Primary care within a dental practice?

It’s an interdisciplinary idea that has teeth: Your mouth, noted the U.S. surgeon general in the Oral Health in America report, provides a window into your overall health.

Now, a research team led by Maria Dolce, an associate professor in the School of Nursing at Northeastern, will make that idea a reality.

On Wednesday, the School of Nursing and the Harvard School of Dental Medicine will launch a three-year interprofessional program funded by a $1.2 million cooperative agreement from the U.S. Department of Health and Human Services’ Health Resources and Services Administration. Called the Nurse Practitioner-Dentist Model for Primary Care, it will bring Northeastern nurse-practitioner students and Harvard dental students together in the Harvard Dental Center’s Teaching Practices clinic to provide both primary care and dental services to culturally diverse, medically underserved populations, particularly older adults.

Through hands-on interactions, the students will come to understand the oral-systemic connection in a comprehensive and holistic way.
— Maria Dolce, associate professor

“Harnessing the power of dentistry and nursing is a cutting-edge model of care that enhances health-professions education and offers patients access to healthcare that they otherwise might not have,” says School of Nursing Dean Nancy P. Hanrahan. “Maria Dolce is a national thought leader in this new model.”

Improving best practices

The team approach is key not just for instilling best practices but actually improving them. The nursing and dental students will learn from one another by attending both disciplines’ clinical rotations, engaging in joint problem solving, and negotiating to coordinate care.

“Through hands-on interactions, the students will come to understand the oral-systemic connection in a comprehensive and holistic way,” says Dolce. That includes recognizing the role, for example, that plaque, a reservoir for bacteria, plays in systemic infections such as pneumonia.

Dolce knows whereof she speaks: With a grant from the DentaQuest Foundation, she has already integrated oral-health instruction across all programs in the Bouvé College of Health Sciences, ranging from applied psychology to pharmacy to communication sciences and disorders.

Harnessing the power of dentistry and nursing is a cutting-edge model of care that offers patients access to healthcare that they otherwise might not have.
— School of Nursing Dean Nancy P. Hanrahan

“Interprofessional demonstration projects such as the NPD Model for Primary Care send an important message,” says R. Bruce Donoff, dean of HSDM. To articulate it, he quotes Pulitzer Prize-winning author Louis Menand: “‘The key to reform of almost any kind in higher education lies not in the way that knowledge is produced. It lies in the way that the producers of knowledge are produced.’”

A “roadmap” for other institutions

Practice-based training is not the researchers’ only goal. Dolce and co-principal investigator John Da Silva, vice dean of HSDM, will also evaluate the model by analyzing patient health outcomes using detailed metrics. Among the measures they’ll track is the management of chronic conditions such as diabetes and cardiovascular disease,  both of which are linked to periodontal disease. Finally, they will develop a “roadmap” of the program so other nursing and dental schools can follow their lead.

Under the new model of care, patients who come to the Harvard clinic for routine dental care—many of whom don’t even have primary care providers—will have the opportunity to undergo an annual wellness examination with a nurse practitioner at the same time. If the nurse practitioner deems it necessary, she or he may refer patients to a primary care provider for follow-up.

“We have had a very siloed approach to health-professions education—nurses, physicians, pharmacists, and dentists are all trained separately,” says Dolce. “But with appropriate education, all health professionals, specifically non-dental health professionals, can promote oral health as a component of overall health and wellness.”