Oral Health in Medical Education: A Student’s Perspective

Olivia Nuelle

Many patients do not have dental insurance, a dental home, or access to dental care. And yet, oral health is important. It is linked to systemic health and can exacerbate chronic diseases, such as diabetes. Many oral health conditions are preventable and treatable. Dental caries, the most common chronic childhood disease, are preventable with proper oral hygiene and dental care. However, many patients are unable to see a dentist regularly for a variety of reasons, making it important that physicians are trained in the basics of oral health in order to properly serve their patients’ needs and successfully collaborate with dental providers. Many medical schools do not have robust oral health curriculums. Yet, the Institute of Medicine and other national organizations promote the important role that medical providers play with regards to a patient’s oral health care. Through the hard work of oral health champions working at medical institutions, there has been a push to better teach oral health and weave it throughout curriculum.

University of Massachusetts and many other medical schools have put a renewed emphasis on teaching preventative care and social determinants of health. The mouth and oral cavity are an important window into the overall health of a patient and an integral component to health maintenance. Adding oral health topics into medical school curriculum ensures that students are taught about the importance of oral health care and its impact on patients’ overall health, and further integrates social determinants of health and preventative care into clinical medicine.

Above are Screenshots from the series of Step 1 review videos shared on YouTube.

During the summer between my first and second year of medical school, I worked with Dr. Hugh Silk to catalog areas where oral health is taught in the curriculum at University of Massachusetts and identify areas of the curriculum to further integrate oral health information. The goal was to make sure that critical oral health topics like childhood caries, oral manifestations of common infections and diseases, and the effect of oral health on systemic disease were included in the curriculum. We identified areas where oral health topics were pertinent to material already being taught. The goal was to have a longitudinal oral health curriculum woven through the four years of medical education. Through collaboration with each course director and utilization of validated national curriculum like Smiles for Life, we were able to increase the amount of oral health topics in the curriculum and further emphasize the importance of this information with regards to patients and their well-being. Smiles for Life has modules and quizzes that cover all aspects of the oral exam, oral health maintenance, and oral health in all ages of patients. Using a validated curriculum is a great way to make sure that important information is being taught and taught well. We also created some of our own educational material in the form of PowerPoint lectures and independent learning modules. We created a series of Step 1 review videos with Dr. Sachs specifically covering oral health related topics and how they show up on the Step 1 exam (https://12daysinmarch. com/oral-health-topics/).

At University of Massachusetts, during the clinical years, there are oral health elective rotations and interstitial days. These interstitial days are a great example of the longitudinal nature of a well-implemented oral health curriculum. The entire third year class attends these days full of various lectures on topics deemed essential to supplement the learning done in clinical rotations. Oral health lectures are woven throughout the interstitial curriculum and nicely build off information taught in the first two years. There is a component of review, and there is a clinical component which pairs well with the clinical learning we do in our third year. The oral health interstitial time we have had so far has been engaging and thought-provoking. The lecturer was passionate and knowledgeable about the topics discussed and was able to relate them to clinical care and discuss the impact that oral health has on patients.

In my third year so far, by using the oral exam in my clinical encounters, I have been able to get a better picture of the health of my patients. In pediatrics, the number of teeth a toddler has can give insight into their development. I had a long conversation with a 10-year-old about how excited she was for braces and the pride she takes in her teeth. Having these conversations allows physicians to lay the groundwork for proper oral hygiene and healthy habits that children can carry through their lives. In adults, the oral exam is an important screening tool to get a sense of their home health maintenance and can open conversations about access to care. These conversations allow a physician to consider more than a patient’s chief health concern and provide comprehensive care.

As a student, I do not expect to graduate medical school as a specialist in any field; however, I am expected to complete a thorough neurological exam and assessment. I also am expected to complete a thorough oral health exam and assessment. After all, the mouth and oral cavity are just as much a part of the body as the nervous system. Through our mouths we eat, communicate, breathe, smile, and laugh. It is a complex and important piece of our overall wellbeing as humans.

Going forward, I hope that oral health information will continue to become a standardized and consistent component of medical education. There are many great national resources available and educational tools that can be integrated into medical curricula. When students start learning about oral health early in their medical education, it will no longer feel like an additional piece of curriculum, but rather an essential piece of the whole. Oral health is a critical aspect of a person’s overall health; therefore, it is an essential part of medical education.

Olivia Nuelle, M.D. Candidate at University of Massachusetts Medical School olivia.nuelle@umassmed.edu