Hugh Silk

Teaching Oral Health in U.S. Medical Schools: Results of a National Survey

Purpose Good oral health is an important aspect of good overall health. Past studies show physicians have had limited oral health training. Method In 2009, the authors sent a 22-question online survey to the deans of education of 126 MD-granting and 28 DO-granting U.S. medical schools to determine the extent to which these schools have an oral health curriculum. Results Eighty-eight schools (57.1%) responded. Of these, 61 (69.3%) reported offering less than five hours of oral health curriculum; 9 (10.2%) offered no curriculum. Schools with greater than 150 students per class were more likely to offer five or more hours of oral health curriculum compared with small or midsize schools (P = .022). School location and having a dental school and/or residency were not significantly related to the number of hours of oral health curriculum (P = .728 and .271, respectively). Awareness of oral questions on the United States Medical Licensing Examination board exams and/or the Association of American Medical Colleges report on oral health education was also not associated with curriculum volume. In schools with an oral health curriculum, topics being covered ranged from 10.0% teaching hands-on skills training to 81.7% covering oral cancers. Only 29.9% reported evaluating students around oral health topics. Conclusions The majority of the responding U.S. medical schools offer very little oral health education. There are few meaningful correlations as to what contributes to schools having a more robust curriculum. Further study is needed to explore how to improve this educational void.

Provision of Fluoride Varnish to Medicaid-Enrolled Children by Physicians: The Massachusetts Experience

OBJECTIVES To evaluate the impact of a 2008 Medicaid policy in Massachusetts (MA), regarding reimbursing physicians for providing fluoride varnish (FV) to eligible children in medical settings. DATA SOURCE Survey of a sample of primary care physicians in MA. STUDY DESIGN Cross-sectional survey of a sample of physicians who provide care to MassHealth (MA Medicaid) enrolled-children. DEPENDENT VARIABLES history of completed preventive dental skills training, and FV provision. INDEPENDENT VARIABLES oral health knowledge, FV-attitudes, and physician and practice characteristics. PRINCIPAL FINDINGS Overall, 19 percent of respondents had completed the training required to be eligible to bill for FV provision. Only 5 percent of physicians were providing FV. Most respondents (63 percent) were not familiar with the new policy, and only 25 percent felt that FV should be provided during well-child visits. Most physicians (60 percent) did not feel that the reimbursement rate of U.S.

Making Oral Health a Priority in Your Preventive Pediatric Visits

26/application was sufficient; 17 percent said that they would not provide FV, regardless of payment. Most common barriers to FV provision were a lack of time and logistical challenges. CONCLUSIONS Our findings suggest that simply reimbursing physicians for FV provision is insufficient to ensure provider participation. Success of this policy will likely require addressing several barriers identified.

Diseases of the Mouth

Oral health is a prevalent health issue for children. Pediatricians have an important role in screening, educating, and making referrals during well-child visits. Advice must be age-specific to be effective. Topics to be covered include hygiene, diet, habits, fluoride, and referrals to dentists. Other members of the office can play a role in educating care givers. Special needs children and literacy issues demand extra attention in oral health management. There are many oral health resources available for pediatricians and parents.

A Cultural Home Visit Training Experience in Medical School

Oral pathologic abnormality is common and can be potentially serious. There are many diseases of the mouth that medical personnel must be able to diagnose and initiate management. The most prevalent lesions can be categorized as infectious, inflammatory, and common benign and malignant lesions. This article discusses prevalence, cause, diagnosis, and management of lesions such as stomatitis, candidiasis, caries, oral cancers, and bony tori.

Addressing Adolescent Oral Health: A Review

Home visits are an important aspect of the art and science of medicine. The home visit experience during the third year family medicine clerkship at the University of Connecticut School of Medicine is designed to help students gain a richer understanding of where patients “are calling from” to quote the American writer Raymond Carver. It challenges them to enhance their appreciation of the cultural diversity of patients and how a broadly defined culture affects their health. Students conduct a home visit, post reflections of the visit online for their colleagues and mentors to read, and participate in an end of rotation wrap-up discussion. The results show an improvement in student knowledge, confirmation that the experience is useful, and that students appreciate the provided resources. Furthermore, students discover that information gained in a home visit is vastly more relevant and succinct than that gained in an office setting.

The Expanding Dental Workforce: The Impact of Nondental Providers

Oral health is one of the most unmet health care needs of adolescents. Oral disease can have a profound effect on overall health, including pain, missed school, heart disease, and even death. Adolescents have specific needs pertaining to oral health in addition to the usual lifelong issues of caries management, sports injury prevention, and dental referrals. Teen years are a higher risk time for oral piercings, increased sugar intake, nicotine initiation, and orthodontic considerations. Adolescents need a unique approach to motivate them about their oral health issues. This is particularly important because lifelong health habits are created during these formative years, and prevention opportunities for sealants and varnish are only available at this age.

The Central Massachusetts Oral Health Initiative (CMOHI): a successful public-private community health collaboration

This article describes the evolution of nondental health providers engaging in oral health and the influences that have played a role. This discussion is followed by a review of why oral health is a natural fit for medical care, an examination of the current trends and successes in oral health education and practice in the health professions, and the need for a comprehensive approach. The article concludes by reviewing the impact these efforts are having and defining roles for each profession in the future with thoughts about what will be required to obtain these goals.

A multi-state initiative to implement pediatric oral health in primary care practice and clinical education: Multi-state initiative to implement pediatric oral health

OBJECTIVES The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts. METHODS A broad-based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school-based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health. RESULTS A state legislative Oral Health Caucus helped secure sought-after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school-based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established. CONCLUSIONS Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.

A multi‐state initiative to implement pediatric oral health in primary care practice and clinical education

OBJECTIVES To implement and study the effect of improving pediatric oral health by training primary care practices and training programs. METHOD In six New England States, primary care practices and clinical training programs (medical schools, residencies, physician assistant programs) were recruited and trained to incorporate pediatric oral health into medical practice. We measured the results of varying practice recruitment approaches and measured training outcomes based on self-reported implementation and state reported EPSDT CMS oral health claims. RESULTS We trained 415 practices across six states with a 74 percent average retention rate of providing services at 6 months. This resulted in 136,963 preventive oral health services (fluoride varnish, oral health assessment, or screening). Thirty-five of 52 health education programs established pediatric oral health curricula. The average cost of recruitment, training, and follow-up for an office or an educational program is approximately