Oral Health and Interprofessional Education Experiences in Family Medicine and Pediatric Residency

Abstract

INTRODUCTION Prevention of dental diseases in children requires interprofessional education (IPE) and care coordination between oral health professionals and primary care providers; however, the extent of preparation of medical residents and its impact on their provision of preventive oral health services in clinical practice requires further investigation. METHODS A two-stage cluster sample of 470 US family medicine and 205 pediatric residency programs was used. A random sample of 30% (N=140) of family medicine and 29% (N=60) of pediatric residency programs were randomly selected. Of these, 42 programs (21%) invited residents to participate. Residents (N=95, 28%) completed an online questionnaire regarding oral health training in residency. Statistical analysis included frequencies and Spearman’s rank correlations. RESULTS Eighty-three percent of family medicine and pediatric residents combined reported receiving oral health education. Clinical experiences involving oral healthcare were frequently reported (77%, n=75); however, IPE with an oral health professional was limited. Both groups indicated they provided anticipatory guidance regarding regular dental visits and toothbrushing “very often” and avoiding bottles at bedtime “often.” Residents reported performing dental caries assessments “often” and applying fluoride varnish “occasionally.” For family medicine residents, moderate correlations (p ≤ 0.01) were found between hours of oral health education and providing anticipatory guidance. For pediatric residents, a moderate correlation (p < 0.01) was found between hours of oral health education and assessing teeth for demineralization. CONCLUSION Increased effort is needed to meet national recommendations for educating family medicine and pediatric residents regarding oral healthcare for children, including increased IPE involving oral health professionals. Received: 05/25/2015 Accepted: 08/28/2015 Published: 10/22/2015 © 2015 Bailey et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Oral Health and Interprofessional Education ORIGINAL RESEARCH 2(3):eP1081 | 2 Introduction Oral health is a vital component of overall health and, therefore, the responsibility of pediatricians. Accordingly, the American Academy of Pediatrics (AAP) recommends pediatricians play an integral role in children’s oral health by providing preventive oral health services including anticipatory guidance, oral health screenings and assessments, and fluoride varnish applications during well-child visits (AAP, 2014). This recommendation applies not only to pediatricians but to other primary care providers (PCP), such as family physicians, nurse practitioners, and physician assistants (PA) (National Interprofessional Initiative on Oral health [NIIOH], 2011). In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended PCP prescribe fluoride supplementation to children beginning at 6 months of age if they reside in areas with suboptimal fluoride concentration in the drinking water and provide fluoride varnish applications to all children beginning at eruption of the first tooth (USPSTF, 2014). In support of these recommendations, medical insurers are requir-ed to reimburse providers under the Affordable Care Act (ACA) for services assigned a grade A or B by the USPSTF. This reimbursement includes fluoride varnish applications for children ages 0-5 years (Kaiser Family Foundation [KFF], 2014). These national children’s oral health initiatives coincide with the recent emphasis on integrating interprofessional education (IPE) opportunities across the healthcare professions to improve the health of the nation and overall quality of care (Institute of Medicine [IOM], 2011). IPE opportunities involving oral health experts such as dental hygienists, dentists, and/or dental professional students are integral to effectively train PCP to de-liver preventive oral health services to children. Little is known about IPE opportunities involving dental professionals in family medicine and pediatric residencies. Patients of all ages experience needless dental diseaserelated pain and expense, in part, because their PCP has not been trained to provide preventive oral health services (NIIOH, 2009). The general health status of children and adolescents can be improved by prevention and early intervention of oral diseases, including dental caries, before they develop into more complicated Implications for Interprofessional Practice