SMILE Detroit: A Pilot Program in Interprofessional Oral Health Care

Dereczyk, Amy, Sylvie Hang, Rami Nazarian, Theresa Gattari, and Kendall Gjetaj

Introduction: 

It is well established that oral health plays an integral role in overall health and wellness. Evidence suggests that adverse oral health conditions can be linked to many systemic diseases including diabetes, atherosclerosis, and cardiovascular disease. 1,2  Moreover, many adverse health conditions have early manifestations in the oral cavity. Yet, 6.1% of children and 16.4% of adults under 65 years of age did not receive needed clinical and preventative dental services in 2011 due to limited financial means. 3  The first Surgeon General’s Report to focus on oral health was released in 2000. The report examined the relationship between oral and systemic health and called for the development of a national plan to improve quality of life and decrease health disparities related to oral health stating, “the public health infrastructure for oral health is insufficient to address the needs of disadvantaged groups, and the integration of oral and general health programs is lacking.” 4  Over a decade later, lack of access to basic dental services still stands as a major contributor to oral health disparities throughout the United States, especially in Detroit. A report from the Michigan Department of Community Health indicates that 45% of third grade children in Detroit have untreated dental caries. Additionally, 22% of adults 65 years and older residing in Detroit report having all of their natural teeth removed as a result of infection, unintentional injury, or head and neck cancer treatment.5 In response to this national and local issue, the University of Detroit Mercy and Wayne State University collaborated to create a program designed to better educate health care students on oral health.  The SMILE (Students of Michigan for Interprofessional Leadership and Education) Detroit project was a pilot program designed to address oral health education and promotion by creating an interprofessional experience that increased awareness between health professional students.

 

Methods:

The SMILE Detroit pilot involved three phases.

Phase 1: Oral Health Huddle.

Faculty from the each discipline led the student groups through systemic and oral disease case studies. Students discussed the cases from their profession’s vantage point, thus facilitating interprofessional communication. Additionally, barriers to oral health care, the role of physicians and PAs in providing basic oral health services, and how we can better facilitate interprofessionalism was discussed amongst health care providers in an effort to reduce oral health disparities.

 

Phase 2: Oral Health Bootcamp The oral health bootcamp took place at the University of Detroit Mercy School of Dentistry. The oral health bootcamp was centered around a  “see one, do one, teach one” learning approach in which dental students demonstrated how to perform an oral exam and how to identify gingivitis, periodontitis, caries and other basic oral diseases. In addition, students demonstrated basic preventative dental services including how to apply varnish. Students then proceeded to practice on one another.

 

Phase 3: Community Outreach. After successfully completing both phase one and two, students will apply the skills and knowledge obtained during the first two phases by providing free oral health screenings at a local clinic.

 

Volunteer faculty and 23 students from all disciplines participated in phase one and two. Readiness for Interprofessional Learning Scale (RIPLS), a validated interprofessional evaluation tool was used to pre and post survey participants.

Results: 

Pre and post survey results demonstrated overall improvement in score on knowledge of oral health. Over 90% of students strongly agreed that collaboration would benefit both health care providers and patients in addressing oral health promotion and prevention of chronic systemic diseases.

Discussion: 

The SMILE Detroit pilot program strives to promote interprofessional and oral health education.  Our results show that creating awareness among multiple disciplines increased knowledge overall.  More importantly, it clearly demonstrates the desire and need for collaboration among health professionals on key oral health issues to help prevent chronic conditions and diseases.

 

References:

  1. Lamster IB, Lalla E, Borgnakke WS, Taylor GW. The relationship between oral health and diabetes mellitus. J Am Dent Assoc. 2008 Oct;139 Suppl:19S-24S
  2.  Meurman JH1, Sanz M, Janket SJ. Oral health, atherosclerosis, and cardiovascular disease. Crit Rev Oral Biol Med. 2004 Nov 1;15(6):403-13.
  3. National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Hyattsville, MD. 2013.
  4. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial. Research, National Institutes of Health, 2000. Available at: http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/. Accessed
  5. Michigan Department of Community Health. 2013. Burden of Oral Disease in Michigan 2013. Retrieved from http://www.michigan.gov/documents/mdch/Burden_of_Oral_Health_Annual_Report_416501_7.pdf