The IOH Toolkit begins with two fundamental ideas: 1) Patients benefit when oral health is considered essential to comprehensive health care, and 2) Health outcomes improve when care is delivered collaboratively by an interprofessional team. In recent years, a consensus has formed around this second point, and academic institutions have responded by seeking ways to embed interprofessional education (IPE) within their health professions curricula.

This toolkit is designed to help faculty and administrators at schools and academic health centers advance IPE through the integration of basic oral health competencies into courses and programs across the health professions. This curricular innovation has two aims:

• Contribute to the development of interprofessional collaborative practice competencies in health professions students.
• Prepare the next generation of health professionals to deliver integrated primary care services that include oral health.

Health professions educators who want to advance IPE will find that oral health integration programs offer students from across the health professions an overlooked opportunity to learn about interprofessional collaborative care. The connections between oral and overall health suggest a wide range of opportunities for this kind of collaboration.

• Oral health affects nutrition, speech, and appearance.
• Oral health may also be associated with cardiovascular disease, respiratory disease, diabetes, adverse pregnancy outcomes, and behavioral health.
• Oral health presents opportunities for patient education focused on prevention.
• Oral health care delivery requires the same professional, communication, and cultural competencies that should underlie all health care delivery.
• Oral health concerns disproportionately affect vulnerable and underserved populations, inviting opportunities for IPE that focus on issues of access and equity.

Who should use this toolkit?

This toolkit will be useful for oral health and IPE advocates interested in integrating oral health in other health professions curricula at the course, program, or institutional level.

Faculty champions. If you are an individual or group of individuals looking to start the ball rolling, you’ll find resources here to help you implement classroom-level changes that can link oral health to:

• Related course objectives or curriculum
• Community service-learning programs
• Unfolding case studies or clinical case presentations

Program pioneers. If you are interested in making program-level changes at your institution, this toolkit has what you need. You can choose from a variety of programming options.

• Faculty development workshops
• Simulated learning exercises
• Didactic sessions
• Cooperative education assignments
• Service learning projects

Each of these options stands on its own so you can pick and choose the topics and formats that fit your programming requirements.

System-wide change agents. If you are looking to make institutional-level changes that integrate oral health competencies across health professions programs, this toolkit will be of use to you from the first step to the last. From raising awareness and assessing your institution’s readiness, to training faculty and educating students, chapters will walk you through the process, giving you valuable tools for turning your vision into a reality.

What is oral health integration and why does it matter?

The mouth resides in the body, and the two interact in myriad ways, yet a separation has persisted between professions that provide care for the body and professions that provide care for the mouth. Oral health integration ensures that primary care and dental providers work as a team to deliver integrated care that recognizes both the oral and the systemic needs of their patients.

From an educational perspective, oral health integration refers to the inclusion of oral health competencies in the curricula of other health professions. Why does this matter? Tooth decay is the most prevalent chronic disease in U.S. children and adults even though it is largely preventable. Further, oral health concerns disproportionately affect vulnerable and underserved communities. Equipping all health professionals with basic oral health competencies will reduce oral disease and promote health equity.

Why use the IOH Toolkit?

This toolkit advances IPE through programming and activities that:

• Function independently or as part of a larger program
• Involve students from any combination of health professions programs
• Allow students to learn online or venture into the community
• Educate faculty and build external partnerships

Unlike programs designed for specific professions, settings, or populations, the IOH Toolkit has broad application. Whether you are an individual faculty member who wants to add an oral health dimension to your courses or an administrator seeking ways to embed IPE throughout the health professions curricula, this toolkit has resources you can use. It offers both high-level guidance and detailed step-by-step instructions for all phases of the integration process.

The IOH Toolkit also differs from other oral health toolkits in its flexibility. It includes activities for both entry-level and more advanced students and curricular modules suited to a range of settings and pedagogical approaches.

Chapters in this toolkit are based on the successful implementation of the Innovations in Oral Health (IOH) program at Northeastern University’s Bouvé College of Health Sciences. You’ll find step-by-step instructions, comprehensive lesson plans, and sample forms, worksheets, and assessments to help you create your own plan and put it into action.

With generous funding and support from the DentaQuest Foundation, Northeastern University Bouvé College of Health Sciences established the Innovations in Oral Health (IOH) Program to help prepare students across multiple health professions to enter their practices ready and willing to recognize the oral health needs of their patients and collaborate with dental professionals to address those needs.

At the launch of the IOH Program in 2013, organizers convened an Oral Health Summit where over 125 health professionals, funders, policymakers, faculty, students, and community leaders from across New England gathered to address systems change for improving oral health. Their collective wisdom was distilled into a core set of guiding principles that influenced the development of program activities and initiatives. Those principles included:

• Embrace a network mindset and engage in collaborative leadership to advance interprofessional education and practice in oral health.
• Promote experiential learning innovations linking oral health education and practice.
• Partner with communities of practice to promote integration of oral health and primary care.
• Develop student leadership and advocacy for oral health to achieve health equity.

These principles, combined with the DentaQuest Foundation’s Oral Health 2020 vision to “improve lifelong oral health and eradicate dental disease in children,” served as common ground from which to advance interprofessional education and practice across health professions and promote medical-dental collaboration.

In the two years that followed, educators at the Bouvé College of Health Sciences implemented a series of programs and activities aimed at integrating oral health throughout the curricula within their college. The IOH Toolkit is the culmination of these initiatives. It provides a roadmap for engaging all health care providers in oral health surveillance and strengthening educational resources to support oral health integration across the health professions.

The U.S. Health Resources and Services Administration (HRSA) has identified increasing the number of health professionals with core competencies in oral health and interprofessional collaborative practice as a key strategy for improving the health of millions of Americans who currently lack access to dental care. Implementing this strategy will require a fundamental shift in health professions education away from the traditional separation between caring for the mouth and caring for the body.

This toolkit promotes a team-based approach to care that brings together students from multiple health professions to learn from and about one another’s roles and responsibilities while also learning to improve oral health across the lifespan. Educators will find a variety of teaching strategies, including online, simulation, case-based, and service learning as well as cooperative education. Where appropriate, these strategies are accompanied by ready-to-use instructor’s guides focused on diverse aspects of oral health integration.

The IOH Toolkit relies on the third edition of Smiles for Life: A National Oral Health Curriculum as a curricular foundation for its educational programming. The combined elements of flexibility, low cost, and accessibility make this online educational platform a powerful tool. But online programming alone cannot provide the interactive clinical and team-based experiences that characterize the best IPE. As a remedy, this toolkit uses a blended approach, incorporating online materials from Smiles for Life into classroom and clinical settings. In this way, students and faculty can reap the advantages of online education without missing out on the benefits of face-to-face, hands-on learning.

Smiles for Life

The Smiles for Life online curriculum undergirds programming described in the following toolkit chapters: Faculty Development, Simulation Learning, and Interprofessional Case-Based Learning.

Background. The Society of Teachers of Family Medicine Oral Health Group created the Smiles for Life curriculum to develop oral health competency in primary care professionals and faculty. This widely respected online program equips practicing health professionals with the skills they need to:

• Recognize oral health conditions
• Assess oral health risks
• Participate in preventive activities on behalf of their patients

These competencies align with the Interprofessional Education Collaborative and the core competencies developed by HRSA as part of its 2014 Integration of Oral Health and Primary Care Practice initiative.

To learn more, see this Framework for Competency Development in Oral Health.

Content. Smiles for Life consists of eight self-paced online courses that cover oral health across the lifespan. Educators can access downloadable modules that include the course slides along with presenter notes, companion videos, an implementation guide, learning objectives, test questions, and a resource list.

Course 1. The Relationship of Oral to Systemic Health
Course 2. Child Oral Health
Course 3. Adult Oral Health
Course 4. Acute Dental Problems
Course 5. Oral Health and the Pregnant Patient
Course 6. Caries Risk Assessment, Fluoride Varnish and Counseling
Course 7. The Oral Examination
Course 8. Geriatric Oral Health

Access. Smiles for Life is available online and may be used free of charge. Faculty interested in completing Smiles for Life courses should register as individual clinicians.

Note: Registration is not required to view the courses, but it is required to receive continuing education credits. Those who wish to train others and download resources for classroom use must register as educators to gain full access to instructor materials.

Endorsements. Seventeen organizations have endorsed Smiles for Life, including:

• American Academy of Family Physicians
• American Academy of Physician Assistants
• American Academy of Pediatrics
• National Association of Community Health Centers
• National Association of Pediatric Nurse Practitioners
• American Dental Association

Strategic planning.

• How could oral health integration help your institution achieve its mission?
• What aspects of oral health integration support the vision put forth for your institution or your program?
• How might oral health integration support the objectives laid out in your institution’s current strategic plan?

Costs.

• What costs will you incur to meet your objectives? Consider faculty and staff time, materials, and use of classroom or clinical space.
• What no-cost resources are already at your disposal?
• Will you require additional employees? Part-time support? A graduate assistant?
• How will you fund your initiative? Can you secure institutional support such as discretionary funds from your department or college? What grant opportunities are available?

Environmental support.

• How much collaboration already occurs among health professions programs at your institution?
• Is IPE an established and valued aspect of educational programming?
• Does oral health already have a foothold in existing curricula?
• If not, how much resistance do you anticipate to its introduction?

Organizational capacity.

• What staff resources will be required to support the goals of your initiative?
• Will you require part-time support? Volunteers? Graduate assistants?
• What kind of administrative support do you have? Who will manage implementation?

Partnerships.

• Which partners must you engage, both internally and in the community?
• What roles do you anticipate for each of your partners?
• Do you have faculty champions already on board?
• Do you have established community partnerships on which to build?

Communication.

• How do you plan to communicate your message to faculty, students, and potential partners in the community?
• Do you have a website? Newsletter? Email distribution list?
• Do you have a social media plan?
• Who will manage communication?

Evaluation.

• How will you evaluate progress and outcomes for your program?
• What tools will you put in place to evaluate faculty, staff, students, and community partners?
• What metrics will you use to measure progress?

Adaptation.

• Do you have a plan for refining your program in response to evaluation outcomes?
• By what process and timeline will you review performance, review objectives, and update your plans?

• Size of your organization
• Available resources
• Faculty skill sets
• Organizational support
• Current level of oral health integration

• Are You Ready?
• Create Awareness and Secure Support
• Faculty Development

• Web-based resources hosted by other entities.
• Forms created by IOH. These samples may be copied and modified to meet your particular needs.
• Forms created by other entities. These should be used without modification.

• Framework for Competency Development in Oral Health