By hosting the first national conference on oral and systemic health in Baltimore on Dec. 10, the University of Maryland, Baltimore (UMB) took another major step toward true interprofessional health care education, says Jay A. Perman, MD, president of the University.
More than 120 leading dental hygienists, nurses, other health professionals, educators in the health professions, and clinical/public health practitioners attended the conference on the Oral Systemic Link: Creating Collaborative Initiatives. Pathways to promote interprofessional education, research, and practice for dental hygiene and nursing collaborations were explored.
"This important event on the link of oral and systemic health highlights trends of working together to help reform our health care delivery system rather than working alone in our individual professions," says Perman. "It is a terribly important collaboration that needs to be developed."
Conference speakers presented extensive and powerful links between oral health and systemic conditions. Diabetes, osteoporosis, anxiety, tension, depression, earaches, eating disorders, poor nutrition, and some cancers "can be identified by, and linked to, conditions in the oral cavity and head and neck regions." said dental hygienist Jacquelyn Fried, MS, RDH, director of interprofessional initiatives at the University of Maryland School of Dentistry (SOD) and the conference co-chair (pictured on left with co-chair Shannon Idzik, DNP, MS, CRNP, assistant professor and Director of the Doctor of Nursing Practice Program, UM School of Nursing).
"The oral-systemic link highlights commonalities between nursing, dental hygiene and other health professions. These commonalities lead to collaborative models, interprofessional models. Why? Because of shared patient outcomes that promote wellness and the desire for interprofessional education that develops well-rounded providers," said Fried.
"We need to re-invent ourselves due to comorbidity," said Christian S. Stohler, DMD, DrMedDent, dean of the University of Maryland School of Dentistry. "The concept of co-morbidity is not even understood by our insurance providers, not addressed. That is one reason our health care system is out of control."
Periodontal disease is often at the center of co-morbidities, said Mark Reynolds, DDS, PhD, MA, professor and chair of the Department of Periodontics at the dental school. "Inflammation is the tie that binds," Reynolds said, explaining that periodontal disease is caused by bacterial infections that "are not only tissue invasive, but cell invasive and found throughout the body. People don't often know they have it until severe disease is present."
Reynolds said inflammatory diseases such as rheumatoid arthritis are also linked to oral bacteria. "So what?" he said rhetorically. "Well, the treatment of oral disease, particularly periodontal disease, reduces hospitalization costs."
Also, Perman, a pediatric gastroenterologist, said that "periodontal disease has been associated with premature, low-birth-weight babies in a number of studies. According to these studies, the greater the extent of maternal periodontal disease, the more likely the mother may have a premature baby."
JoAnn Gurenlian, RDH, PhD, interim director of the graduate dental hygiene program at Idaho State University and president-elect of the International Federation of Dental Hygienists, said that as a dental hygienist, she sees much more than the average person sees in a smile. The smile to her is a window into the personýs mouth and body. "The whole point of what we want to accomplish" in interprofessional collaboration, Gurenlian said, "is to look at the whole person. Oral health is health, and we forget that. In nursing, in physical therapy, in speech pathology, in medicine, in any other [health] group, oral health is [currently] rarely thought of. And how could that be so? Students get only an hour of oral health education in their curriculum."
Judith Haber, PhD, APRN, FAAN, the Ursula Springer Leadership Professor in Nursing and associate dean of graduate programs at the New York University College of Nursing, outlined dental hygiene/dental/nursing educational opportunities, such as nursing students conducting an oral health history and recognizing normal versus pathological variations of oral structures. A side-by-side consultation project with interprofessional students on comprehensive oral-systemic patient assessments and referrals for systemic health risks would be another innovation, said Haber, who also discussed collaborative innovations in pediatrics and summer research projects.
"There were multiple dynamics in play at this conference," said Kathryn Montgomery, PhD, RN, NEA-BC, associate dean for strategic partnerships and initiatives and associate professor at the University of Maryland School of Nursing. "There was clinical content, there were practice issues and interprofessional education, as well as a new conference-participation approach with full engagement of participants in 'active learning.'
University of Maryland, Baltimore