Dental schools place to start
Michael J. Reed, D.D.S., founder of the Dallas-based Mobile Dental Care and president of the Specialty Care Dentistry Association, had a suggestion for improving dental/medical integration: deeper integration of dental and medical schools, when possible.
“Really, it is on my list to collaborate with my medical colleagues better,” he said. “But we are all trying, and eventually we’ll get there. It would sure make the care of the U.S. population better if we doctors could combine our professional schools and all be one big happy family.”
Dental schools across the country have taken the opportunity to teach students about the mouth-body connection and the need to collaborate with physicians to advance patients’ overall health.
Gary Stafford, D.M.D., senior associate dean for academic systems at the Oregon Health & Science University School of Dentistry, said he remembered only limited exposure to the medical side of health care when he was in dental school nearly four decades ago.
Now, he said he’s proud of multiple initiatives the school has launched, with the support of its parent institution, to educate dental students on the importance of communicating with medical providers.
Whether it is working with medical providers during external rotations, collaborating with social workers at the OHSU dental clinics, participating in workshops held in the university’s interprofessional education program or administering flu and COVID-19 vaccines with the help of the university’s occupational health personnel, the students are getting fully immersed in understanding the mouth-body connection, Dr. Stafford said.
“We’re very proud of that,” he said.
Another example is NYU.
“I believe that integrated health is the future of health care,” said Charles Bertolami, D.D.S., the Herman Robert Fox dean of the NYU College of Dentistry. “Closing the dental-medical gap in care is not only transformative for patients, but for the next generation of dentists as well. NYU Dentistry has pioneered programs that enable dentists and dental students to work alongside their colleagues in medicine, nursing and nutrition in ways that increase understanding and collaboration — and ultimately benefit patients by caring for the whole person."
The NYU College of Dentistry has an ongoing collaboration with NYU Steinhardt nutrition students to provide nutritional counseling to pediatric patients and their families, many of whom are underserved. The NYU Dentistry/Bellevue Prenatal Oral Health Program trains dentists located in Bellevue Hospital's OB/GYN clinic to care for underserved pregnant women.
The NYU Rory Meyers College of Nursing's Teaching Oral-Systemic Health program has several interprofessional training opportunities for students to learn about the mouth-body connection. This includes an annual three-day simulation in which dental, medical, nursing and pharmacy students learn how to work together on patients, as well as featuring real-life interprofessional experiences with pediatric patients.
In addition, since 2020, the NYU College of Dentistry has been the home to the Manhattan location of Metro Community Health Centers, a federally qualified health center, which provides an opportunity to implement collaborative practice models that aim to better identify disease precursors and underlying conditions in order to improve overall health and well-being. NYU patients now have access to both dental and medical care (and providers who accept Medicaid) under one roof.
One patient population in particular is benefiting from this special attention to the mouth-body connection: veterans who have been diagnosed with blood cancer. With support from The Leukemia & Lymphoma Society, veterans can be referred by their medical providers at the VA to come to NYU Dentistry for oral health care, which is especially important before starting their cancer treatment.
Dalal Alhajji, D.M.D., a clinical instructor at NYU Dentistry, is working to bridge the gap between dental and cancer care, working closely with oncologists at NYU Langone's Perlmutter Cancer Center. The center refers patients to Dr. Alhajji for oral health screening prior to starting cancer treatment, which can help prevent complications during chemotherapy or bone marrow transplants.
Mark Fitzgerald, D.D.S., associate dean of Community-Based Collaborative Care & Education at the University of Michigan School of Dentistry, said his colleagues at the dental school work diligently at establishing and teaching protocols that help reinforce the importance of the mouth-body connection.
The school’s renovated clinic, which had a ribbon-cutting ceremony in September, is specifically designed to create an environment where health care providers from multiple disciplines can work in collaboration to deliver the best health and oral care possible for their patients, Dr. Fitzgerald said.
“Everything in the clinic is designed to meet the needs of patients who present with needs that extend beyond those of traditional ‘healthy’ people,” he said.
This includes special rooms for conscious sedation, a room where wheelchair-bound patients can receive their care without needing to leave their wheelchair, special conference rooms for teams of providers to meet to discuss cases or consult with patients, and room for teams of providers to be present chairside to assist in the diagnosis and management of patient needs, Dr. Fitzgerald said.
“Because dentists tend to see their patients on a regular basis and at times their patients may not be seeing their primary health care providers, we can be partners in the overall monitoring, reinforcement and provision of care," he said.
Obstacles remain, however, across the landscape.
Wenyuan Shi, Ph.D., former chairman and professor of oral biology at the UCLA School of Dentistry, said that unlike other body parts in the head-neck areas — such as ENT (ear, nose and throat) — that have been considered part of medicine, dentistry and oral health have always been treated separately.
“The mouth is the gateway to the body,” said Dr. Shi, chief executive of the Forsyth Institute. “Yet as important as oral health is for overall health, it is always overshadowed by medicine. [Dentistry] never gets the attention it needs. When it comes to technology development, all major Wall Street investment firms cover medical health, but hardly any covers dental innovation. When comes to major technology conferences … they only talk about innovation in medicine, not dentistry.”
Dr. Lee said other obstacles exist, but that they can be overcome.
“The main challenge in fostering the culture of shared responsibility for a patient’s total health is in making sure it is able to remain top of mind, even under the pressure of a daily schedule,” he said. “Being part of a larger, integrated health system, with all our team members and systems that make it easier for our clinicians to do the important things around medical-dental integration, along with our existing culture of providing high-quality care, helps us to overcome the challenges keeping the culture of overall health a priority even if at times the clinical schedule may seem too busy for it.”