Bulletin of Dental Education

Dentistry in the News - November 2012

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University of Louisville School of Dentistry Receives Support to Transform Health Care Education

Health care is changing, and how the University of Louisville (UofL) prepares students to deliver high-quality care is adjusting to those changes. A new educational initiative will have nursing and dental students collaborating to better identify and manage systemic diseases such as diabetes and cardiovascular disease that are sometimes linked to oral health. The UofL Schools of Nursing and Dentistry have received nearly $1.1 million from the U.S. Department of Health & Human Services Health Resources and Services Administration (HRSA) to support the project. 

A report of the Interprofessional Education Collaborative, a consortium of several health profession organizations including ADEA, the American Association of Colleges of Nursing (AACN), and the American Medical Association (AMA) highlighted the need for students in health care professions to become proficient collaborators so they are better prepared to practice effective team-based care.

“Our family and adult nurse practitioner students will be learning together with dental students,” says Marcia Hern, Ed.D., CNS, RN, Dean of UofL’s School of Nursing. “The goal is to help them enhance communication between the two professions and develop new best practices in patient assessment, consultation, and management to improve overall health for the underserved.”

Adult and family nurse practitioner students and dental students will both take the Introduction to Interprofessional Education Course. These students also will participate in a second shared course–Integrated Health Assessment. The combined courses will better prepare nursing students to conduct oral examinations and dental students will broaden their knowledge of how oral health is connected to overall health.

On a pilot scale, the work already is underway. Since 2011, Dedra Hayden, M.S.N., APRN, instructor, has worked two-days a week at the UofL School of Dentistry to teach students how to conduct patient health history reports. The adult and family nurse practitioner students have taken part in a rotation at the dental school to learn more about conducting oral examinations.

A Future Vision

UofL’s nursing and dental schools would like to be part of a new paradigm of health care delivery, where patients can receive primary care and dental care in one-stop. New York University (NYU) Colleges of Nursing and Dentistry serve as the model; they established a nurse managed primary care clinic within the dental school. Patients without a primary care provider (PCP) can receive care at this clinic and those with a PCP are offered health prevention services that complement the care they already receive, often the same day as their dental visit. 

“It is not unusual for dentists to screen for highly prevalent health conditions like diabetes and heart disease,” says Wendy Hupp, D.M.D., Assistant Professor of Oral Medicine, UofL School of Dentistry. “As the population continues to age and struggle with chronic illness, we see the need for new effective forms of health care delivery.”

“If we were able to offer a nurse practitioner managed primary care clinic here at the dental school, the benefit to patients would be profound,” Dr. Hupp says.

Dental Student's Oral Cancer Screening Rewards Patient

For four years, William Ruber has traveled from his home in Brooklyn, Michigan, to Ann Arbor to receive dental care at the University of Michigan School of Dentistry.  Since June 2011, fourth-year dental student Jody Atzmon has been his “student dentist.”

Student Dentist 1

When Mr. Ruber returned to the School of Dentistry in November 2011 for a routine appointment with Ms. Atzmon, something unusual was detected during an extraoral examination on the left side of his neck. “It was a small, hard lump, roughly dime-size in diameter that felt like an enlarged lymph node but only on one side of his neck,” she says.  

Ms. Atzmon discussed her findings with Mr. Ruber and the clinical faculty members she was working with. They agreed more investigation was needed, and she urged her patient to make an appointment with his medical doctor to check his lump.

When he returned home, Mr. Ruber told his wife, Bobbi, what his student dentist discovered.  “I wasn’t too concerned, nor was my wife, because the lump was small,” he says. He followed Ms. Atzmon’s recommendation and visited his physician who referred him to a specialist.

Ms. Atzmon said when Mr. Ruber returned to the School of Dentistry for a follow-up appointment in December, the lump was still present and getting larger. Concerned about its growth, she again consulted with School of Dentistry faculty members who advised her to urge Mr. Ruber to have the lump re-evaluated. An aspiration biopsy was conducted in January. The results were negative.

But the feeling of relief disappeared when Mr. Ruber returned to the School of Dentistry in February 2012 for another appointment with Ms. Atzmon. The lump was still there, but “it had grown to a rather large size in a short period of time.  Now I was even more concerned,” she says.

Mr. Ruber made an appointment with a surgeon to have the lump removed. The pathology report revealed the lump in his neck was a Warthin’s tumor, a benign salivary gland tumor that is frequently found in men 60 years of age and older, especially those who smoke.

This was the first patient Ms. Atzmon has treated with a Warthin’s tumor. “I’m thankful it was benign and that it was found early,” she says. Ironically, she says since treating Mr. Ruber, she has discovered other lesions in three patients where biopsies have been necessary.

An extraoral head and neck examination is standard for all patients, both new and returning, who are treated at the School of Dentistry. “I cannot stress enough the importance of doing oral cancer screenings on all patients because this can save a life,” she says. 

Ms. Atzmon says with the classroom education and clinical training she and other dental students have received at the School of Dentistry, “I was able to recognize these growths, give my patients vital information, and recommend appropriate follow-up care with their physicians.”

Paul Edwards, D.D.S., M.S., a specialist in oral and maxillofacial pathology, and a full-time clinical professor in the Department of Periodontics and Oral Medicine, also praised Ms. Atzmon and was relieved the tumor was not malignant.

“Fortunately, the type of tumor Mr. Ruber had was benign. But the only way to know for sure is to have a biopsy performed since many neoplasms in this area turn out to be malignant,” Dr. Edwards said. “Jody did a terrific job identifying the lesion and then emphasizing to Mr. Ruber the importance of talking to his physician about follow up treatment.”

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