Mouth matters

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August 26, 2013

Maria Dolce, an asso­ciate pro­fessor of nursing in the Bouvé Col­lege of Health Sci­ences, learned the impor­tance of team-​​based care by treating the crit­i­cally ill for some three decades.

She was aston­ished when she read com­ments from a cancer patient—one of nearly 500 sto­ries she was ana­lyzing for her doc­toral research—who wrote that she “had been to the den­tist twice with bleeding/​swollen gums, and had been to the doctor once with var­ious other symptoms—bruising, per­sis­tent cough, a cut that wouldn’t heal. Nei­ther one of these health­care providers con­nected the dots or even sug­gested a blood test.”

For Dolce, this story high­lighted two major gaps in the field: edu­cating health pro­fes­sionals about the rela­tion­ship between oral and sys­temic health and designing effec­tive models of pri­mary care that pro­mote inter­pro­fes­sional col­lab­o­ra­tion and communication.

Backed by a grant from the Den­taQuest Foun­da­tion, Dolce is now bridging these gaps with the devel­op­ment of a unique edu­ca­tional pro­gram called Oral Health Care TIPS (more for­mally known as Inno­va­tions in Inter­pro­fes­sional Oral Health Care: Tech­nology, Instruc­tions, Prac­tice, and Service).

The program—which aligns with Northeastern’s focus on solving the world’s most com­plex prob­lems in health, secu­rity, and sustainability—is part of the university’s broader com­mit­ment to improving health through inter­dis­ci­pli­nary col­lab­o­ra­tions. TIPS will inte­grate the oral health care cur­riculum with other health care pro­grams at the uni­ver­sity, bringing its team approach out into the com­mu­nity through pri­mary health care ser­vices. The goal is to pro­mote oral health care while pre­venting dis­ease, a model Dolce hopes to dis­sem­i­nate to aca­d­emic cen­ters and pri­mary care prac­tices across the country.

From the begin­ning, TIPS will aim to fun­da­men­tally change the land­scape of oral health care by edu­cating the next gen­er­a­tion of health­care pro­fes­sionals. “Cul­ti­vating col­lab­o­ra­tive lead­er­ship within our own stu­dents is key,” said Dolce. “Empow­ering stu­dents and unleashing their lead­er­ship poten­tial will drive our inter­pro­fes­sional edu­ca­tion model and inno­va­tions in oral health care.”

“Preparing health pro­fes­sionals with team-​​based com­pe­ten­cies in oral health pro­mo­tion and dis­ease pre­ven­tion, and shifting from edu­cating health pro­fes­sionals sep­a­rately to inter­pro­fes­sional edu­ca­tion are imper­a­tives for improving oral health in America,” added Bouvé dean Terry Fulmer.

According to Dolce, the “silent epi­demic” of oral dis­eases is one of healthcare’s greatest chal­lenges. Each year, oral dis­eases affect mil­lions of chil­dren and adults, most of them from the nation’s most vul­ner­able pop­u­la­tions: poor chil­dren, preg­nant women, older adults, indi­vid­uals with spe­cial health care needs, and racial and ethnic minorities.

Nonethe­less, dental dis­ease is pre­ventable, said Ralph Fuc­cillo, chief mis­sion officer of Den­taQuest and pres­i­dent of the Den­taQuest Foun­da­tion. “A pri­mary care clin­i­cian may be the first and some­times only health pro­fes­sional to eval­uate the oral health of some people. The work of pro­fessor Dolce and her North­eastern Uni­ver­sity col­leagues is expanding the role that the health team has to improve oral health,” he explained. “That’s thou­sands of new eyes ready to iden­tify and help indi­vid­uals who are at risk for dental disease.”

Dolce envi­sions a sce­nario in which an older adult patient expe­ri­encing dry mouth visits a pri­mary care prac­tice where she is treated by a team including a physi­cian, nurse prac­ti­tioner, phar­ma­cist, den­tist, nutri­tionist, mental health clin­i­cian, and other health pro­fes­sionals. “That’s because dry mouth in older adults is often related to the use of many dif­ferent med­ica­tions and can lead to other prob­lems impacting quality of life like their ability to eat, swallow, speak, and sleep, some­times causing psy­cho­log­ical dis­tress and increasing the risk for devel­oping tooth decay,” said Dolce. “A physi­cian cannot tackle all of these chal­lenges alone.”