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Achieving Patient-Centered Care through Interprofessional Collaborative Practice

Course Number: 471

The Role of Oral Healthcare Providers in Interprofessional Collaborative Practice

For decades, oral healthcare providers have been playing an important role on Interprofessional collaborative teams. One of the salient examples, is in the area of cleft lip and cleft palate where a team of oral health, health, and social care providers and others have been working together to coordinate care for this group of patients with complex needs that could only be addressed by an interprofessional team. More recently, oral healthcare providers have been valuable members of interprofessional teams in the treatment of chronic pain patients because of our work in temporomandibular joint disorder (TMD) and sleep medicine.

Our role as a team member with other professionals continues to be in demand as more medical conditions are linked to oral health. The CDC has predicted the number of patients who will be diagnosed with diabetes will double or triple by 2050.51 This will necessitate an increased readiness of oral healthcare providers to manage their patients through screening and refer for non-dental conditions that contribute to an overall improvement in their patient’s overall health. Several studies have demonstrated diabetes is a risk factor for the development of periodontal disease and patients in certain populations have more severe periodontal disease.52-54 These patients could be better managed when we collaborate as an interprofessional team viewing the disease process from a dental, medical, pharmacotherapeutic and mental health management standpoint. In a recent interview with David Gesko, Senior Vice President & Dental Director HealthPartners, he described running a study in their clinics that demonstrated that dentists were able to screen for diabetes.55 He stated that “being able to integrate allows Health Partners to really look at a patients’ overall health”. Therefore, oral health care providers would become an important source for screening these patients and helping to provide a reciprocal referral base between oral healthcare and other health professionals.

As the number of individuals being diagnosed with chronic renal failure increases, there is an increased probability oral health professionals will care for these patients.56 In addition, one of the most common causes for chronic renal failure is chronic hypertension, which can be easily monitored by oral health professionals. One advantage dentists have is patients routinely have visits, and this affords the provider with an opportunity to monitor patients’ blood pressure over an extended period of time. As oral health professionals observe patients having higher than normal blood pressure, or higher blood pressure readings in spite of medication, it would then be appropriate to counsel the patient and communicate with other members of the patient’s team. Therefore, oral healthcare providers can play a significant role in screening patients for certain primary care metrics and it was found that dentist were willing to incorporate screening in their practices.28,57

In addition, oral healthcare providers treat a large population of patients that have mental health conditions and chronic pain patients who are taking medications that can cause xerostomia, which increases gingival inflammation and increases caries rates. Newly diagnosed patients with mental health conditions and some chronic pain patients would benefit from referral to an oral healthcare provider as many of the common medications prescribed for management of these disease processes have xerostomia as a side effect.58 A dialogue with other healthcare colleagues about the impact of medications on the management of oral health and a referral would allow for these patients to be evaluated and a have a customized care plan that might include fluoride therapy, recommendation for products that help lubricate that teeth and soft tissues.

Other examples of collaboration have occurred to advocate for early childhood dental visits. This initiative has also contributed to a partnership between obstetrics and gynecology and oral healthcare providers. At Rice Memorial Dental clinic in Willmar, Minnesota, mothers who have recently given birth receive dental education, along with obstetrics and gynecological services while still in the OB ward at Rice Memorial Hospital. 59 Dental hygienists or other dental clinic staff establish a relationship with the new mothers, provide infant oral health education, answer questions and have them complete an information card, and then mail the family a 1st birthday card as a reminder for them to schedule the early childhood dental visit by age 1. Dental Hygiene faculty and students at the University of Minnesota School of Dentistry go on rounds with physicians and medical students on rounds at the Fairview Hospital in Minneapolis, Minnesota. This collaboration evaluated 50 patients between August – December in 2021 with 30% of the patients being referred for dental treatment. In the Fall of 2021 and the Spring of 2022 this interprofessional collaboration assessed 53 and 74 patients respectively.60,61 This highlights the opportunity to not only discuss good oral healthcare practice after pregnancy to minimize periodontal diseases, but to also help prevent caries the most common chronic childhood disease.61 Another example is Dr. Erin Westfall, a Mayo Clinic faculty, in Mankato, Minnesota, who proposed and developed an integrated model to oral healthcare in a medical office. She analyzed the need within her community and believed medical integration can improve patient experience and provide the person-centered care that patients in her community need. The practice focuses on integrating oral health in to primary care and focusing on preventive needs for children, adolescents, pregnant women, and adults with chronic diseases.62 A clear example that indicates that oral health professionals have an opportunity to help enhance the public’s understanding of the importance of oral health in improving overall health.