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
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.”
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.
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.”
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
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