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

Special care in dental curriculum: A transversal axis for integrating oral health with systemic health

AIMS

Distance between dentistry and medicine is a traditional and historical obstacle that affects multiple levels of the health system, especially the health policies to improve health service quality. Changes in dental education, especially involving the adoption of integrative health models in professional development, are considered essential for reducing this gap. We aimed to show a dental curriculum focused on special care as a tool for medicine-dentistry integration.

METHODS

In this study, we present a new proposal for an undergraduate dental curriculum in which topics related to special care are addressed transversally and are the core for interdisciplinary integration of oral health with systemic health. We also describe how themes related to dental home care and hospital dentistry were included in this course as basic professional competencies.

RESULTS AND CONCLUSION

This initiative is aligned with the global trend to adopt educational systems that contribute to the reduction of health care inequalities and improve health service quality.

Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI)

OBJECTIVE

Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education.

METHODS

The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy.

RESULTS

When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513).

CONCLUSION

Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.

Application of Medical-Nursing Integration Multidisciplinary-Assisted Surgical Wound Nursing Mode in Improving the Quality of Wound Treatment

Surgical treatment is a common clinical intervention for trauma, but postoperative pain and poor nursing lead to slow wound recovery and wound infection. Therefore, it is extremely important to select effective nursing intervention methods to improve the quality of wound treatment. This study explored the application value of the wound care model of medical integration and multidisciplinary-assisted surgery in improving the quality of wound treatment. The results show that medical-nursing integration in multidisciplinary-assisted surgical wound nursing mode can improve the quality of wound treatment and pain level in patients, which is beneficial to improving team cohesion of medical staff and satisfaction evaluation of patients.

Nursing Research on Benign Prostatic Hyperplasia Based on Continuous Nursing Care

Purpose. To explore the nursing research of prostatic hyperplasia based on continuous nursing and based on the combination of medical care and nursing.Methods. A prospective study of 96 patients with benign prostatic hyperplasia admitted to our hospital from November 2019 to May 2021 was selected. According to the random number table method, they were divided into an observation group and a control group with 48 cases each. The control group used routine nursing and discharge guidance, and the observation group implemented continuous care based on the combination of medical care and nursing on the basis of the control group. The differences in the scores of quality of life, self-care ability, quality of life score, and sleep quality were compared between the two groups. Results. After 3 months of nursing, the quality of life scores (health status, psychology, social relationship, environment, physiology, and quality of life scores) of the observation group was higher than those of the control group ( $P<0.05$ ). After 3 months of nursing, the quality of life scores of disease, physiology, society, psychology, and satisfaction of the observation group was significantly higher than those of the control group, which was statistically significant ( $P<0.05$ ). After 3 months of nursing, the observation group’s sleep quality scores in all dimensions (time to fall asleep, sleep time, sleep quality, sleep efficiency, hypnotics, sleep disorders, and day disorders) were higher than those of the control group ( $P<0.05$ ). After 3 months of nursing, the observation group’s self-care skill score, self-responsibility score, health knowledge score, and self-concept score were better than those of the control group ( $P<0.05$ ). Conclusion. Continued nursing care based on the combination of medical and health care for prostate hyperplasia is beneficial to improve sleep quality and improve the patient’s quality of life score and self-care ability and provide certain references for clinical care of patients with benign prostatic hyperplasia.

The dilemma of different dental degrees: DDS and DMD

Although the Doctor of Dental Surgery (DDS) evolved from the surgical and the Doctor of Medicine in Dentistry (DMD) from the medical (DMD) roots of the dental profession, dental schools in the US currently award both degrees, verified as equivalent by finding no differences between them in standards of admissions, accreditation, or state licensure requirements while continuing to be subjectively perceived as different enough to create professional and public confusion. In contrast, Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs) are both objectively and subjectively perceived as different in philosophy and healthcare training while objectively passing similar examinations to be licensed as physicians. Following from the history of both dental degrees and their implications for training and dental practice, the objective of this manuscript is to update the scientific, socio-political, and professional reasons for awarding only the DMD for future graduates while continuing to recognize the contributions of DDS graduates to oral healthcare. Working with the American Dental Association (ADA), American Dental Education Association (ADEA), and dental school librarians, a historical review was undertaken of the establishment of two doctoral degrees for dentists in the United States, including beliefs and attitudes of faculty and local dentists at the times of initiation or change in degrees awarded. Among the current 68 dental schools in the United States, there are approximately equal numbers of DDS- and DMD-granting schools. Except for some Harvard physicians, some of whom practiced dentistry, who wanted dentistry to be a specialty of medicine and the unexpected, serendipitous substitution of "medicine" for "surgery" which could not be translated into required Latin in 1867, all dental schools would have awarded only the DDS degree. Now, with the ongoing reorganization of the healthcare workforce in the United States, a single degree with broader healthcare connotations of the DMD will facilitate the integration of dentistry with overall healthcare, without changing the fundamental oral healthcare responsibilities of both DDS and DMD graduates.

Input From Practice: Reshaping Dental Education for Integrated Patient Care

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.

Dentists as Primary Care Providers: Expert Opinion on Predoctoral Competencies

Dentistry and medicine traditionally practice as separate professions despite sharing goals for optimal patient health. Many US residents experience both poor oral and general health, with difficulty accessing care. More efficient collaboration between these professions could enhance health. The COVID-19 pandemic disclosed further disparities while underscoring concerns that physician supply is inadequate for population needs. Hence, enhancing healthcare provider education to better meet the public's health needs is critical. The proposed titles “Oral Physician” or “Oral Health Primary Care Provider” (OP-PCP) acknowledge dentist's capacity to diagnose and manage diseases of the orofacial complex and provide some basic primary healthcare. The US Surgeon General's National Prevention Council and others recommend such models. Medical and dental education already overlap considerably, thus it is plausible that dental graduates could be trained as OP-PCPs to provide primary healthcare such as basic screening and preventive services within existing dental education standards. In 2018, 23 dental and medical educators participated in an expert-opinion elicitation process to review educational competencies for this model. They demonstrated consensus on educational expansion and agreed that the proposed OP-PCP model could work within existing US Commission on Dental Accreditation (CODA) standards for predoctoral education. However, there were broader opinions on scope of practice details. Existing CODA standards could allow interested dental programs to educate OP-PCPs as a highly-skilled workforce assisting with care of medically-complex patients and to helping to reduce health disparities. Next steps include broader stakeholder discussion of OC-PCP competencies and applied studies including patient outcome assessments.

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

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.