educational and clinical preparation of a dental workforce that can function and flourish within integrated care environments. Most dental schools teach to traditional concepts and standards of dental care delivery which may be inconsistent with those of integrated care and could deter the entry and retention of graduates in contemporary, non-traditional practice models. To better understand how the dental school curriculum should be modified to accommodate integrative care models, a number of patient care organizations actively engaged in dental-medical integration were site visited to gain insight into the readiness of newer graduates, with emphasis on the US DMD/DDS graduate, to function in integrated practice. Leaders, practicing clinicians and staff were interviewed and common observations and themes were documented. This manuscript will focus on those educational components that integrated care organizations identify as absent or inadequate in current dentist education which must be addressed to meet the unique expectations and requirements of integrated patient care. These changes appear pivotal in the preparation of a dental clinician workforce that is respectful and receptive to new practice concepts, adaptative to new practice models, and competent in new care delivery systems.

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“…Interprofessional education (IPE) is being actively advanced by health professions organizations, 20 and limited IPE has been widely adopted in North American dental and medical schools, although students in some programs learn together in the first year of preclinical and basic science classes. 21,22 Donoff and Daley 22 argue that collaborative learning should be even more deeply integrated, such that medical schools incorporate oral health competencies into curricula and dental schools incorporate competencies for taking a patient's medical history (including vaccinations) and chronic disease screening. (Such integration has been undertaken by the University of Massachusetts Medical School, Virginia Tech Carilion School of Medicine, and the University of Colorado School of Medicine.…”

Section: Purposeful Educational Unitymentioning

confidence: 99%

Education Solutions to the Medical-Dental Divide

Rasmussen

McMillan

et al. 2022

AMA Journal of Ethics

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Arbitrarily cordoning off the mouth from the rest of the body is the educational approach that, since 1840, has been responsible for the medical-dental schism that persists today, preventing oral health's integration with overall health. This divide has also thwarted oral disease prevention initiatives, access to services, and health equity. This article offers an educational plan for reunifying medicine and dentistry, which involves interprofessional education, dual degree training, integrating oral health into medical education, and integrated residency training. Rebuff and Persistent SchismLong referred to by dentists as the "historic rebuff," 1 the divide between medicine and dentistry began in 1840 when physicians at the University of Maryland College of Medicine rejected a proposal from colleagues to include dental instruction in the medical curriculum, resulting in the formation of the school's separate College of Dentistry. 2 Dentistry's rejection of Medicare in the 1960s 2 exacerbated the longstanding schism and created the current imbalance in reimbursement structures for medical and dental care. 3,4,5,6 (Interventions deemed "dental" for patients with serious and complex oral, facial, and cranial conditions, for example, still incur tremendous financial burden on patients and families.) The depth of the division between medicine and dentistry is discernible even within a single organization in the separation of patients' medical and dental electronic health records, although integration would help coordinate comprehensive care, reduce inefficiency, enable and ease referrals, and facilitate access to diagnostic and treatment services. Dentistry as MedicineThe separation of professional education, reimbursement structures, and records management has underscored the arbitrary separation of mouth from body, preventing oral health integration into general medical care and obstructing oral disease prevention initiatives, access to care, and equity. 2,7 Some leaders in health care continue to call for medical-dental integration. The Mayo Clinic, for example, maintains an oral surgery service it included over a century ago. 8 Charles H. Mayo, MD, addressed the American Dental Association in 1928, stating: "The practice of medicine includes dentistry and dentistry is the practice of a special branch of medicine." 9 In 1962, Surgeon General

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Oral health care in the 21st century: It is time for the integration of dental and medical education

Cited by 17 publications

References 28 publications

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City

Input From Practice: Reshaping Dental Education for Integrated Patient Care

Education Solutions to the Medical-Dental Divide

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