Should dentists become 'oral physicians'? Yes, dentists should become 'oral physicians'

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.

Easy Street, is that the right place for us?

Easy Street is a fictional place where life is carefree. Many doctors and patients are finding simplified, less demanding treatments more appealing, especially in these infectious times that encourage approaches involving minimal contact. In orthodontics, the move to perform more clear aligner therapy may be a faulty step toward Easy Street. A case is made against further trivialization of our specialty.

Disaster Management: Knowledge, Attitude, Behavior, Willingness, and Preparedness among Nigerian Dentists

Objective:

This study’s objective was to explore the disaster management knowledge, attitude, behavior, willingness, and assistance among Nigerian dentists.

Methods:

This cross-sectional, questionnaire-based study was conducted in Edo State (Nigeria) among selected Nigerian dentists that attended the Annual Scientific Conference of School of Dentistry, University of Benin (Benin City, Nigeria) between 2016 and 2017. The 54-item, modified Chhabra, et al disaster management questionnaire, which elicited information on demographic characteristics, disaster management knowledge, attitude, preparedness, and willingness, was the data collection tool.

Results:

A total of 126 dentists participated in the study, giving a 68.1% retrieval rate. The willingness to render assistance in the case of disaster among the participants was 95.2%. More than three-quarters (81.0%) reported that they had not received any disaster management training and 92.9% reported that they were not familiar with any government paper on response to disaster. The mean disaster management knowledge and attitude scores were 16.95 (SD = 0.40) and 34.62 (SD = 0.56), respectively. Disaster management knowledge had positive significant correlation with attitude and behavior. The disaster management attitude had positive significant correlation with behavior and negative significant correlation with preparedness. Disaster management behavior had positive significant correlation with preparedness and willingness to render assistance. Willingness to render assistance had significant correlation with preparedness.

Conclusion:

Data from this study revealed high-level of willingness to render assistance in disaster, high disaster management attitude, but with low disaster management knowledge, behavior, and preparedness. The significant correlation between knowledge, attitude, behavior, and preparedness implies that training will offer immense benefit.

Odai ED, Azodo CC, Chhabra KG. Disaster management: knowledge, attitude, behavior, willingness, and preparedness among Nigerian dentists.Prehosp Disaster Med. 2019;34(2):132–136

The Dentist of the Future: Dental Surgeon or Oral Physician?

There is an accepted recognition of the need for the dentist to be able to diagnose and treat the number of older dental patients with more complex health care problems. Therefore in the future, dentists and other dental professionals will need to broaden their role in the delivery of overall health care and the designation of a dentist as an 'oral physician’ as well as a 'dental surgeon’ would seem logical. To deliver this developing role it will be necessary to ensure that undergraduate dental teaching programmes are designed appropriately to provide clinicians with the necessary clinical skills.18

Should Dental Schools Train Dentists to Routinely Provide Limited Preventive Primary Medical Care? Two Viewpoints: Viewpoint 1: Dentists Should Be Trained to Routinely Provide Limited Preventive Primary Care and Viewpoint 2: Dentists Should Be Trained in Primary Care Medicine to Enable Comprehensive Patient Management Within Their Scope of Practice

This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.

The Role of Dentistry in Disaster Management and Victim Identification: An Overview of Challenges in Indo-Nepal Scenario

BACKGROUND

Recently, natural disasters and terrorist activities have been leading to mass casualty situations unexpectedly around the globe. In addition to the traditional emergency medical services centering around medically trained and paramedic personnel, dental practitioners having vital skills and attributes may be important in responding to a mass casualty situation.

OBJECTIVE

This paper aims at discussing the role of dentists in disaster management and the role of forensic odontology in the disaster victim identification (DVI), its status in India and some suggestions to develop the plans for same.

MATERIALS AND METHODS

Articles were searched in various medical databases such as Google Scholar, Pubmed Central, Sciencedirect,Wiley online Library, Scopus, Copernicus to gather all relevant information on the subject. Various keywords were used as search tool such as 'Mass disaster', 'Forensic odontology', 'Victim identification'.

RESULTS

The search resulted in total of 170 articles which we reviewed. Due to limitation to the list of references we have constricted our review to only 39 articles for more informative literature and supported the topic of the present manuscript 'The Role of Dentistry in Disaster Management and Victim Identification: An Overview of Challenges in Indo-Nepal Scenario' more specifically.

CONCLUSION

Every disaster is unique and involves interplay of different factors and circumstances such as nature of disaster, number of victims and extent of body fragmentation that ultimately challenges the disaster response planning. Apart from the victim recovery and evacuation, the disaster response planning must include the established procedures for the identification of the victims of the disaster. The identification of victims essentially relies on forensic anthropology, radiology, DNA typing and fingerprints, as well as odontology.

Screening for substance misuse in the dental care setting: findings from a nationally representative survey of dentists

AIMS

The dental setting is a potentially valuable venue for screening for substance misuse. Therefore, we assessed dentists' inquiry of substance misuse through their patient medical history forms and their agreement with the compatibility of screening as part of the dentists' professional role.

DESIGN

A nationally representative survey of general dentists using a sampling frame obtained from the American Dental Association Survey Center (November 2010-November 2011).

SETTING

United States of America.

PARTICIPANTS

A total of 1802 general dentists.

MEASUREMENTS

A 38-item survey instrument assessing the relationship between dentists' practice, knowledge, behaviors and attitudes with their query about substance misuse and their belief that such screening is part of their professional role.

FINDINGS

Dentists who accepted substance misuse screening as part of their professional role were more likely to query about misuse with their patients (85.8%) compared with those who did not accept such screening as part of their role (68.2%) (P < 0.001). Prior experience and knowledge about substance misuse were the strongest predictors of dentists' inquiry about patient substance use/misuse and acceptance of screening as part of their role in their clinical practice (P < 0.05).

CONCLUSION

While more than three-quarters of US dentists report that they ask their patients about substance misuse, two-thirds do not agree that such screening is compatible with their professional role.

Primary care in dentistry - an untapped potential

Dentistry is neither an allied health profession nor a paramedical profession. It is the only anatomically focused health care profession that is university-based and for which primary care responsibility is maintained by the profession. Dentists must have a reliable knowledge of basic clinical medicine for safely and effectively treating individuals with chronic and other diseases, which make them biologically and pharmacologically compromised. With changes in the life expectancy of people and lifestyles, as well as rapid advancement in biomedical sciences, dentists should have similar knowledge like a physician in any other fields of medicine. There are number of primary care activities that can be conducted in the dental office like screening of diabetics, managing hypertension etc., The present review was conducted after doing extensive literature search of peer-reviewed journals. The review throws a spotlight on these activities and also suggests some the measures that can be adopted to modify dental education to turn dentists to oral physicians.

The dentist as doctor: a rallying call for the future

BACKGROUND

When the future status of dentistry is considered, scholarship in the profession plays a key role. It is by scholarship that dentistry distinguishes itself as a learned and esteemed profession, and this position paper aims to explore and promote this vital core value.

METHODS

As Fellows of the American Dental Education Association's selective Leadership Institute, the authors spent over a year critically examining the role of scholarship in dentistry, which was identified as a critical issue for the profession. A review of the health care literature was conducted to inform this paper's position.

RESULTS

Scholarship is clearly the trait that distinguishes a profession from a trade, as evidenced by trends in other health care professions, as well as dentistry. Although dentistry is a learned profession rightly meriting that distinction, there are a few notable areas that can be improved.

CONCLUSIONS

Because scholarship defines a profession, dentists as doctors and the leaders in oral health should demonstrate the highest scholarship; absence of scholarship risks perception of dentistry as a trade. All dentists can consistently manifest scholarship by integrating basic science, as well as by incorporating the dental evidence-base, into daily practice.

Diabetes screening at the periodontal visit: patient and provider experiences with two screening approaches

OBJECTIVES

This study examined patient and dental provider experiences during the periodontal visit of diabetes screening approaches involving the collection of gingival crevicular blood (GCB) and finger stick blood (FSB) for haemoglobin A1c (HbA1c) testing.

METHODS

At a large, urban, US periodontics and implant clinic, FSB samples from 120 patients and GCB samples from 102 of these patients were collected on special blood collection cards and sent to a laboratory for HbA1c testing, with test results sent to the patients from the laboratory. Quantitative and qualitative data from patients and qualitative data from providers were collected and analysed.

RESULTS

Quantitative and qualitative data support the feasibility and acceptability of the approaches described. Themes that arose from the interviews with providers and patients include 'a good chance to check', 'patient choice', 'FSB versus GCB testing' and 'a new way of interacting and viewing the dental visit'.

CONCLUSIONS

Periodontal patients and dental providers believe that the dental visit is an opportune site for diabetes screening and generally prefer GCB to FSB collection. HbA1c testing is well tolerated, convenient and acceptable to patients, and GCB testing reduces time and liability obstacles for dental providers to conduct diabetes screening.

Rapid HIV testing in dental practices

Despite increasing discussion about the dental care setting as a logical, potentially fruitful venue for rapid HIV testing, dentists' willingness to take on this task is unclear. Semistructured interviews with 40 private practice dentists revealed their principal concerns regarding offering patients HIV testing were false results, offending patients, viewing HIV testing as outside the scope of licensure, anticipating low patient acceptance of HIV testing in a dental setting, expecting inadequate reimbursement, and potential negative impact on the practice. Dentists were typically not concerned about transmission risks, staff opposition to testing, or making referrals for follow-up after a positive result. A larger cultural change may be required to engage dentists more actively in primary prevention and population-based HIV screening.

Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008

We assessed the proportion and characteristics of patients who do not regularly visit general health care providers but do visit dentists and whose unaddressed systemic health conditions could therefore be identified by their dentist. Of the 26.0% of children and 24.1% of adults that did not access general outpatient health care in 2008, 34.7% and 23.1%, respectively, visited a dentist. They varied by census region, family income, and sociodemographics. Dental practices can serve as alternate sites of opportunity to identify health concerns among diverse groups of US patients.

A model for dental practice in the 21st century

The dental profession is responsible for the prevention, diagnosis, and treatment of diseases and disorders of the oral cavity and related structures. Although the majority of the US population receives excellent oral health care, a significant portion is unable to access regular care. Along with proposals to develop midlevel providers, the scope of practice for dentists needs to be reconceptualized and expanded. A broad number of primary health care activities may be conducted in the dental office, such as screening for hypertension, diabetes mellitus, and dermatopathology; smoking prevention and cessation activities; and obesity interventions. More than 70% of adults saw a dentist in the past year, which represents an unrealized opportunity to improve both oral health and general health.

Need for an Ethical Framework for Testing for Systemic Diseases in Dental Clinics

Testing for systemic diseases in dental clinics is a potentially attractive avenue for oral health professionals and may be viewed as an opportunity to increase professional reach, expand practice, and improve financial returns. However, several ethical questions arise that must be addressed before such activities are adopted. (1) What should be the level of training dentists must acquire to deal with challenges associated with testing? (2) How well are dental practices aware of and compliant with the Health Insurance Portability and Accountability Act and procedures related to informed consent? (3) What is the evidence regarding acceptability and effectiveness of testing? (4) What should be the acceptable standard of practice for conduct of invasive and noninvasive tests? (5) What is the boundary delineating "testing" and "reporting" vis-à-vis counseling? (6) What is the value of testing without counseling? (7) What assurances need to be in place to ensure voluntariness of testing? (8) How would data from testing be used in "research," especially with the growth of practice based research networks? and (9) Does the American Dental Association Code of Ethics need to incorporate guidance for practicing dentists? We discuss how ethical principles can be used to develop a framework of guidelines for potential testing for systemic diseases in dental clinics..

Stomatology and odontology: perspectives of Spanish professors and senior lecturers in dentistry

The curricula of dental faculties in many countries of the European Union can be described as odontological. The faculties of some of the countries who have become and are becoming members of the European Community have traditionally educated dentists in the stomatological tradition. In 1987, the Spanish dental education system initiated movement from the stomatological model to the odontological. Both models have their respective strengths and weaknesses. This study surveyed professors and senior lecturers in Spain's public dental faculties to assess their perspectives on 10 items related to the tension between the odontological and the stomatological approach to preparing dentists. Amongst other things, the results of the study indicate that the respondents believe the odontological model, with its emphasis on strengthening technical qualifications, may not prepare individuals for dental practice better than the stomatology tradition; and that the odontological model results in the loss of the strength of the stomatological model, that is, the strong foundation in clinical medicine. The suggestion is advanced that European dental educators consider revising the odontology curriculum to strengthen the education of dental students in clinical medicine. A curriculum in which dental and medical students share the first 3 years of study could accomplish this. It is further suggested that subsequent years in the curriculum be flexible enough for students to earn degrees in both dentistry and medicine, if desired. Such an approach is not inconsistent with the accepted profile and competencies of the European dentist.