Leslie R. Halpern

Violence and abuse: core competencies for identification and access to care.

Violence and abuse (V/A) is recognized as a significant public health problem, especially in females. Injuries to the head, neck, and/or mouth are clearly visible to the dental team during examination. This article provides compelling evidence that supports the pivotal position occupied by oral health care professionals within the arena of detection, intervention, and prevention of V/A. This article reviews the epidemiology of orofacial risk factors for V/A, diagnostic tools and surveys for identifying victims of all ages, and suggests interdisciplinary educational curricula/specific algorithms to provide the necessary core competencies for identifying victims in the oral health care environment.

Orofacial Pain: Pharmacologic Paradigms for Therapeutic Intervention.

Pain is a universal experience with profound effects on the physiology, psychology, and sociology of the population. Orofacial pain (OFP) conditions are especially prevalent and can be severely debilitating to a patients health-related quality of life. Evidence-based clinical trials suggest that pharmacologic therapy may significantly improve patient outcomes either alone or when used as part of a comprehensive treatment plan for OFP. The aim of this article is to provide therapeutic options from a pharmacologic perspective to treat a broad spectrum of OFP. Clinical-based systemic and topical applied pharmaceutical approaches are presented to treat the most common OFP syndromes.

Interprofessional Collaborative Practice: An Oral Health Paradigm for Women

Interprofessional collaborative practice (IPC) is paramount to the future of oral health education. As such, it is critical that todays health care education continues to expand its curriculum to promote oral health as an essential component in the IPC approach to womens health. This article explores models that can be implemented using an IPC framework to foster better approaches in the delivery of care to female patients.

Dental management in patients with hypertension: challenges and solutions.

Hypertension is a chronic illness affecting more than a billion people worldwide. The high prevalence of the disease among the American population is concerning and must be considered when treating dental patients. Its lack of symptoms until more serious problems occur makes the disease deadly. Dental practitioners can often be on the frontlines of prevention of hypertension by evaluating preoperative blood pressure readings, performing risk assessments, and knowing when to consider medical consultation of a hypertensive patient in a dental setting. In addition, routine follow-up appointments and patients seen on an emergent basis, who may otherwise not be seen routinely, allow the oral health provider an opportunity to diagnose and refer for any unknown disease. It is imperative to understand the risk factors that may predispose patients to hypertension and to be able to educate them about their condition. Most importantly, the oral health care provider is in a pivotal position to play an active role in the management of patients presenting with a history of hypertension because many antihypertensive agents interact with pharmacologic agents used in the dental practice. The purpose of this review is to provide strategies for managing and preventing complications when treating the patient with hypertension who presents to the dental office.

The Alphabet Soup of Interprofessional Education and Collaborative Practice Acronyms with Dental Seasoning

In 2009, six health professional educational associations came together to enhance efforts to develop team-based approaches to health care and initiated the Interprofessional Education Collaborative (IPEC). IPEC awareness increased as its core competencies for interprofessional practice became disseminated. The Collaborative continued to become incorporated in 2013 with Richard Valachovic, DMD, MPH (President and Chief Executive Officer of the American Dental Education Association) as its President (https://ipecollaborative.org/About_IPEC.html). Notably, while IPEC was in formation, the World Health Organization (WHO) released the report “Framework for action on interprofessional education and collaborative practice” as a foundation for addressing the global health workforce crisis by having “collaborative practiceready” graduates. IPEC’s role and development are based upon Interprofessional Education (IPE) for preparing health care professional students to work in interprofessional collaborative practice (IPCP or IPC), also known as interprofessional practice (IPP) or collaborative care. An overarching view of IPE and IPCPmay be seen as Interprofessional Education and Collaborative Practice (IPECP), which is directed at patient-centered care and the PCP (which might be used to represent either Primary Care Provider or Primary Care Physician). In addition to IPEC and WHO’s efforts, other entities and products have been developed as resources for IPECP. A current list in North America, albeit not remotely exhaustive, includes from the general health professional perspective: the American Interprofessional Health Collaborative (https://aihc-us.org/), National Center for Interprofessional Practice and Education (https://nexusipe.org/), and an increasing number

Effects of Diabetes on Salivary Gland Protein Expression of Tetrahydrobiopterin and Nitric Oxide Synthesis and Function

BACKGROUND Xerostomia is defined as dry mouth resulting from a change in the amount or composition of saliva and is often a major oral health complication associated with diabetes mellitus (DM). Studies have shown that xerostomia is more common in females at the onset of DM. Evidence suggests that nitric oxide (NO) plays a critical role in healthy salivary gland function. However, the specific mechanisms by which NO regulates salivary gland function at the onset of DM have yet to be determined. This study has two aims: 1) to determine whether protein expression or dimerization of NO synthase enzymes (neuronal [nNOS] and endothelial [eNOS]) are altered in the onset of diabetic xerostomia; and 2) to determine whether the changes in nNOS/eNOS protein expression or dimerization are correlated with changes in NO cofactor tetrahydrobiopterin (BH4) biosynthetic enzymes (guanosine triphosphate cyclohydrolase-1 and dihydrofolate reductase). METHODS Functional and Western blot studies were performed in streptozotocin-induced and control Sprague-Dawley female rats with DM (type 1 [t1DM]) using standardized protocols. Confirmation of xerostomia was determined by increased water intake and decreased salivary flow rate. RESULTS The results showed that in female rats with DM, salivary hypofunction is correlated with decreased submandibular and parotid gland sizes. The results also show a decrease in NOS and BH4 biosynthetic enzyme in submandibular glands. CONCLUSIONS These results indicate that a decrease in submandibular NO-BH4 protein expression may provide insight pertaining to mechanisms for the development of hyposalivation in DM-induced xerostomia. Furthermore, understanding the role of the NO-BH4 pathway may give insight into possible treatment options for the patient with DM experiencing xerostomia.

Emerging Topics for Dentists as Primary Care Providers

Modifications of the traditional dental workforce have been proposed. The focus of this article is on expanding the role of the dentist as a primary health care provider, and includes topics that are emerging in the realm of general dentistry for further integration into primary health care and womens health. The evidence base for the clinical application of these topics in dentistry is under development. In the near future, dentistry will have core competencies involving the topics discussed in this article as well as other new interdisciplinary health care aspects to enhance the overall health and well-being of patients.

Immunizations: An Evolving Paradigm for Oral Health Care Providers

Oral health care professionals are at risk for the transmission of bacterial and viral microorganisms. Providers need to be knowledgeable about the exposure/transmission of life-threatening infections and options for prevention. This article is designed to increase the oral health care providers awareness of the latest assessment of vaccine-preventable diseases that pose a high risk in the dental health care setting. Specific dosing strategies are suggested for the prevention of infections based on available evidence and epidemiologic changes. This information will provide a clear understanding for prevention of vaccine-preventable diseases that pose a public health consequence.

The Barber Pole Might Have Been an Early Sign for Patient-Centered Care: What Do Interprofessional Education and Interprofessional Collaborative Practice Look Like Now?

In 2009, the Interprofessional Education Collaborative (IPEC) was initiated. Its release of interprofessional collaborative practice (ICP) core competencies in 2011 was pivotal for the engagement of health care professionals, including dentistry; in patient-centered, collaborative efforts for interprofessional education (IPE); and ICP. Thereby, IPEC is helping to put into application, in North America, the 2010 World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice. This article introduces IPE/ICP in 5 phases of evolution, emphasizing dental influence and inclusion, from historical perspectives through current applications that are expanded on in the accompanying articles elsewhere in this issue.

Women’s Oral Health: Growing Evidence for Enhancing Perspectives

Womens health, including oral health, is an evolving science with foundation knowledge from many disciplines. Key milestones, particularly in the last decade, provide a roadmap towards the necessary inclusion of gender into dental practice. Such focus is especially important for the evolving role of oral health care providers as primary health care providers. Continued progress of the vibrant incorporation of evidence-based womens oral health into the standard practice of oral health care is encouraged. This expanded preface provides an introduction to this DCNA issue, a brief history and timeline of major womens oral health events, and resources for further consideration.