Screening for Systemic Disease in the Dental Office
Dentistry has a unique window into patient care. Many dental patients develop long-term relationships with their dentist that last decades and occasionally generations. But many patients who regularly see dentists do not see a primary healthcare provider with anything approaching the same regularity. This places the dental practitioner in a privileged position to observe and intervene in potentially lifesaving general health matters.
At the New York University College of Dentistry we have adopted a patient care philosophy based on the conviction that it is our obligation to care for the entire patient, not just the mouth. As NYU College of Dentistry Dean Charles N. Bertolami often notes, “a disembodied mouth doesn’t walk into a dental office—a person does; and that person brings along a body as well as a mouth.” Accordingly, our students are taught to evaluate patients for a variety of general health risks, not solely because such health risks may affect dental health outcomes, but because they may affect general health outcomes. Using an integrated health-care risk assessment approach, these oral health professionals in training are learning to identify risk factors for both oral and systemic disease, and to refer their patients for further screening, evaluation, and medical treatment, as needed.
For example, all dentists are aware that tobacco use negatively affects periodontal health and increases the risk of oral cancer. But at NYUCD our students do more than just tell patients they should quit. In keeping with our philosophy of caring for the whole patient, and given our knowledge that smoking causes premature death, we launched a formal, mandatory program last spring to train students and faculty to utilize the five As of Tobacco Interventions for Healthcare Clinicians; Ask, Advise, Assess, Assist, and Arrange for follow-up. Moreover, NYUCD is partnering with the Manhattan Tobacco Cessation Center, housed at NYUCD and headed by Dr. Donna Shelley, Director of Interdisciplinary Research and Practice, on a tobacco cessation project involving dental students, who, to date, have dispensed more than 500 units of nicotine replacement to patients seeking to quit smoking.
Impressive as this is, our students’ social responsibility does not end there. They also provide information for follow up, which is available both at NYUCD through its onsite NYU College of Nursing Faculty Practice and through the New York State Quit-line.
The NYU College of Nursing Faculty Practice, which opened at NYUCD in 2006, is playing an important role in advancing NYUCD’s educational philosophy of linking oral and systemic health needs in order to improve comprehensive health outcomes.
Working together, the NYU Colleges of Dentistry and Nursing offer a unique opportunity for all patients to have access to an integrated health-care “home” that addresses both their oral and general healthcare needs. The Nursing Faculty Practice, which is managed by nurse practitioners who are on the faculty of the NYU College of Nursing, offers comprehensive primary health care, including routine physical examinations, counseling, and age appropriate health and cancer screenings, and has the advantage of being conveniently located on the lobby level of the College of Dentistry.
NYU dental students have always collected data on their patient’s health, but the collaborative programs that have resulted from the dentistry/nursing alliance at NYU and the convenience of having a Nursing Faculty Practice onsite at NYUCD have given a new relevance to the importance of incorporating risk assessment for serious systemic conditions into the dental exam.
For example, a patient with the complaint of excessive thirst, hunger, and frequent urination could have the early signs of diabetes. A patient who sleeps on two pillows and complains to their dentist of waking in the middle of the night may be suffering from congestive heart failure.
Another example is a patient who presents to the dental office with modifiable risk factors for heart disease, such as smoking, obesity, and elevated blood pressure. Each of these patients has conditions that might affect dental care outcomes, but more importantly, these conditions may be life threatening. Our students are encouraged to identify a series of health indicators and risk predictors that could save a life.
Dental students seek consultation from the patient’s primary healthcare provider and encourage the patient to control their risk and disease. If a patient does not have a primary care provider or has not seen a provider in a year or more, a referral is made to the Nursing Faculty Practice for an appointment with one of the NYU College of Nursing nurse practitioners.
The unique collaboration between the NYU Colleges of Dentistry and Nursing, with its focus on screening for physical health problems in a dental office, highlights the opportunities that exist to develop a collaborative model that expands access to care by addressing oral health as part of general health, well being, and life expectancy.