1Introduction¹

On February 15–16, 2024, the Global Forum on Innovation in Health Professional Education at the National Academies of Sciences, Engineering, and Medicine held a hybrid workshop at the University of Pennsylvania’s Penn Dental Medicine that was designed to provide unique learning opportunities for exploring a value proposition for holistic oral health. The workshop engaged experts from around the globe representing multiple sectors and professions to learn from and with each other about best practices for providing interprofessional, compassionate, cost-effective oral health prevention and care for persons with disabilities. Workshop presenters defined disabilities broadly to include anyone with a physical or mental health challenge. This includes those who were born with a disability and those who acquired the disability at any stage of life from infancy through older ages, permanently or temporarily, and regardless of whether or not the person works in the health professions. The workshop was planned by an expert planning committee based on the statement of task of the workshop (see Box 1-1). Discussions at the workshop were universal in nature and were intended to contribute to the broader understanding of whole-person oral health education.

BOX 1-1

Statement of Task.

Chapter 1 of these proceedings details the opening remarks and the objectives of the workshop. Chapter 2 lays out the presentations that frame the workshop objectives, focusing on the value of oral health, particularly for those with disabilities, and discusses the importance of interprofessional education and collaboration practice for a holistic approach to oral health promotion. Chapter 3 explores a value proposition for oral health promotion and disease prevention from multiple vested interest group perspectives and also includes the outcomes of breakout session discussions. Chapter 4 focuses on national and international examples of Whole Health through oral health, and Chapter 5 situates the value proposition within the larger community ecosystem by discussing oral health equity and the Whole Health home. Chapter 6 describes the closing session of the workshop that included a reflective roundtable discussion on lessons learned and final remarks on health equity that closed the workshop. Appendix A contains a list of references, and Appendix B contains the workshop agenda. Biographies of the Workshop Planning Committee and Speakers are provided in Appendix C and D, respectively. Lastly, members of the Global Forum on Innovation in Health Professional Education that hosted the workshop are listed in Appendix E.

Opening the workshop, Bruce Doll, from the Office of Research at Uniformed Services University, briefly summarized the different sessions of the workshop and emphasized that each attendee has perspectives and expectations that can complement the planned sessions to achieve the objectives of the workshop. He discussed his personal experiences in rural areas of Alaska, Thailand, the Philippines, and Haiti, where delivery of general and oral health care differed greatly from his other work experiences. In these rural communities, he worked with internists, nurses, public health professionals, and veterinarians, and they all had to find ways to work together to improve oral health. The challenging, constrained environment required adapting spontaneously to achieve favorable outcomes, and Doll found that planning for the unexpected was critical.

Doll noted that to maximize outcomes for all three of the vested interest groups—patients, providers, and payers—all three must embrace a commonly generated and collectively executed value proposition (described in Chapter 3). To achieve the desired outcome of oral health promotion and disease prevention, he noted, all three vested interest groups would have to work together. Drawing upon his past experiences as a rural dental provider with global experience made Doll realize that health promotion efforts must be approached with cultural humility and align with a community’s deeply held beliefs, expectations, infrastructure, and a host of other factors. In oral health, he found that the spontaneity he and his colleagues were forced to employ fell short of what he believes is the highest goal—young people retaining their teeth. But for this to happen, Doll said, planning is key. He finished by emphasizing the importance of active participation by all the attendees to make the meeting meaningful for those in the room as well as for those joining virtually.

Following Doll, Anita Glicken, the executive director of the National Interprofessional Initiative on Oral Health, noted that every person looks through a different window when it comes to the perceived value of whole-person interprofessional oral health care. Glicken is also a clinical social worker, and she discussed what her work as a social worker has to do with oral health care, something that is not always well understood. Glicken mentioned that each profession has its own contribution to patient health, but only together can they serve the whole person; unfortunately, people often work within their silos in a fragmented health care system. In the United States, each year 109 million people see a physician but do not visit a dentist, while 29 million people visit a dentist but do not see a physician, she said. Glicken discussed how this fragmentation of care affects a provider’s communication with a patient, as well as the flow of information between providers about their patient’s health.

Currently, she said, there is little to no communication between dental providers and medical care professionals. In an example, she discussed how people with chronic illnesses, such as diabetes, are responsible for conveying medical information about their illness and medication use to their dentist and conversely, dental information to their medical health care team. According to Glicken, this is a serious burden on the patient and an unreliable way of communicating critical health information. Some other examples Glicken mentioned were the role oral pathogenic bacteria play in chronic diseases such as diabetes, and she also wondered how often it is considered how mental health might play a role in the care and progression of oral disease or the combination of chronic illnesses and mental health.

Glicken noted that access to care is another significant barrier: 58 million Americans are living in dental health professional shortage areas (HRSA, 2024), and 68.5 million adults are without dental insurance or dental coverage (CareQuest Institute for Oral Health, 2023). These people often end up in the emergency room (ER), resulting in 2 million ER visits for nontraumatic dental problems each year (Akinlotan and Ferdinand, 2020).

Poor oral health can often be prevented, Glicken remarked, so it is important to ask, who else in the workforce can be recruited to participate in prevention? A national interprofessional initiative was formed in 2009, the National Interprofessional Initiative on Oral Health (NIIOH), which is a consortium of payers, health professionals, and national organizations. NIIOH is a system change initiative that provides “backbone support” and facilitates interprofessional agreement and alignment to prepare an interprofessional oral health workforce for whole-person care. Given the critical relationship of oral health to overall health, said Glicken, through interprofessional collaborations NIIOH members are able to contribute to conversations in substantive ways about improving health equity and lowering costs. Their work follows the assumption that if oral health can be integrated into primary care education and professional coursework, providers would enter the workforce ready and willing to partner.

Glicken continued by explaining that all-health integration is not a new concept. In 2000, a surgeon general’s report first called attention to the issues of disparity and access to care, and the oral–systemic connection that could potentially be addressed through an interprofessional shared collaborative approach to whole-person care (HHS, 2000). However, according to Glicken, the subsequent call to action was largely ignored until two documents gave a big lift to the oral health integration movement a decade later. The first was a report on the integration of oral health and primary care practice, describing what can be done by defining a set of oral health core clinical competencies for nondental providers (NIH, 2021). The second was the interprofessional education collaboratives core competencies for practice, which describe what can be done together through a comprehensive team-based care environment (IPEC, 2023). These challenges and strategies subsequently inspired a philosophy of collective impact where people work within and across health professions to create a movement that drives change using the unique capacities of each health professional to maximize the effect, Glicken said.

Today, thousands of health professions students and clinicians are learning to think differently about how to work together. Glicken remarked that Smiles for Life, a comprehensive and widely used national oral health curriculum, is free to access online and includes up to 8 hours of free continuing education. The site has been visited more than 3 million times, and over 500,000 courses have been completed for credit. Educators can download module content to use in education, so the real reach of the program is even broader, said Glicken. Eight health professions and over 20 professional organizations endorsed it, which helped the widespread use.

Glicken ended her talk by saying that during the workshop, participants would explore the concept of whole-person care. Doing so, she said, could improve access and value of care for persons with physical and mental disabilities by bridging professional silos and focusing on disease prevention, valued care, and population health through interprofessional oral health efforts.

Footnotes

1

The planning committee’s role was limited to planning the workshop. This Proceedings of a Workshop was prepared by independent rapporteurs as a factual account of what occurred at the workshop. The statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.