Models for Interprofessional Practice: Innovative Collaboration Between Nursing and Dentistry

April 30, 2010

Surveillance Spotlight
The International Centre for Oral–Systemic Health, based at the University of Manitoba's faculty of dentistry, was launched in January 2008. The centre is proud to partner with JCDA to provide summaries of contemporary literature and news in oral–systemic health that may affect modern dental practice

In previous columns I discussed the importance of interprofessional health education and practice as they relate to oral–
systemic health and emerging guidelines for co-management of patients.1-3 It will become increasingly common for health
professionals in medicine and nursing to collaborate with the dental team in multidirectional screening and referral networks,
to mutually reinforce health promotion and wellness messaging, and to jointly develop treatment plans and comprehensively
co-manage patients.

Within this context, it is important to disseminate new models of patient care as well as information related to the
effectiveness and impact of these outcomes on overall patient health. An innovative collaborative practice approach to oral–
systemic health has been developed at New York University (NYU), where the School of Nursing has merged with the College
of Dentistry. This model is based on the premise that nurse practitioners can improve access to oral health care and enhance
oral health promotion and disease prevention by working closely with the dental team from the first point of contact with
patients.4

The NYU Nursing Faculty Practice is an onsite primary care practice that operates as a comprehensive diagnostic and
treatment centre. A reciprocal referral and consultation mechanism was implemented for the nursing and dental clinics so that
seamless oral–systemic health care can take place under one roof. The emphasis is on oral health being integral to overall
health. Nurses have the opportunity to screen patients for poor oral health conditions such as caries, periodontal disease and
various lesions, while dentists can screen for highly prevalent major systemic conditions such as diabetes and heart disease. In
the case of periodontal disease, it can be co-managed with a range of other medical conditions, such as arthritis, osteoporosis
and adverse pregnancy outcomes.

In the first 18 months of this operation model, the nursing practice recorded 510 new patient visits. Of these, 220 (43%)
were referrals made by the dental school faculty or students for general health promotion services, diagnosis and management
of systematic health problems, or for medical consultations before a dental procedure. Similarly, many patients who presented
for primary health care at the nursing practice were subsequently referred to the dental school clinic for oral health screening
and evaluation.

The nurse practitioners have done a considerable amount of work to familiarize faculty, students and dental clinic staff
about the nursing profession, and, specifically, about the role and scope of their practice. The nurses now teach second-year
dental students how to take a blood pressure reading. A chairside consultation project with the third- and fourth-year dental
students was designed to raise their awareness regarding patient health risk profiles and the need for primary care and specialty
referrals. The collaboration has resulted in presentations on healthy lifestyles by the nurses to dental clinic patients. Patient
perception about the importance of obtaining dental services in addition to primary care services has changed markedly.

The dental faculty and students have reciprocated by providing nursing practitioners basic instruction in general oral health
screening and the importance of oral health for overall health and well-being. The nurses are able to identify obvious caries,
signs of periodontal disease and poor oral hygiene, and counsel patients regarding the potential connections between poor
oral health and chronic inflammatory diseases and conditions, such as diabetes, cardiovascular disease, arthritis and adverse
pregnancy outcomes. Patients have been very accepting of the dental referral and have been more than willing to add the oral
health evaluation and treatment component to their comprehensive health care plan.

As patients continue to be managed cooperatively at the NYU clinics, it will be interesting to evaluate the health outcomes
data that emerge from this new model of care. If overall patient health is improved, we may soon see the model used
throughout the nursing and medical professions. This would mean huge changes not only in the way dentistry is practised, but
also in how the health care system in general functions. And that is something none of us could have even imagined just a few
years ago when oral–systemic science began to gain major traction within the public health discourse.

Dr. Iacopino is dean and professor of restorative dentistry, and director of the International Centre for Oral–Systemic Health, at the faculty of dentistry, University of Manitoba, Winnipeg, Manitoba. Email: iacopino@cc.umanitoba.ca.

The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.

References

  1. Iacopino AM. Practising oral–systemic medicine: the need for interprofessional education. J Can Dent Assoc. 2008;74(10):866-7.
  2. Iacopino AM. New "syndemic" paradigm for interprofessional management of chronic inflammatory disease. J Can Dent Assoc. 2009;
    75(9):632-3.
  3. Iacopino AM. Management of systemic inflammation by dentists and physicians: new guidelines. J Can Dent Assoc. 2009;75(8):564-5.
  4. Haber J, Strasser S, Lloyd M, Dorsen C, Knapp R, Auerhahn C, et al. The oral-systemic connection in primary care. Nurse Pract. 2009;
    34(3):43-8.

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