Dentists as Primary Care Providers: Expert Opinion on Predoctoral Competencies (original) (raw)
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Dental Public Health for the 21st Century: Implications for Specialty Education and Practice
Journal of Public Health Dentistry, 1998
A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.
Journal of Dental Education, 2017
This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into nondental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.
The Value of the Oral Medicine Specialty in the Modern Healthcare Systems
Saudi Journal of Health Systems Research, 2021
Background: Oral medicine is a subdiscipline of dentistry that concerns itself with the oral health of patients; it focuses on providing diagnosis and management of oral and maxillofacial diseases, as well as direct dental care for those in medically complex situations. As primary healthcare providers, physicians and dentists are often the first to evaluate patients with orofacial symptoms and make diagnoses related to oral health, whether explicit or manifested through systemic diseases. However, a lack of familiarity with oral medicine among healthcare providers often leads to significant delays in the accurate diagnosis and appropriate treatment of many oral and maxillofacial disorders. It has been well established that a lack of training and education in oral health among physicians is an impediment to alleviating the situation. Summary: Several studies and scientific reports in the medical community have shown a greater professional interest in oral health and medicine, with nu...
Emerging Topics for Dentists as Primary Care Providers
Dental Clinics of North America, 2013
The most recent strategic plan of the National Institutes of Health Office of Research on Women's Health (ORWH) 1 has the vastness of women's health research whittled down to 6 goals (Box 1). This ORWH strategic plan approach is significantly different than from its 2 predecessors. The 2020 plan does not place disease-specific emphasis, instead "it encompasses disease-specific research in a broader vision of women's health that can benefit both women and men by increasing our
Primary Care, the Dental Profession, and the Prevalence of Chronic Diseases in the United States
Dental Clinics of North America, 2012
Primary care is the principal point of consultation for patients within a health care system, usually an MD who is a general practitioner or family physician. Increasingly, however, nurse practitioners, physician assistants, or pharmacists are serving as primary care providers. Patients are then referred for secondary specialty care or tertiary subspecialty care. The role of the primary care provider is to monitor patients' health, and assess and control risk factors for acute and chronic disease. Because the majority of the United States population has seen a dentist in the past 24 months, and as dentists must increasingly monitor the chronic disease problems of their dental patients, there is a proposal that dentists could and should serve as the primary care provider for their dental patients. This article documents the epidemiology of chronic disease in the United States and sets the stage for a discussion of
Dental Education Required for the Changing Health Care Environment
Journal of Dental Education
To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra-and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21 st Century."
Bridging the dental-medical divide
Journal of the American Dental Association, 2018
Background. The National Academies of Sciences, Engineering, and Medicine commissioned an environmental scan describing the status of health care integration of oral health and primary care services. Methods. The authors conducted an environmental scan of US integration activities with publications from January 2000 through August 2017. They categorized services as preventive oral health services (POHS) provided by medical care providers, POHS provided by dental providers in nondental settings, preventive health services provided by dental providers, or care coordination using dedicated personnel and technology. The authors chose 4 programs as case studies and interviewed key personnel in each program. One case study illustrates each category of integrated services; additional examples describe category variation. Results. The case study involving Into the Mouth of Babes illustrates medical professionals delivering POHS to children. The case study involving Grace Health presents dental hygienists embedded in the obstetrics-gynecology clinic to provide oral screening, prophylaxis, and education to pregnant women. At HealthPartners, medical care providers refer patients with diabetes to dentists and waive copays for periodontal care. The InterCommunity Health Network Coordinated Care Organization uses dedicated patient coordinators, technology, and coordinated payment and referral mechanisms to facilitate care. Conclusions. Integration of dental and medical care increased access to and coordination of patient care by means of offering health care services traditionally provided by the other profession. Practical Implications. Integration models demonstrate the incorporation of POHS by primary care professionals, the embedding of dental professionals into primary care clinics, and the incorporation of care coordination to increase the delivery of oral health care. Similarly, dentists identify and refer patients with medical needs or preventive gaps to medical homes.
O-Health-Edu: Advancing oral health: A vision for dental education
European Journal of Public Health, 2020
The prevalence and burden of untreated oral diseases throughout the life course remains high worldwide, and inequalities in oral health and dental care are increasing. This is a major public health issue that is not being enough addressed by the health care systems. To better manage populations' oral health, oral health professionals must be trained to adapt to population needs and societal and technological changes. Furthermore, dental institutions must fulfill their social responsibility by prioritizing educational and research activities that promote advancing individual and community health. In Europe, great variability exists between dental programs within the same country or between countries. This variability is an issue as European graduates can practice around the European Union through mutual recognition of their qualifications. This might lead to inequities in the availability, accessibility, acceptability and quality of health services. The convergence of competencie...