Oral Health Often Overlooked By Health Care Practitioners

Judith Haber, PhD, APRN, BC, FAAN Associate Dean, Graduate Programs The Ursula Springer Leadership Professor in Nursing New York, NY 10003MedicalResearch.com Interview with:
Judith Haber, PhD, APRN, BC, FAAN
Associate Dean, Graduate Programs
The Ursula Springer Leadership Professor in Nursing
New York, NY 10003

Medical Research: What is the background for this study? What are the main findings?

Dr. Haber: The background of the project originally aligns with publication of the Surgeon General’s Report (2000), challenging health providers to think about the “mouth as a window to the body”.  More recent Institute of Medicine (IOM) reports, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) highlighted the extant problems with oral health access, oral health disparities and outcomes and the potential role of the primary care workforce in addressing this population health issue.  However, there is a dearth of curricular focus on oral health in the curriculum of health professionals.  The IOM challenged the Health Resource and Service Administration (HRSA) to convene an Expert Panel to develop interprofessional oral health core clinical (IPOHCC) competencies; the report, Integrating Oral Health and Primary Care Practice, delineating the IPOHCC competencies, was published in 2014.   Our HRSA funded initiative, Teaching Oral-Systemic Health (TOSH), focuses on building interprofessional oral health workforce capacity with a special focus on the nursing, medical and dental professions.  We have operationalized the IPOHCC competencies by transforming the HEENT component of the health history, physical exam, risk assessment, diagnosis, and management plan, including collaboration and referral, to the HEENOT approach.  When a health professional uses the HEENOT approach, he or she cannot forget about oral health.

Medical Research: What should clinicians and patients take away from your report?

Dr. Haber: Primary care clinicians, physicians, nurse practitioners, midwives, nurses, and physician assistants, need to “put the mouth back in the head” by recognizing that oral health is a Healthy People 2020 Leading Health Topic, integrating the IPOHCC competencies, including the HEENOT approach, as a standard component of their electronic health record (EHR), as an integral component of each patient encounter and management of the patient’s overall health.   As consumers, patients should expect that assessment of their oral cavity, screening for oral health issues such as oral cancer, smoking cessation, and periodontal disease, and oral health preventive interventions, and referrals to dental providers are standard features of their primary care visits.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Haber: Recommendations include the need to integrate interprofessional oral health competencies into the faculty development, curriculum, and best clinical practices of primary care providers.  Link integration of IPOHCCs with the Interprofessional Education Competencies (IPEC) and prepare a collaborative practice ready primary care workforce that has a collective impact on improving oral health access, reducing oral health disparities, and improving oral health and overall health outcomes.  Since all of the health professions have to provide evidence of meeting interprofessional accreditation criteria for their future accreditation reports and site visits, we recommend that oral-systemic health is the perfect exemplar for operationalizing the IPEC competencies across the health professions


Putting the Mouth Back in the Head: HEENT to HEENOT
Haber J1, Hartnett E, Allen K, Hallas D, Dorsen C, Lange-Kessler J, Lloyd M, Thomas E, Wholihan D.

Am J Public Health. 2015 Mar;105(3):437-41. doi: 10.2105/AJPH.2014.302495. Epub 2015 Jan 20.