ISSUE
               
The Future Is Interdisciplinary
Dentistry, Hygiene, and Nursing Collaborations Across the Lifespan
- Barbara Kancelbaum


Nurse practitioner student Nicole Kurtis performs an oral health exam in the Pediatric Outreach Program.




Nurses and physicians spend an enormous amount of time working in the same rooms, with the same patients, yet they have not always seen themselves as teammates. Nurses and dentists have even less opportunity to confer about their patients and collaborate in their care. Patients benefit when healthcare professionals function as a team to better understand one anotherís roles and skills and provide patients with a continuum of care. However, a team requires practice. At NYU, innovative projects connect nurses and nursing students with their counterparts in medicine, dentistry, and other health professions to work together in the classroom, in research settings, and in the community.

Nursing and dental students are joining together in community health settings throughout New York. The pediatric nurse practitioner (PNP) students of Donna Hallas, PhD, RN, PNP-BC, CPNP, are learning oral health skills that offer a vital service to children who do not have access to dental care. Professor Jill Fernandez, RDH, MPH, Clinical Associate Professor of Pediatric Dentistry, guides PNP students as they accompany dental students who provide oral health exams to children in Head Start programs. The PNP students learn how to apply varnish to childrenís teeth to prevent caries-a new skill for nurse practitioners.

According to Dr. Hallas, nurse practitioners can play an important role in early childhood oral health care because they see young children and provide parent education earlier and at more regular intervals than dentists do. Particularly in the community clinics where NP students complete their clinical training, NPs who conduct oral assessments and make referrals can increase awareness of the importance of oral health.

"Having oral health skills is particularly important to nurses when providing anticipatory guidance to parents of young children," Dr. Hallas says. "Just as nurses need to talk with parents of preschoolers about safety and nutrition, they should also talk about cavity prevention." Dr. Hallas and Lily Lim, DDS, Clinical Assistant Professor of Pediatric Dentistry, along with Professor Fernandez, recently received a grant from the American Dental Association to improve dental care in very young children and are enthusiastic about the great potential for collaboration-among students, among faculty, and among researchers.

Dr. Lim and Neal Herman, DDS, lead another collaborative effort by assigning to teams of PNP and pediatric dental students joint cases that they present together. Discussions have included the best team approach to managing a complicated patient, such as a child who has a complex mix of seizures, asthma, and poor oral health.

Assistant Professor of Nursing Nancy Van Devanter, DrPH, RN, partnered with Joan Phelan, DDS, and Miriam Robbins, DDS, of the College of Dentistry to develop a program with the Visiting Nurse Service of New York (VNSNY) to train home care nurses to conduct oral health assessments and offer smoking cessation help for patients with HIV. Dr. Van Devanter is using pilot data to seek funding to implement and study a new model of care in which NYU dentists would train senior nurses at VNSNY, who would in turn train home care nurses to conduct oral health assessments and make referrals to dentists for complex problems.

"Itís not typical for nurses to do oral health care, but it is hard for patients receiving home care to obtain it otherwise," Dr. Van Devanter says. "This project is an opportunity to increase oral health care for patients with HIV, which is also a population with high tobacco use."

Through the smoking intervention, College of Nursing faculty will train VNSNY home health aides, social workers, and nutritionists to use an evidence-based practice that is effective in helping people quit.

Access for the Underserved

The VNSNY is also partnering with Carelink in a five-year project funded by the Health Resources and Services Administration and led by Donna McCabe, DNP, APRN-BC, GNP, that involves the NYU Colleges of Nursing, Social Work, and Dentistry. NYU students provide health care and assessment in community agencies and naturally occurring retirement communities in several parts of New York City. Last year, the College of Dentistry received a one-year grant from the United Hospital Fund that will involve dental, dental hygiene, and nursing students in screening more than 300 older adults for oral health needs. Led by Donna Shelley, MD, MPH, a Clinical Associate Professor at NYU College of Dentistry and Director of Interdisciplinary Research and Practice, and Theresa Montini, PhD, MSW, a research scientist at the College of Dentistry, the project is intended to develop an oral health referral system for community-dwelling, medically underserved older adults.

Identifying Health Risks in the Dental Office

The Nursing partnership with Dentistry at NYU is providing research opportunities that might have been overlooked in the past. Observing the strong link between diabetes and periodontal disease, Shiela Strauss, PhD, advocated that diabetes screening should be done in the dental setting with all periodontal patients. When Dr. Strauss joined the College of Nursing in 2007, she recognized the powerful potential for research collaboration with dental professionals.

Spurred by conversations with Louis Terracio, PhD, Vice Dean for Research at the College of Dentistry, Dr. Strauss conducted an analysis of data from the CDCís National Health and Nutrition Examination Survey to determine whether more patients with periodontal disease than without would be recommended for screening according to American Diabetes Association guidelines. Her dramatic results-indicating that 93.4 percent of those with periodontal disease met the guidelines for diabetes screening-received a great deal of media attention.

Dr. Strauss then conducted a study with the late Alla Wheeler, RDH, MPA, and Stefanie Russell, DDS, MPH, PhD, of the College of Dentistry, to determine whether blood from periodontal pockets would provide the same blood glucose-level readings as from finger-stick samples. In a pilot study of 50 patients whose blood was collected from both the finger and the mouth, the team found that for the 22 patients with moderate or severe periodontal disease, the correlation of the two readings from a handheld glucometer was extremely high (0.89). Dr. Strauss hopes that glucometer readings taken in the dentistís office will be a first step toward earlier diagnosis and treatment for diabetes.

"Just giving people the results of their diabetes screening isnít helpful unless they understand what it means," Dr. Strauss says. "Thatís where nurses are so essential, to provide counseling to patients and to train dental practitioners on how to provide patient support."

College of Nursing Dean Terry Fulmer, Dr. Strauss, and Dr. Russell were funded by the National Institute on Aging to examine the feasibility of screening for elder mistreatment in busy primary care and dental clinics. Using touch-screen technology, they enrolled patients at both the Bellevue Hospital Center and the College of Dentistry to determine whether clinicians can incorporate brief screenings for elder mistreatment during patient visits. More than 200 patients have participated, and the clinicians have learned how to examine patients for signs and symptoms of mistreatment.

"With the aging demographics, it will be more important than ever to be sure that all older adults receive brief screenings to help ensure quality of life and quality care," Dean Fulmer says. "Traditionally, hospital clinics have been engaged in geriatric assessment, but the addition of dental clinics is a new paradigm and an important one."