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Mouth matters

Maria Dolce, an associate professor of nursing in the Bouvé College of Health Sciences, learned the importance of team-based care by treating the critically ill for some three decades.

She was astonished when she read comments from a cancer patient—one of nearly 500 stories she was analyzing for her doctoral research—who wrote that she “had been to the dentist twice with bleeding/swollen gums, and had been to the doctor once with various other symptoms—bruising, persistent cough, a cut that wouldn’t heal. Neither one of these healthcare providers connected the dots or even suggested a blood test.”

For Dolce, this story highlighted two major gaps in the field: educating health professionals about the relationship between oral and systemic health and designing effective models of primary care that promote interprofessional collaboration and communication.

Backed by a grant from the DentaQuest Foundation, Dolce is now bridging these gaps with the development of a unique educational program called Oral Health Care TIPS (more formally known as Innovations in Interprofessional Oral Health Care: Technology, Instructions, Practice, and Service).

The program—which aligns with Northeastern’s focus on solving the world’s most complex problems in health, security, and sustainability—is part of the university’s broader commitment to improving health through interdisciplinary collaborations. TIPS will integrate the oral health care curriculum with other health care programs at the university, bringing its team approach out into the community through primary health care services. The goal is to promote oral health care while preventing disease, a model Dolce hopes to disseminate to academic centers and primary care practices across the country.

From the beginning, TIPS will aim to fundamentally change the landscape of oral health care by educating the next generation of healthcare professionals. “Cultivating collaborative leadership within our own students is key,” said Dolce. “Empowering students and unleashing their leadership potential will drive our interprofessional education model and innovations in oral health care.”

“Preparing health professionals with team-based competencies in oral health promotion and disease prevention, and shifting from educating health professionals separately to interprofessional education are imperatives for improving oral health in America,” added Bouvé dean Terry Fulmer.

Maria Dolce, center, meets with nursing major Kathryn Robinson, right, and doctoral student Ashwini Ranade, left. Photo by Casey Bayer.

Maria Dolce, center, meets with students including nursing major Kathryn Robinson, right, and doctoral student Ashwini Ranade, left. Photo by Casey Bayer.

According to Dolce, the “silent epidemic” of oral diseases is one of healthcare’s greatest challenges. Each year, oral diseases affect millions of children and adults, most of them from the nation’s most vulnerable populations: poor children, pregnant women, older adults, individuals with special health care needs, and racial and ethnic minorities.

Nonetheless, dental disease is preventable, said Ralph Fuccillo, chief mission officer of DentaQuest and president of the DentaQuest Foundation. “A primary care clinician may be the first and sometimes only health professional to evaluate the oral health of some people. The work of professor Dolce and her Northeastern University colleagues is expanding the role that the health team has to improve oral health,” he explained. “That’s thousands of new eyes ready to identify and help individuals who are at risk for dental disease.”

Dolce envisions a scenario in which an older adult patient experiencing dry mouth visits a primary care practice where she is treated by a team including a physician, nurse practitioner, pharmacist, dentist, nutritionist, mental health clinician, and other health professionals. “That’s because dry mouth in older adults is often related to the use of many different medications and can lead to other problems impacting quality of life like their ability to eat, swallow, speak, and sleep, sometimes causing psychological distress and increasing the risk for developing tooth decay,” said Dolce. “A physician cannot tackle all of these challenges alone.”