Ray C. Williams, DDS from the School of Dentistry, University of North Carolina, Chapel Hill stated “Apparently oral disease could, in fact, contribute to
systemic diseases, such as atherosclerosis, diabetes, and adverse outcomes in pregnancy. This concept of the oral health–general health connection is now supported by sound and rational evidence-based observations.”44 He goes on to say that “there is a promising future for preventing and treating this common and troubling condition that affects not just the mouth but the whole body.” Dietetic students and dental hygiene students could be the future professionals engaging interprofessional camaraderie by working together to promote general health and to prevent systemic disease.
Disease, medication, and oral factors have significant impact on the patient’s nutritional status, and the opposite is also true.32 If the conditions and treatments are interrelated and reciprocal, would interprofessional education and training not be beneficial?
Limitations
The length of the survey composed of 76 questions could be considered a
limitation. Participants verbalized the intensity of the survey because of the volume of the questions. This may have skewed the results because participants’ attention and focus may have decreased as the questions continued past their threshold of concentration. The lack of dietetic faculty surveyed at Baylor inhibited comparison of dietetic faculty from each institution. Despite being specific to certain inclusion criteria, the small sample size of the groups may not allow the findings to be generalizable to other institutions with dietetic internship and dental hygiene programs. The data collected on proficiency,
perceived roles, attitudes, and value were analyzed by self-reported surveys. Other limitations such as the definition of “healthy” have been noted previously.
Further Discussion
The survey data results on attitudes on IPE as well as value of the ‘other’ profession were encouraging and positive. They were consistent among the ETSU and Baylor dietetic, dental hygiene, and faculty groups. However, the knowledge proficiency related to nutrition and oral health between ETSU (45.8% of those surveyed who were considered proficient) compared to Baylor (96% of those surveyed who were considered proficient) is evidence to support the proposal of implementing an interdisciplinary curriculum plan. The questions asked were simple, basic nutrition knowledge questions related to oral health found to be appropriate by experts in the disciplines and program faculty. If dental hygiene students are counseling patients on nutrition choices related to oral health, it is important to understand critical points that may assist in counseling. Some of the most significant areas of opportunity include:
• Question number 8- carbohydrates contain 4 kilocalories per gram
• Question number 11- registered dietitians are trained to treat eating disorders The latter finding was observed in the qualitative part of the study and is documented below:
When I shadowed a clinical round of routine cleaning I asked a dental hygiene
student “What do you do if you have a patient with a suspected eating disorder?” The student replied “I don’t know. I mean, we have been trained to identify what to look for, but we don’t know where to direct them or what to do above and beyond what we do here.”
The opportunity to clarify each profession’s role is a major area of opportunity for each discipline and could affect the patient population for both groups. IPE could segue the disconnect that is observed among dietetics and dental hygiene at ETSU.
Data in the area of perceived roles were interesting among the groups. It is significant related to areas of ETSU dietetic students not feeling comfortable counseling patients on oral health issues related to nutrition, which the majority answered “unsure” and Baylor dietetic students “somewhat agreed”.
Also, ETSU and Baylor dietetic students were “unsure” about counseling on periodontal disease, which is commonly related to diabetes, an area of expertise for the registered dietitian. This is interesting because ETSU does not have an interdisciplinary program, but Baylor currently does.
The results, especially in areas of proficiency of nutrition knowledge related to oral health and perceived roles among the groups, may be evidence enough to support exploring future IPE possibilities at ETSU. The potential for interdisciplinary education and training between dietetic and dental hygiene students is promising. Learning together to teach each other may have multi-dimensional benefits. We are each an expert in our field but must comply with the scope of practice outlined in our profession. When our knowledge is congruently applied to our colleagues’ knowledge, the result may be quality treatment and more long-term solutions versus temporary “Band-Aid” fixes. One of several comments from the qualitative part of the survey revealed similar sentiments including “The importance of the collaboration in the knowledge of both roles (hygienist and dietitian) to effectively treat our patient.” and “I expect for a future registered
dietitian to work very close with RDH. It is very important for both systemic and intraoral diseases to be discussed by both parties when patients are at risk.”
Two survey comments revealed a profound contrast between ETSU and Baylor dental hygiene students’ nutrition knowledge related to oral health. An ETSU dental hygiene student stated “I would like them to know even though we deal with the oral cavity daily we do not know a great deal about nutrition” while a Baylor student stated “That we are very educated about health, nutrition, and the oral connection of vitamins, etc.” The study results clearly highlight the opportunity for intervention in the area of nutrition knowledge and perceived roles in dental hygiene at ETSU and between ETSU dietetic and dental hygiene students. The positive attitudes related to the benefits, need, and contributions of IPE were undisputed. The self-reported value expressed toward the ‘other’ profession establishes a strong foundation for IPE to enhance and use the strength of each professional and possibility to impact the future of their practice. Refer to
Appendix B for more comments from ETSU and Baylor dietetic and dental hygiene faculty.
The integration of skills from each future professional may lead to increased prevention of dental caries, promoting oral health and strong nutrition practices for the pediatric population, treatment and prevention of diabetes, eating disorders, heart disease, and a plethora of other diet, behavioral, and lifestyle related diseases. By understanding the role and contributions of each of these professions, clarity of the interdependent relationship between oral health and nutrition will be established. In turn this will
continue to build a stronger inter-professional foundation focusing on a team approach to healthcare and wellbeing, and ultimately leading to an improvement in systemic health for future patients.
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APPENDICES
APPENDIX A: SURVEY INSTRUMENT
(Appropriately worded and adjusted for each version which included ETSU and Baylor dietetic and dental hygiene students and faculty in each discipline)
Thank you for supporting our research by completing this survey. We realize your time is valuable and we appreciate your participation. The purpose of this research study is to define areas of opportunity to establish a foundation for the implementation of
complimentary curricula in dietetics and dental hygiene. The procedures, which will involve you as a research subject, include completing this survey that will take about 30 minutes of your time. Participation in this research experiment is voluntary. You may refuse to participate. You can quit at any time. If you quit or refuse to participate, the benefits or treatment to which you are otherwise entitled will not be affected. You may quit by contacting Monique Richard at [email protected] or Dr. Michelle Lee at 423-439-7524 or [email protected]. For questions, comments or concerns, please contact Monique Richard at [email protected] or Dr. Michelle Lee at 423- 439-7524 or [email protected]. You may contact the ETSU Institutional Review Board at 423-439-6054 for any questions you may have about your rights as a research subject. By continuing to answer the questions in the rest of the survey, you confirm that you have read this document.
PLEASE NOTE: “Shared learning” and “interdisciplinary education/experiences” are used interchangeably
Sex: Male Female Age: _____
Race/ethnicity: ___White ____African American ____Hispanic ____Other:___________
I am a:
____ First year dietetic intern ____ Second year dietetic intern Please state the
University/Program______________________________________________________ Section I: (Self-perceived proficiency)
Please rate your answers:
1-Strongly agree 2-Somewhat agree 3-Unsure 4-Somewhat Disagree 5-Strongly Disagree
1.) I am educated about the choices of food and beverages which may lead to the development of risk factors associated with diabetes, cardiovascular disease, hypertension, and other disease.
1 2 3 4 5 2.) I know how many calories are in a gram of fat, protein, and carbohydrate and know their basic metabolic roles.
1 2 3 4 5 3.) I know what vitamins and minerals are important to obtain from a diet in order to promote dental health.
1 2 3 4 5
4.) I am knowledgeable about recommending dietary guidelines for patients with diabetes.
1 2 3 4 5 5.) I am very comfortable educating my clients about complex carbohydrates and simple sugars.
1 2 3 4 5 6.) I am knowledgeable about identifying signs and symptoms of eating disorders. 1 2 3 4 5 Section II (Knowledge)
7.) High quality protein-rich foods are associated with a decreased risk of developing dental caries.
T F
8.) Carbohydrates have 4 kcal/g. T F
9.) Glossitis could be a result of inadequate folate and/or niacin. T F
10.) Magnesium is important for bone health. T F
11.) I know a dental hygienist is trained to identify dental erosions, therefore able to identify patients with a possible eating disorder.
T F
12.) It is the type of carbohydrate consumed that affects blood glucose levels as well as increases risk of dental caries.
T F
13.) Simple sugars will elevate blood glucose levels more than complex carbohydrates. T F
14.) Diet soda is healthier than regular soda. T F
15.) An appropriate amount of calories for an average individual is approximately between 1500-2000 calories a day (depending on height, weight, and health). T F
16.) Release of sugar in the body will be the same for a candy bar and a potato. T F
17.) It is possible to prevent the onset of diabetes with diet. T F
18.) Exercise stimulates the body to become more sensitive to the effects of insulin. T F
Please refer to the nutrition facts label to the right to answer the next three questions
19.) This food has a low total fat content per serving. T F
20.) The entire bag contains 155 calories. T F
21.) A serving is about as big as both your palms cupped together. T F
22.) Which eating disorder is characterized by binging and purging? A. Anorexia nervosa
B. Bulimia nervosa C. Binge eating D. Anorexia athletica
23.) The number of ounces in a cup is:
A. 10
B. 12
C. 8 D. 5
24.) Two tablespoons of peanut butter looks most like: A. A ping pong ball
B. A softball C. A marble D. A tennis ball
25.) If left untreated, diabetes can cause all of these conditions EXCEPT: A. Retinopathy (blindness)
B. Nephropathy (kidney failure) C. Pancreatic cancer
D. Neuropathy (nerve damage) 26.) Insulin is made in the:
A. Liver B. Pancreas C. Kidney D. Blood
27.) Insulin functions to:
A. Lower blood glucose levels B. Break down carbohydrates C. Help the GI tract with digestion
D. Make an enzyme that transports nutrients
Section III: (Perceived roles) Please rate your answers:
1-Strongly agree 2-Somewhat agree 3-Unsure 4-Somewhat Disagree 5-Strongly Disagree
28.) Oral health assessment and counseling should be included in any routine appointment, just like nutrition diagnosis and treatment.
1 2 3 4 5 29.) I have an obligation to improve the health of my patients, which may include discussing oral health care with them.
1 2 3 4 5 30.) Registered dietitians are adequately trained to discuss oral health issues with patients.
1 2 3 4 5 31.) Patients need specific instructions about how to change their behavior regarding oral health.
1 2 3 4 5 32.) I know dental hygienists attend an accredited program, take a national board examination, and a clinical board examination.
1 2 3 4 5 33.) I know dental hygienists are oral health care experts that provide specific instruction in dental and oral health behavior and value them as health care professionals.
1 2 3 4 5 34.) I would refer my future patient to a dental hygienist.
1 2 3 4 5 35.) Patients need follow-up and ongoing guidance after my initial assessment to maintain behavior changes consistent with adequate oral health care.
1 2 3 4 5 36.) It is NOT worth my time to counsel patients with poor oral health about nutrition and the impact on oral care.
1 2 3 4 5 37.) For most patients, oral health care education does LITTLE to promote improvement of dietary habits.
1 2 3 4 5 38.) For most patients, oral health care education does LITTLE to promote improvement of oral health and overall health.
1 2 3 4 5
39.) Patients are NOT motivated to change unless they are sick, have pain, or have a very serious condition.
1 2 3 4 5 40.) I am comfortable in counseling patients with periodontal disease about foods and