Oral health care, training necessary in primary care practice

Oral health training in primary care
Oral health training in primary care

NEW ORLEANS — Providing preventive dental services is an important but poorly trained component of primary care, according to two poster presentations at the American Association of Nurse Practitioners (AANP) 2015 meeting.

A presentation by Catherine G. Ferrario, PhD, APN, FNP-BC, professor, and Lola M. Prince, PhD, APN, FNP-BC, professor and associate dean of graduate nursing, both at University of St. Francis in Joliet, Illinois, concluded that the role of primary care providers includes performing oral health evaluations that combine patient history, risk assessment, and clinical presentation.

In addition, they should be involved in identifying and prioritizing strategies to prevent or mitigate the impact of the risk for oral and systemic diseases. Adverse outcomes of poor dental health include heart disease, respiratory disease, diabetes complications, and low self esteem.

Providers should consider in their assessment medications that can increase the risk for dental caries, Dr. Ferrario said. These include calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and nonsteroidal anti-inflammatory drugs.

They noted that many people across the United States face barriers to oral health care, which in turn result in increased periodontal disease. In 2011, the Centers for Disease Control and Prevention estimated that there were 33.3 million underserved persons living in areas where there was a shortage of dental health professionals. Medicaid will reimburse for preventive dental services in primary care, but Medicare does not pay for dental services for older adults, according to Dr. Ferrario.

“For vulnerable populations that can't afford or don't have access to dentists, the solution is that nurse practitioners and physician assistants conduct a good oral assessment and teach them about how to take care of their mouth,” she said.

Primary care providers can begin educating patients on tooth care and keeping the mouth clean very early. For instance, Dr. Ferrario said, parents should be encouraged to begin brushing their infant's teeth as soon as they erupt. In addition, the use of fluoride varnish can be beneficial to oral health.

“If you have a patient that wouldn't have fluoride in the community water supply, fluoride varnish can be used across a patient's lifespan,” Dr. Ferrario said. “Fluoride varnish applied to teeth helps prevent tooth decay.”

Dr. Ferrario and Dr. Prince suggest primary care providers consider participating in Smiles for Life, a free oral health curriculum for providers that is available online (smilesforlifeoralhealth.org).

Oral health education continues to be lacking among primary care providers, according to another presentation by Ruth Chavez, DNP, CNP, RN, assistant professor at Otterbein University in Westerville, Ohio, and Marjorie Vogt, PhD, DNP, CNP, FAANP, clinical professor at Ohio University in Athens.

Studying the oral health education, knowledge, and practice patterns of 271 nurse practitioners in Ohio, they found that most nurse practitioners have spent less than 3 hours on dental health as part of their education and in practice, rarely perform oral health screening exams.

Only half of their study subjects routinely counsel their patients on oral health and periodontal disease. Although most agreed that oral health training and care is important, most lack knowledge of dental practices, such as how to apply fluoride.

“We need to make it part of our practice so that we routinely check our patient's oral health because this is becoming a big issue, regardless of state,” Dr. Chavez said. She suggested primary care providers review the guidelines and resources provided by the Oral Health Nursing Education and Practice program (ohnep.org), which is recommended by the AANP and National Organization of Nurse Practitioner Faculties.

References

  1. Ferrario CG, Prince LM. “The nurse practitioner role in the prevention and treatment of dental disorders.” Presented at: AANP 2015. June 9-14, 2015. New Orleans, Louisiana.
  2. Chavez R, Vogt M. “Oral health education, knowledge, and practice patterns of Ohio nurse practitioners.” Presented at: AANP 2015. June 9-14, 2015. New Orleans, Louisiana.
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