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100 Million Mouths, other initiatives putting oral health at forefront of primary care

UMass Chan Medical School leading efforts to integrate oral health into health care training nationwide

The project was named 100 Million Mouths because 100-plus million people do not visit a dentist in any given year but are likely to visit their primary care provider.

The 100 Million Mouths: Creating Primary Care Champions for Equitable Oral Health Campaign is a project to recruit and train health professionals who will develop oral health curricula at primary care training sites in every state. The ambitious initiative is the latest effort spearheaded at UMass Chan Medical School to integrate oral health into primary care education nationwide and is led by Hugh Silk, MD, MPH, and Judith Savageau, MPH, at UMass Chan, and other members of the Center for Integration of Primary Care and Oral Health (CIPCOH).

“The project is to create 50 state champions who will work to implement some oral health curricula in every health school in the country,” said Dr. Silk, professor of family medicine & community health. “We named it 100 Million Mouths because 100-plus million people do not visit a dentist in any given year but are likely to visit their primary care provider. So, if we could have oral health promotion and disease prevention addressed by primary care graduates in their practices, we could improve the health of that many people.”

Oral health champions are taught to reach out to medical, osteopathic, physician assistant, nurse practitioner, and midwifery schools, as well as pediatrics, medicine/pediatrics, internal medicine, obstetrics and gynecology, and family medicine residencies, and geriatric fellowship programs. They are taught to use existing national and state resources, and to partner with local and state experts such as the state dental director, department of public health, and local academic and community-based dentists and dental hygienists.

Fourteen states have oral health champions established, with more being added each year.

“We’ve started with those states that need the most in terms of a variety of metrics and outcomes such as numbers of dentists and rates of cavities. We also want to have champions who work with vulnerable populations to address health equity and social justice in every aspect of oral health education,” said Savageau, associate professor of family medicine & community health. “For example, one champion works with a lot of Head Start preschool programs, and one is working with the Navajo Nation, whose rates of cavities are very high.”

Supported with multi-year funding from the CareQuest Institute for Oral Health, 100 Million Mouths advances the work of the CIPCOH. Silk is co-principal investigator of the cooperative agreement collaborative between the UMass Chan Department of Family Medicine & Community Health and Harvard University Schools of Medicine and Dentistry.

Originally funded by the U.S. Health Resources and Service Administration, CIPCOH projects have included nationwide surveys of training programs for primary care disciplines, establishing core oral health competencies and developing a tool for oral health curriculum evaluation.

Silk and Savageau have led numerous CIPCOH projects, many engaging with students of the T.H. Chan School of Medicine and the Tan Chingfen Graduate School of Nursing.

Third-year medical student McKenzie Jones conducted a CIPCOH-funded summer research project in which he surveyed every T.H. Chan School of Medicine course director to identify oral health components throughout the curriculum. He found that the UMass Chan weaves key concepts of the topic throughout the multi-year curriculum, with each iteration building knowledge and skills. It fulfills most of the oral health competencies and objectives established by the Association of American Medical Colleges. Jones’ study has been submitted to the journal Medical Teacher for publication.

“Throughout four years you’ll get exposed to oral health every year in most courses,” said Jones. “I would say that most of us now consider oral health a part of primary care based on the way that we were taught.”

Ekaterina Skaritanov, also a third-year medical student, chose the Population Health Clerkship on oral health led by Silk and Susan Feeney, DNP, assistant professor of nursing, to learn more about how oral health care contributes to overall health and its role in advancing health equity in Worcester.

“I learned that oral health has a connection to essentially every system in the body, and can reflect overall health status,” Skaritanov said. “I realized that even though we’re not dentists, making sure to look in adults’ and kids’ mouths during office visits, encouraging people to go to the dentist if they can, and helping those who can’t connect to dental insurance and dentists that accept Medicaid will be important in my practice as a physician.”

Prompted by their oral health population clerkship experience, Skaritanov and fellow medical students May Dong, Allison Holt, Lauren McKenna, and Suryateja Rao, and nursing student Isabella DiMare published an opinion piece in the Worcester Telegram & Gazette citing ways to narrow oral health disparities.

Skaritanov also received a Martin Luther Community Service grant to provide toothbrushes and toothpaste to families at the Marie’s Mission diaper bank in Worcester, educate them about the importance of oral health and connect them to pediatric dentists.

Other student-led, community-engaged UMass Chan oral health projects have assessed the oral health of homeless individuals, provided oral exams and dental referrals in a free clinic, and proposed adding dental hygienists to a rural community health center.

Related UMass Chan news stories:
Remillard Family Community Fund announces recipients of grants to improve local health
Martin Luther King Jr. Semester of Service Student Awards address local health care needs
School of Medicine oral health curriculum featured in AAMC News
Hugh Silk, MD, takes leadership role at new center to integrate oral health into primary care training