CU Dental Magazine Fall 2014
By: Brenna Deutchman
Eight years ago a small group of dental and medical students came together to collaborate and learn from one another around the theme of team-based care. Fast forward to 2014 – that small group has grown to include the majority of the Anschutz Medical Campus health professional students. Now, physician assistant, nursing, pharmacy, medical and dental students work together in the dental clinics as part of the dental school’s Frontier Center.
Funded by Delta Dental of Colorado Foundation, the Frontier Center’s primary objective is to “continue to catalyze changes and create collaborations between dentistry, primary care and pharmacy that will enhance patient care.”
ORAL AND SYSTEMIC HEALTH WORKSHOPS
Oral and system health workshops, led by dental students, allow hands-on practice of the basic head and neck exam and intraoral exam. Students then practice applying fluoride varnish on each other. Workshops are held for physician assistant students in the fall and medical and nursing students in the spring.
"We really want to emphasize that the mouth is an important part of the body,” says Mark Deutchman, MD, Professor, School of Medicine and School of Dental Medicine. “Our goal is that both groups of students develop a better appreciation for the connection between oral health and overall health.”
“Our [physician assistant] students all participate in an interprofessional workshop with the dental students as part of their physical assessment course in their first year of training. Our mission is primary care and care of the underserved. Oral health disparity is essentially a primary care issue so it aligns perfectly with our mission.” Jon Bowser, MS, PA-C, Director, Associate Dean and Section Head, Physician Assistant Program.
“I didn’t realize that children don’t usually see the dentist until after it is too late,” a comment shared by a PA student. “As a primary care provider we see these kids often throughout their development and can provide them with interventions to help mitigate caries and educate kids and parents on the importance of oral health.”
Faculty l Mark Deutchman
MD, Associate Dean for Rural Health; Professor, Department of Family Medicine; Director, Rural Track, School of Medicine; Director, Colorado AHEC, Professor, School of Dental Medicine
As a Family Physician interested in whole person care, I fully recognize that the mouth is part of the body.
It is also true that physicians have traditionally received very little training in oral health and therefore have avoided what they know little about.
As soon as we understand that oral conditions such as periodontitis and systemic conditions like diabetes are related, it becomes a “no-brainer” to address both.
Similarly, when we understand that early childhood caries is the most common disease of childhood, and that it is a vertically-transmitted preventable infectious disease, it becomes our responsibility too. We see children frequently during their first two years of life for checkups and immunizations. When tooth decay is extensive and untreated, it causes pain, disability, adversely affects nutrition and eventually ruins adult teeth. Why not “immunize” children against tooth decay by promoting good oral hygiene, proper diet and fluoride? The same emphasis we place on positive health behaviors for diet, exercise and self-care can easily be applied to oral hygiene. And, if patients get the same message from their physician as they hear from their dentist, it will make a greater impression.
This workshop, which was originated through the Frontier Center, started as a pilot elective but now is required for each and every medical student.
Through the workshop, medical students not only practice an important part of the physical exam, they meet and appreciate dental students’ knowledge and skills.
The dental students also have had a series of classes on medical conditions through the efforts of the Frontier Center.
We also want [the students] to own a professional responsibility to address the oral-systemic connection and see their medical and dental colleagues as collaborators in patient care.
Faculty l Diane Brunson
MPH, RDH, Director of Public Health and Interprofessional Education, School of Dental Medicine
I first became involved in the Frontier Center while I served as the State Dental Director at the Colorado Department of Public Health and Environment. From the beginning I knew that collaboration would be critical to achieving the center’s goal.
There is a nationwide movement toward patient-centered care to improve health outcomes. For healthcare to be patient-centered, providers must communicate and collaborate.
Across our campus, we have seen tremendous support and willingness from all of our health professions to make collaborative education work; yet coordinating multiple curriculum schedules has been a challenge. While each program’s schedule is full, we recognize the importance of professional education activities and continue to expand them campus-wide.
One specific expansion is our recent glucometer training, led by pharmacy students for our dental students. We’ve done a great job so far in educating other professionals on oral health and fluoride varnish, but the pharmacy training stands out because this type of hands-on experience gave our dental students more exposure to primary care.
I would like to see more collaboration and this type of experiential learning. I envision students serving our public together in a university clinic where they can put into practice the co-location and cooperation they have learned through our center.
Student l Stephanie Dunlap
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 2014
During the second semester of the third year of pharmacy school we began interprofessional IPPE practices. Although most worked with physicians, a few students had the opportunity to visit with the School of Dental Medicine.
Through these IPPE visits we were able to work with students to help them become more familiar with medications that they frequently see in their patient population. One of the major points we covered was interviewing patients on their medications to determine the best course of treatment. For example, a patient who was on warfarin and dealing with addiction may present concerns with compliance or malnutrition, which would have an impact on their risk of bleeding. By reviewing how this drug was affected by food and its duration of action in the body we were able to prevent an adverse outcome.
We worked closely with the staff who taught us about reading X-rays, oral infectious disease, and provided knowledge of medication concerns experienced by dentists (such as osteonecrosis from bisphosphonates). We were able to see firsthand the effects of misuse of various drugs including anything from “meth mouth” to “aspirin burn.”
Overall, we found these experiences to be very valuable both for our learning and for the dental students. Continuing to collaborate between these two schools will help build interprofessional communications, serve as a tool to expand pharmacist relationships beyond strictly medical fields, and better integrate dentistry into the fold of healthcare providers.
Faculty l WES NUFFER
PharmD, BCPS, CDE | Assistant Professor | Assistant Director of Experiential Programs, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences | Department of Clinical Pharmacy
The integration of pharmacy students into other practices is important in their longitudinal experiential training. These students are in their 3rd year and are almost completely done with all the didactic learning. They are strong on skills and knowledge, and weaker on clinical experience.
This program challenges them to step into a different clinic environment with no other pharmacy representative there as their safety net. They need to represent the profession of pharmacy and begin to learn how they can complement other professions, as well as gain a better appreciation for other practitioners’ scope of practice.
The integration of these students with dental medicine has been a tremendous learning experience for the pharmacy students. At first glance, students question just how much overlap there is between pharmacy and dentistry, only to discover a wealth of learning that can occur from the dental profession as well as teaching that the pharmacy students can provide to dental students.
Whether the pharmacy student is doing a medication profile review, screening for interactions, educating on drug allergies, or learning about concerns specific to the dental field (such as osteonecrosis from bisphosphonates), students quickly identify areas where they can contribute to the dental practice.
Students from both professions begin to recognize strengths that the other profession brings, and the collaboration is extremely valuable. This appreciation carries out into practice, where the pharmacist or dentist may rely on one another when providing comprehensive care to patients.