March 2021 Volume LVI Number 2

 
 
 
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Resident's Corner

March 2021 Volume LVI Number 2

The Value of an Interprofessional Team
 
Living in a world where as professionals we are becoming more and more spe- cialized, sometimes it is helpful to take a look back at the big picture. As experts in our field, we begin to silo our focus on more specific topics, and as a necessary consequence, lose our understanding of other areas. However, in caring for our patients, we pledge to care for the whole child, not just his or her teeth.
 
What does caring for the whole child mean?
 
  • Understanding of his/her medical conditions and how they might relate to oral health – conditions like congenital heart disease, diabetes, chronic kidney disease, obesity, and mental health disorders.
  • Acknowledging how home dynam- ics might impact oral hygiene. Does your patient live with mom and dad or perhaps grandma and auntie? Does your patient have dental insur- ance and access to a dental home? Does the family live in a food desert or rely on stamp benefits? What is involved in getting the patient to a dental appointment – days off from work, care for other siblings, trans- portation?
The truth is it is hard to master all of these things. The truth is there are mas- ters of each of these things. A solution? COLLABORATION. Forming a team, a network of experts, to care for your pa- tients is the best way to ensure you are addressing the whole patient, and not just his/her caries. Who might you want on your team?
  • Primary care provider (nurse practitioner, physician’s assistant or pediatrician)
  • Social worker
  • Nutritionist or diet counselor
  • Psychologist
Perhaps you already have this network and never really thought about it. Many pediatric dentists participate in cranio- facial teams which include multiple spe- cialties collaborating care for patients. The plastic surgeon, geneticist, pediatric dentist, oral surgeon, physiologist, lan- guage specialist, and otolaryngologist sit around one table to develop a compre- hensive plan. As a resident at a children’s hospital I’m fortunate to sit at that table.
 
Just last week, my co-resident and I examined a three-year-old with an unrepaired cleft palate and severe early childhood caries. As a recent immigrant from Ethiopia, mom did not speak any English and was relying on her daughter to help navigate the medical system. In our conversations we learned the patient still goes to sleep with a bottle of milk and had never seen a dentist. They had never been told otherwise. Because of our collaborative approach, the patient will be undergoing dental rehabilitation in combination with her cleft repair, and the family will have the assistance of a case worker.
 
I would be remiss to acknowledge that being within a hospital system it is easier to communicate and coordinate with other providers. With a few clicks I can see the last cardiology progress note, and within minutes I have the on-call doctor answering my page. But why stop with our medically complex patients or those treated in the hospital setting?
 
What if we truly worked side by side to provide comprehensive health care services for all our patients?
 
In his editorial three years ago, Marko Vu- jicic stated it is time to get dentistry out of its care delivery silo and engage with the rest of the health care system. We practice what we learn, so these changes need to begin with our training. Harvard School of Dental Medicine piloted a Nurse Practitioner-Dentist Model for Pri- mary Care when I was a dental student, and I am sure many others exist. The fo- rum allowed basic screening for the most prevalent chronic disorders like diabetes and hypertension. Wouldn’t you be more motivated if your primary care provider and dentist spoke with you at the same time regarding how your dietary choices affect your overall health?
 
Primary care and pediatric dentistry have the same goal of prevention. Life is complicated, and no less so for our pa- tients. It is our duty to address the whole patient, so consider adding some other experts to your team!
 
Dr. Jillian Muhlbauer is a graduate of the Harvard School of Dental Medicine and current second year resident at Children’s National Hospital in Washington, DC. She is originally from Massapequa Park, NY and is a member of the AAPD Resident Committee.

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