From Mouth to Heart: The Oral–Systemic Connection
) From Left: Professors Lloyd, Haber and Dorsen ) ) ) |
Madeleine Lloyd, MSN, APRN, BC, FNP, MHNP Caroline Dorsen, MSN, APRN, BC, FNP Judith Haber, PhD, APRN, BC, FAAN Editor’s Note: On September 1, 2006, a Nursing Faculty Practice staffed by NYU Nurse Practitioners opened at the College of Dentistry (see story on page 84). The following article offers a glimpse at the activities taking place within this innovative new healthcare model. Prior to initiating dental treatment for severe periodontal disease, a third–year NYU dental student referred his patient, Robert, a 62–year–old businessman, to the in–house NYU Nursing Faculty Practice for a medical consultation related to elevated blood pressure of 190/100. Because Robert’s periodontal disease was more severe than expected for his age, the dental student realized that Robert could have an undiagnosed systemic disease. Robert had no primary care provider and stated that he had not had any health care in over 20 years due to his self–disclosed "fear of doctors." A comprehensive history, physical exam, and lab work were conducted by the NYU Nurse Practitioner (NP). Nurse Practitioners are licensed, registered nurses who have completed either a master’s or doctoral degree and are board certified. They are qualified to assess, diagnose and treat common and acute health conditions. Nurse Practitioners are experts at managing chronic illnesses such as hypertension, diabetes and asthma. They order, perform and interpret diagnostic tests such as lab work, EKGs, and X–rays, as well as prescribe medications and adjust medication regimens. On physical examination, Robert was obese (220 lbs, BMI 31), had elevated blood pressure (180/110), elevated fasting glucose (323) and evidence of dyslipidemia (LDL 198; HDL 32). The rest of his physical exam and EKG were normal. The NP prescribed antihypertensive medications and a statin to reduce his cholesterol, made a referral to cardiology for risk stratification and a stress test to detect asymptomatic atherosclerotic heart disease. His treatment plan included weekly counseling with the NP on therapeutic lifestyle behaviors with weight loss, exercise, smoking cessation and improved nutrition as priorities.After three weeks, Robert’s blood pressure and blood sugar stabilized and he was referred back to his dental student for treatment of his periodontal disease, including extensive cleaning with root planing and scaling. Robert continued to make appointments to see his NP for management of his hypertension and related co–morbidities that included health promotion and disease prevention strategies such as prostate and colon cancer screening and immunizations. Robert’s involvement in weekly lifestyle health education visits with the NP was key to the lifestyle modifications he made, all of which contributed to stabilizing and improving his blood pressure, blood sugar and cholesterol so that he could begin treatment with his dental student for his periodontal disease. At every visit, Robert commented on how grateful and satisfied he was with his NYUCD/NYUCN health team. As he put it, "What a great idea…getting your general health care and dental care under one roof. I like it enough to keep coming back!" Every day at the NYU Nursing Faculty Practice, events occur that show the oral–systemic connection to be a two–way street. For example, Type 2 diabetes triples the risk of developing periodontal disease and consequently makes blood glucose control challenging, which was the case with Robert. This bi–directional relationship also has economic implications, because healthcare costs for people with severe periodontal disease are 21 percent higher than for people with good oral health. Robert’s experience exemplifies the powerful links between oral health and general well–being that are documented in Healthy People 2010, the nation’s prescription for health improvement. The report lists a number of objectives aimed at reducing risk factors for both oral health problems, such as periodontal disease, and systemic health problems, such as diabetes, cardiovascular disease, autoimmune diseases, cancer and premature births. This concept is at the heart of the unique alliance between the NYU College of Dentistry and the College of Nursing, which aims to chart new interdisciplinary directions in education, research and patient care. As Dr. Terry Fulmer, Dean of the College of Nursing, says, "Our goal is to create innovative, collaborative clinical practice models in which nurse practitioners and dentists partner to achieve high quality and cost–effective health outcomes." Since we know that approximately 60 percent of the American adult population visits a dentist each year, but not a general healthcare provider, we can conclude that the same percentage is reflected in the NYUCD patient population, which means that approximately 40 percent of our 60,000–member patient population lacks access to general health care. Working collaboratively, the NYU Colleges of Dentistry and Nursing therefore have an unprecedented opportunity to create an oral–systemic healthcare partnership that can address this need. Our NP–managed NYUCN Nursing Faculty Practice works with dental students and faculty to identify this pool of dental patients, recruit them to our general healthcare practice through referrals, patient education programs, health promotion offerings, targeted health screenings, and community outreach. All of our Nurse Practitioners are prepared to provide a unique and full range of general healthcare services to NYUCD patients and to the residents of the surrounding community, especially the elderly. Given that older adults have a high prevalence of chronic illnesses which puts them at risk for increased morbidity with resulting disability and decreased quality of life, and in light of NYUCN’s national leadership in geriatric nursing, the elderly are an especially important target population. Accordingly, a special component of our practice mission is to help older adults make decisions that meet their healthcare needs and help improve their quality of life in relation to both their oral and systemic health. At the NYU Colleges of Dentistry and Nursing, we are convinced that our pioneering "one–stop shopping" approach to health care has the potential to become a 21st century national model that will demonstrate how both high quality general health care and dental care can be delivered in a synergistic way to improve health outcomes. |
