100 Million Mouths Campaign: Creating a Pilot Program to Advance Oral Health Equity.

PURPOSE: More individuals access primary care compared with oral health services. Enhancing primary care training to include oral health content can therefore improve access to care for millions of individuals and improve health equity. We developed the 100 Million Mouths Campaign (100MMC), which aims to create 50 state oral health education champions (OHECs) who will work with primary care training programs to integrate oral health into their curricula. METHODS: In 2020-2021, we recruited and trained OHECs from 6 pilot states (Alabama, Delaware, Iowa, Hawaii, Missouri, and Tennessee) with representation from varied disciplines and specialties. The training program consisted of 4-hour workshops over 2 days followed by monthly meetings. We conducted internal and external evaluations to assess the program's implementation through postworkshop surveys, identifying process and outcome measures for engagement of primary care programs, and through focus groups and key informant interviews with the OHECs. RESULTS: The results of the postworkshop survey indicated that all 6 OHECs found the sessions helpful in planning next steps as a statewide OHEC. Each OHEC was also successful in engaging 3 primary care training programs within their state and incorporating oral health curricular content through various modalities, including lectures, clinical practice, and case presentations. During the year-end interviews, the OHECs reported that they would overwhelmingly recommend this program to future state OHECs. CONCLUSIONS: The 100MMC pilot program was implemented successfully, and the newly trained OHECs have the potential to improve access to oral health within their communities. Future program expansion needs to prioritize diversity within the OHEC community and focus on program sustainability.

Behavioral Health Within Primary Care Postgraduate Dental Curricula: A Mixed Methods Study.

PURPOSE: This study evaluated the integration of behavioral health topics (anxiety disorder, depressive disorder, eating disorders, opioid use disorder, and intimate partner violence) into primary care postgraduate dental curricula. METHODS: We used a sequential mixed methods approach. We sent a 46-item online questionnaire to directors of 265 Advanced Education in Graduate Dentistry programs and General Practice Residency programs asking about inclusion of behavioral health content in their curriculum. Multivariate logistic regression analysis was used to identify factors associated with inclusion of this content. We also interviewed 13 of the program directors, conducted content analysis, and identified themes pertaining to inclusion. RESULTS: A total of 111 program directors completed the survey (42% response rate). Less than 50% of programs taught their residents to identify anxiety disorder, depressive disorder, eating disorders, and intimate partner violence (86% taught identification of opioid use disorder). From the interviews, we identified 8 main themes: influences on the inclusion of behavioral health in the curriculum; training strategies; reasons for incorporating the training strategies; training outcomes (ie, ways in which residents were evaluated); training outputs (ie, ways in which a program's success was quantified); barriers to inclusion; solutions to barriers; and reflections on how the current program can be made better. Programs housed in settings with no to minimal integration were 91% less likely (odds ratio = 0.09; 95% CI, 0.02-0.47) to include identifying depressive disorder in their curriculum compared with programs in settings with close to full integration. Other influences for including behavioral health content were organizational/government standards and patient populations. Barriers to including behavioral health training included organizational culture and lack of time. CONCLUSIONS: Advanced Education in General Dentistry and General Practice Residency programs need to make greater efforts to include in their curricula training on behavioral health conditions, particularly anxiety disorder, depressive disorder, eating disorders, and intimate partner violence.

Context matters: Integration of social determinants of health in AEGD and GPR curricula.

PURPOSE: To examine the integration of social determinants of health (SDH) in the US Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. METHODS: This study used an explanatory sequential mixed-methods approach. A 46-question survey was sent to all 265 AEGD and GPR programs in February 2019. Descriptive statistics and multivariate analyses were conducted to identify factors influencing SDH curricular inclusion. A convenience sample of program directors (PDs) was interviewed between June and December 2019. Through content analysis, themes and subthemes were identified. RESULTS: Of the 265 AEGD and GPR PDs, 111 completed the survey (42% response rate). Almost three-quarters of PDs (72%) agreed that it was important for residents to understand basic SDH concepts. However, programs lacked eight of the 10 surveyed SDH subtopics. The odds of teaching five or more SDH subtopics were 0.09 (95% CI: 0.02-0.41) for programs with none-to-minimal levels of SDH integration in their clinical settings compared to close-to-fully integrated ones. Coding of PD interviews (N = 13) identified five major themes: 1. influences to integrate SDH, 2. training strategies, outcomes, and outputs, 3. reasons for training strategies, 4. barriers and solutions, and 5. future integration goals. Most PDs cited delivering SDH content during patient care and reported time and organizational culture being barriers to more curricular inclusion. CONCLUSIONS: AEGD and GPR curricula are deficient in SDH content and risk underpreparing residents for caring for the underserved. PDs and organizational leaders must prioritize SDH inclusion in order to train dentists for integrated person-centered care.

Primary Care and Oral Health Integration: Comparing Training Across Disciplines.

BACKGROUND: Primary care (PC) training programs must incorporate oral health (OH) into their curricula to reduce health disparities. The purpose of this study was to evaluate and compare OH education integration across multiple PC disciplines. METHODS: In 2017, the authors surveyed deans and program directors (PDs) across 13 disciplines (2,245 PC programs) and used the Input Process Output framework to evaluate training factors across these disciplines. RESULTS: Nine disciplines represented by 767 respondents were chosen for analysis (disciplines with ³40% response rate were included). Most of the physician assistant (PA) and pediatric nurse practitioner (PNP) programs reported departmental support for OH and covered curriculum content topics on oral health risk assessment and evaluation. Similarly, over-half (>60%) PA and PNP PDs agreed that learners could answer OH-related questions on their board exams. CONCLUSION: Best practices learned from PNP and PA programs can be shared across disciplines to help bolster OH integration.

Integrating Oral Health: Physician Assistant Education in 2017.

PURPOSE: This study describes the inclusion of oral health in physician assistant (PA) education programs in 2017. A 2014 study found that 78% of responding programs (n = 98 of 125) had integrated this content into their curriculum. The current study represents a partnership between the National Interprofessional Initiative on Oral Health, the Center for Integration of Primary Care and Oral Health, and the PA Leadership Initiative in Oral Health. The PA profession was one of 14 health professions surveyed to assess the quantity and quality of oral health integration, including barriers to and facilitators of change. METHODS: An electronic cover letter explaining the research purpose was emailed to all US PA education program directors along with a link to a web-based survey. Most questions were followed by predefined response options; some questions offered an opportunity to include narrative responses or comments. RESULTS: There was greater inclusion of oral health curriculum in 2017 than in 2014, for both the number of programs including oral health education and the breadth of their curriculum. CONCLUSIONS: Efforts to equip PA faculty to integrate oral health core clinical competencies into their curriculum should continue, because existing strategies appear to be sustainable and effective in expanding oral health content across PA programs.