Oral health has become an important component of a University of Colorado (CU) physician assistant program, reflecting a growing trend toward interdisciplinary collaboration among health professionals.
Physician assistants (PAs) are particularly useful for doing oral exams in children, especially for underserved populations and in rural areas, according to Mark Deutchman, MD, a professor in both the medical and dental schools at CU.
Dr. Mark Deutchman introduced an oral health curriculum in the University of Colorado School of Medicine and teaches medical topics to dental students.The university began incorporating dental education into its physician assistant curriculum in 2009, largely through the efforts of Dr. Deutchman. The concept "has grown like wildfire" in the last few years, he told DrBicuspid.com.
He introduced an oral health curriculum in the medical school, teaches medical topics to dental students and developed the school's Smiles for Life curriculum, which has been endorsed by the ADA. Dr. Deutchman also serves in the Delta Dental Frontier Center Project, which provides collaborative education, combining oral health and preventive practices in primary care.
The CU program includes comprehensive oral health courses that incorporate aspects of the Smiles for Life program, which teaches core areas of oral health relevant to medical clinicians.
"We're training people to recognize that oral health is a component of your overall health," he said. "Number one, it's a knowledge of the importance of oral health. Oral disease has an exacerbating impact on other diseases and vice versa."
Consider the oral impact of various medicines, Dr. Deutchman added. "If you put somebody on medications that dries up their saliva, you're going to increase their risk of getting root caries," he said.
The physician assistant curriculum now includes classes on the oral-systemic connection and hands-on workshops for doing oral exams and oral cancer screening. Students are also taught how to check children's teeth and apply fluoride varnish.
Emphasis on prevention
Oral health is a great match for physician assistants because they have always been involved in preventive care, according to Anita Glicken, former director of CU's physician assistant program who now heads the National Commission on Certification of Physician Assistants Health Foundation.
She also helped start the National Interprofessional Initiative on Oral Health (NIIOH), a consortium of dentists, physicians, nurse practitioners, and physician assistants working to improve oral health that was funded by the DentaQuest Foundation, the Washington Dental Service Foundation and the Connecticut Health Foundation.
Colorado
"PAs are at the front and back end of the disease process and are often the first point of contact for patients, so it really makes sense to intervene at that level," she told DrBicuspid.com.
Also, they have traditionally worked with colleagues from other health professions, Glicken said. But the real impact of physician assistants the last couple of years has been identifying oral cancers, she noted. They are also particularly useful for screening early childhood caries.
"A large percentage of PAs work with underserved populations, especially in rural areas at federally qualified health centers and community health centers," Glicken noted. "PAs are providing care to patients that otherwise wouldn't have access to that kind of trained intervention."
Some 46 of Colorado's 64 counties are rural or frontier areas.
Since few pediatric dentists are located outside urban areas, one of the challenges is getting general dentists to work with young children, because they are unaccustomed to dealing with such patients, according to Dr. Deutchman. "You have to not be afraid the kid is going to holler because when he hollers it's bad for the other patients. But when he hollers, guess what? His mouth is open," he laughingly noted.
Physician assistants and nurse practitioners do a lot of health maintenance and routine exams, Dr. Deutchman pointed out, so they are key to helping identify oral problems.
Referring patients to dentists and physicians is a core PA function, Glicken added, noting that the hardest part is often finding dentists to provide follow-up care.
"This is really an active partnership of building interprofessional competencies in oral health," she said.
