Women's Health Nurse Practitioner Program the OHNEP Interprofessional Oral Health Faculty Toolkit

The OHNEP Interprofessional Oral Health Faculty Toolkit Women’s Health Nurse Practitioner Program

CURRICULUM INTEGRATION OF INTERPROFESSIONAL ORAL HEALTH CORE COMPETENCIES:

• Introduction to Reproductive Healthcare of Women • Ambulatory Care of Women • Integrated Care of Women • Resources

S The Oral Health Nursing Education and Practice (OHNEP) program has developed an Interprofessional Oral Health Faculty Tool Kit to provide you with user friendly curriculum templates and teaching-learning resources to use when integrating oral health and its links to overall health in your Women’s Health Nurse Practitioner program.

Oral health and its relation to overall health has been identified as an important population health issue. Healthy People 2020 (2011), the IOM Reports, Advancing Oral Health in America (2011) and Building Workforce Capacity in Oral Health (2011), as well as the IPEC Competencies (2011), challenged HRSA to develop interprofessional oral health core competencies for primary care providers. Publication of the report, Integrating Oral Health in Primary Care Practice (2014), reflects those interprofessional oral health competencies that can be used by Women’s Health Nurse Practitioners for faculty development, curriculum integration and establishment of “best practices” in clinical settings.

The HRSA interprofessional oral health core competencies, the IPEC competencies and the NONPF core competencies provide the framework for the curriculum templates and resources. Exciting teaching-learning strategies that take students from Exposure to Immersion to Competence can begin in the classroom, link to simulated or live clinical experiences and involve community-based service learning, advocacy and policy initiatives as venues you can readily use to integrate oral health into your existing primary care curriculum. The Women’s Health Nurse Practitioner program curriculum template illustrates how oral health can be integrated into health promotion, health assessment and clinical management courses.

The Smiles for Life interprofessional oral health curriculum provides a robust web-based resource for you to use that articulates with the oral health curriculum template for each course. A good place to begin oral health integration is by transitioning the HEENT component of the history and physical exam to the HEENOT approach. In that way, you and your students will NOT forget about including oral health in patients encounters.

Research continues to reveal an integral relationship between oral and systemic health. Diabetes, sexually transmitted infections, and eating disorders are but a few of the health problems that have oral manifestations that can be treated or referred to our dental colleagues. It is important for Women’s Health Nurse Practitioners on the frontline of primary care to have the oral health competencies necessary to recognize both normal and abnormal oral conditions and provide patients with education, prevention, diagnosis, treatment and referral as needed.

We encourage you and your students to explore the resources in the templates as you “weave” oral health and its links to overall health into your Women’s Health Nurse Practitioner program. If you need additional technical assistance, please feel free to contact us at [email protected]

WHNP Curriculum Integration of Interprofessional Oral Health Competencies in Introduction to Reproductive Healthcare of Women

INTRODUCTION TO 1) EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE REPRODUCTIVE HEALTHCARE OF KNOWLEDGE: RISK FACTORS FOR ORAL SKILL/BEHAVIOR SKILL/BEHAVIOR WOMEN DISEASES IN WOMEN Goal: Include oral health in history Goal: Demonstrate competency in oral health history and Goal: Describe oral disease risk factors for and risk assessment (HEENOT) in risk assessment in gynecological, well woman, and IPEC Competencies: adolescent and adult women Values and simulation lab preconception visits in clinical setting Ethics, Roles and • Document oral health history and risk factors • Read: Responsibilities • Review American Dental findings in electronic health record Interprofessional • Women’s oral health: why sex Communication, and gender matter (Niessen et Association Caries Risk • Read: Teams & Teamwork al. 2013) Assessment tool, Age > 6 Letters to the Editor: Letters on Preconception • Dietary behaviors and oral- (Appendix 1) Counseling and Care (Silk, 2014) E systemic health in women (Kim S N et al., 2013) U T M R M Y A SKILL/BEHAVIOR KNOWLEDGE: ORAL CARE IN GYN, WELL- SKILL/BEHAVIOR T WOMAN, & PRECONCEPTION VISITS L Goal: Include oral health in physical T Goal: Demonstrate competency in oral health HRSA Oral Health E Goal: Describe oral exam of the adolescent history, risk assessment and HEENOT in exam (HEENOT) in simulation lab I Competencies: Oral V and adult woman V gynecological, well-woman, and preconception Health Risk E E visits in clinical setting Assessment, Oral L • Complete Smiles for Life Modules 1,3, 7 • Review common adult oral • Read Health Evaluation, abnormalities (Appendix 5) A Oral Health Preventive A • Complete Quizzes for SFL modules 1,3, 7 Putting the Mouth Back in the Head: HEENT to • Develop a strategy to promote S Intervention, S (Appendix 2, 3, 4) S HEENOT (Haber et al, 2015) smoking cessation (Review Communication S • Submit SFL certificates of completion E • Document HEENOT findings in electronic health and Education E resources at S record S http://women.smokefree.gov/) S S • Develop a community dental resource network and M have a list of accessible dental providers, including M E E N those who accept Medicaid, to offer to your patients N T T KNOWLEDGE: COMMON WOMEN’S ORAL HEALTH SKILL/BEHAVIOR COLLABORATIVE CASE PRESENTATION ISSUES Goal: Demonstrate understanding of health Goal: Identify a collaborative care plan for female Goal: Describe oral manifestations of common literacy and strategies to improve oral patient with an eating disorder and dental erosion NONPF Competencies: health problems in women Integrates gender-specific health behaviors evidence into practice; • WHNP and dental hygiene student will read Eating Domestic Violence: Enhancing Dental Recognizes disease • • Following health literacy principles, disorder-induced dental complications: a case report manifestations unique to Professionals’ Response to Domestic Violence create a patient brochure demonstrating (De Moor, 2004) and collaborate on case women; Provides infertility (Shanel-Hogan et al., 2005) how practicing good oral hygiene is presentation, including plan for patient education, and sexually transmitted • GERD: Oral manifestations of essential to maintaining good overall prevention, anticipatory guidance, referral and

disease services to sexual OUTCOMES HEALTH OF PATIENT OPTIMIZATION gastroesophageal reflux disease (Ranjitkar et health follow-up care partners of female patients al., 2012) PARTNERSHIP & COLLABORATIVE PRACTICE FOR & COLLABORATIVE INTER-PROFESSIONAL PARTNERSHIP • Sexually Transmitted Infections: Oral manifestations of sexually transmitted infections (DePaola, 2013) CONSTRUCTS

American Dental Association1) EXPOSURE: Caries INTRODUCTION Risk Assessment tool2) , IMMERSIONAge > 6 3) COMPETENCE

(ADA, 2011) APPENDIX 2 Introduction to Reproductive Healthcare of Women

Smiles for Life Module1) 1 EXPOSURE: Quiz:The RelationshiINTRODUCTIONp o f Oral to2) Systemi IMMERSIONc Health 3) COMPETENCE

1. What is the most common 5. What can a primary care clinician 8. Which of the following infections chronic disease of childhood? do to promote oral health? is NOT potentially caused by direct A. Asthma A. Collaborate with dental and extension from a dental source? B. Seasonal allergies other health professionals A. Otitis media C. Dental caries B. Apply dental sealants B. Sinusitis D. Cefuroxime C. Prescribe oral fluoride C. Brain abscess supplements to every patient D. Facial cellulitis 2. What is a consequence of D. Apply fluoride varnish to the teeth of all adults untreated dental caries? 9. What is the suggested common A. Osteonecrosis of alveolar pathway linking chronic periodontitis bone 6. Which of these classes of medications and conditions such as diabetes, B. Gingival hyperplasia is NOT generally associated with coronary artery disease and adverse C. Oral mucositis decreased salivary flow? pregnancy outcomes? A. Direct bacterial extension D. Tooth fractures A. Antihistamines B. Antibiotics B. Poor nutrition C. Corticosteroids C. Circulating antibodies 3.Which condition is associated with D. Anticholinergics D. Inflammation periodontal disease? E. Diuretics A. Asthma 10. Which of the following is NOT a B. Preterm labor 7. A patient undergoing chemotherapy mechanism for inter-relationships C. Sinusitis for cancer is at risk for which of these between oral and systemic disease? D. Hypothyroidism oral complications due to the effects of A. Behavioral 4. Which of the following medications is chemotherapy? B. Iatrogenic linked to gingival hyperplasia? A. Osteonecrosis of alveolar bone C. Neurologic A. Phenytoin B. Gingival hyperplasia D. Inflamatory B. Amoxicillin C. Oral mucositis C. Digoxin D. Tooth fractures D. Coumadin

(Clark et al., 2010) APPENDIX 3 Introduction to Reproductive Healthcare of Women

Smiles for Life Module1) 3 EXPOSURE: Quiz: Adul INTRODUCTIONt Oral Health 2) IMMERSION 3) COMPETENCE

1. Which dental procedure does NOT require 5. Risk factors for adult caries may include all 8. Which of the following statements, prophylaxis for individuals at high risk the following except: concerning xerostomia or dry mouth, is of bacterial endocarditis? A. Low socioeconomic status not true? A. Dental extractions B. Existing tooth restoration A. Xerostomia is caused by a decrease in B. Periodontal procedures C. Decreased salivary flow the production of saliva C. Post-operative suture removal D. A vegetarian diet B. Xerostomia can cause a burning sensation, D. Prophylactic cleaning of teeth if E. Physical disabilities change in taste, and difficulty swallowing bleeding is anticipated C. Medications can contribute to xerostomia E. Re-implantation of avulsed teeth 6. Which of the following patients requires D. Xerostomia can increase the development of bacterial endocarditis antibiotic prophylaxis? caries 2. Periodontal disease can be clinically A. A 26 year old woman with mitral valve E. Xerostomia is rarely a problem for patients distinguished from gingivitis in which of prolapse undergoing routine teeth cleaning wearing complete dentures the following ways? with no anticipated bleeding. A. Inflammation of the gums B. A 64 year old man with a prosthetic mitral 9. Which of the following has been B. White discoloration of the permanent valve who is undergoing a tooth extraction. implicated in the development of recurrent teeth C. A 16 year old boy with a ventricular septal aphthous ulcers? C. Enlarged pockets at the gum base defect completely repaired in infancy who A. Trauma D. Gingival hypertrophy requires extraction of an impacted wisdom B. Vitamin C deficiency 3. Which of the following is NOT a tooth. C. Sickle Cell Anemia common site for oral cancers? D. A 32 year old man who had bacterial D. Herpes simplex virus infection A. Tongue endocarditis 5 years ago who B. Floor of mouth isundergoing orthodontic appliance 10. Which of the following factors is C. Hard palate adjustment. NOT involved in the development of D. Lower lip “Meth Mouth”: A. Poor oral hygiene 4. Which of the following is most likely to 7. Which of the following is not a normal B. Increased carbohydrate lead to poorer oral health in the elderly? age-related tooth change? consumption A. Alzheimer’s dementia A. Gingival recession C. Nighttime mouth breathing B. Coronary artery disease B. Root caries D. Teeth grinding C. Hypothyroidism C. Yellowing of teeth D. All of the above D. Wearing away of teeth with exposed E. Xerostomia dentin

(Clark et al., 2010) APPENDIX 4 Introduction to Reproductive Healthcare of Women

Smiles for Life Module1) 7 EXPOSURE: Quiz: The OraINTRODUCTIONl Examination 2) IMMERSION 3) COMPETENCE

1. What constitutes a tooth’s outer layer? 5. Oral cancer is most common in which area 8. When examining a 9 month old child’s A. Enamel of the mouth? mouth, what is a reason for an early B. Dentin A. Hard palate referral to a dentist? C. Pulp B. Surface of tongue A. The child has only 4 incisors C. Inside of cheek B. Developmental tooth defects are present 2. What is a full complement of adult teeth? D. Posterolateral tongue C. No molars have erupted A. 26 D. No canine teeth have erupted B. 28 6. When performing the “knee-to-knee” oral E. Counting less than 20 teeth C. 30 exam on a young child, in what position 9. You are performing an oral exam on your should the child start? D. 32 21 year old patient who has been using A. Facing the examiner smokeless tobacco for 4 years. What part of 3. A caregiver asks you how many teeth B. Standing up this patient’s oral cavity is especially her 3 year old child should have. What C. Sitting on the exam table important for you to examine? would you respond? D. Facing the caregiver A. The sun-exposed areas of the patient’s cheeks A. 20 B. The inner aspect of the patient’s lips and cheeks B. 22 7. Which of the following is NOT needed by a C. Any discoloration or pitting of the patient’s teeth C. 24 primary care clinician to conduct a thorough D. Any plaque build-up along the patient’s gum line D. 28 oral exam? E. The patient’s posterior pharynx A. An exam light to illuminate key 4. At what age do teeth typically features in the mouth 10. A complete oral examination includes begin to erupt in children? B. Tongue depressors to lift the lip each of the following EXCEPT: A. 3-9 months and retract the cheek A. Temporomandibular joint (TMJ) exam B. 9-15 months C. A mouth mirror to view lingual surfaces of B. Cervical node exam C. 15-21 months teeth C. Palpation of the floor of the mouth D. 21-27 months D. Dental explorer D. Sinus exam E. Gauze pads to grasp the tongue E. Exam of the skin around the mouth

(Clark et al., 2010) APPENDIX 2-4 Introduction to Reproductive Healthcare of Women

Smiles for Life Module1)s 1,EXPOSURE: 3, & 7 Answer INTRODUCTION Key 2) IMMERSION 3) COMPETENCE

Module 1: Module 3: Module 7:

1. C 1. C 1. A 2. A 2. C 2. D 3. B 3. C 3. A 4. A 4. A 4. B 5. A 5. D 5. D 6. B 6. B 6. D 7. C 7. B 7. D 8. A 8. E 8. B 9. D 9. A 9. B 10. C 10. C 10. D

(Clark et al., 2010) APPENDIX 5 Introduction to Reproductive Healthcare of Women

Adult Oral Health 1)Checklist EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE

Please check as you identify each item:

Strep throat (A)

Periodontal disease (B)

Black hairy tongue (C)

Herpetic lesion (D)

Gingival recession (E)

Canker sore (F)

Angular cheilitis (G)

Tori madibularis (H)

Adult Oral Health 1)Checklist EXPOSURE: (Answer INTRODUCTION Key) 2) IMMERSION 3) COMPETENCE

Please check as you identify each item:

Strep throat (A)

Periodontal disease (B) E

Black hairy tongue (C) H F Herpetic lesion (D)

Gingival recession (E)

Canker sore (F) D G Angular cheilitis (G) A C Tori madibularis (H)

Images from: CDC public health images library Gujral, D. M., Bhattacharyya, S., Hargreaves, P., & Middleton, G. W. (2008). Periodontal disease in a patient receiving Bevacizumab: a case report. Journal of medical case reports, 2(1), 47. Jain, A., & Kabi, D. (2013). Severe periodontitis associated with chronic kidney disease. Journal of Indian Society of Periodontology, 17(1), 128. Jeong, J. S., Lee, J. Y., Kim, M. K., & Yoon, T. Y. (2011). Black hairy tongue associated with erlotinib treatment in a patient with advanced lung cancer. Annals of dermatology, 23(4), 526-528. Kwon, K. H., Lee, D. G., Koo, S. H., Jo, M. S., Shin, H., & Seul, J. H. (2012). Usefulness of v-y advancement flap for defects after skin tumor excision. Archives of plastic surgery, 39(6), 619-625. Lee, K. H., Lee, J. H., & Lee, H. J. (2013). Concurrence of Torus Mandibularis with Multiple Buccal Exostoses. Archives of plastic surgery, 40(4), 466-468. women uniqueto manifestations disease Manages healthcare forwomen; equitable, safeandeffective support accessible, policies andresearchthat forhealthcare Advocates NONPF Competencies: IP Collaboration and Education, Communication Intervention, Preventive Oral Health Evaluation, Health Assessment, Oral Oral HealthRisk Competencies: HRSA OralHealth Teams & Teamwork Communication, Interprofessional Responsibilities Ethics, Rolesand Values and IPEC Competencies: C OF WOMEN AMBULATORY CARE © Oral Health© Oral Nursing Education and (OHNEP) Practice ONSTRUC WHNP CurriculumIntegrationofInterprofessionalOralHealthCompetenciesinAmbulatoryCare TS

M N Y R T N E E S S S S T V E A E E L L • during pregnancy Goal: Identifycommonmythsaboutoralhealth KNOWLEDGE: ORALHEALTH INPREGNANCYMYTHS • )EXPOSURE 1) Pregnancy Expert consensus statementOralHealthCareDuring Read: Committee opinionno. 569: oralhealthcareduring pregnancy andthroughthelifespan • • Read: OralHealthDuringPregnanc • outcomes formotherandbaby theycaninfluenceoral-systemichealth and how Goal: Describecommonoralproblemsinpregnancy PREGNANCY KNOWLEDGE: COMMONDISCOMFORTS OF • • Submit SFL certificate ofcompletion SubmitSFLcertificate • CompleteSmilesforLife • Goal: Describeoralexamofthepregnantwoman KNOWLEDGE: PRENATAL ORALHEALTH CARE CompleteQuizzesforSFLmodule5 • Part 2: Oral Health For Pregnant Women and Women Pregnant For Health Oral 2: Part Complete ed hraooia Cnieain for Pregnant Women (Appendix 3) Considerations Pharmacological Read Their Newborns Appendix Review SFLPrenatalPocketCard(See al., 2008) (Appendix 1) (Appendix Oral healthcareduringpregnancy: 2) APTR OralHealthLearningModule APTR Workgroup, Module 5 2012) (ACOG, 2013) y (Silket national

)IMMERSION 2) • • • behaviors literacy toimproveoralhealth andstrategies Goal: understandingofhealth Demonstrate SKILL/BEHAVIOR • Conduct a literature reviewandwrite Conductaliterature • during pregnancy common mythaboutoralhealth Goal: abilitytodispela Demonstrate SKILL/BEHAVIOR Discussriskfactorsfor periodontal • Discusssafeantibioticchoicesfor • • lab careinsimulation prenatal assessment andHEENOTin Goal: Include oralhealthhistory, risk SKILL/BEHAVIOR Following literacy heath principles, prepare During Pregnancy(Appendix6 Review TipsforGoodOralHealth (Appendix Review TwoHealthySmilesBrochure pregnancy forpregnantwomen a FAQ sheetaboutdentalcareduring board health duringpregnancy one ofthecommonmythsaboutoral an evidence-basedargumenttodispel Case Study1(Appendix4) Discuss SFLOralHealthinPregnancy disease inpregnancy pregnant women Women 5) andcommentondiscussion ) M M M U N E E T S S S S V A S A E T T I )COMPETENCY 3) Read: • • WHNP and dental student to collaborate oncase WHNPanddentalstudent tocollaborate • withperiodontaldisease patient Goal: careplanforpregnant Identifyacollaborative COLLABORATIVE CASE PRESENTATION • Identifyapolicy wouldhelppregnantwomenin that • baby influence oral-systemichealthoutcomesformotherand issues, policies, andhealthcaresystem(s)factorsthat Goal: abilitytoanalyzecontemporary Demonstrate SKILL/BEHAVIOR Review • setting visitinclinicalrisk assessmentandHEENOTinprenatal Goal: competency Demonstrate inoralhealthhistory, SKILL/BEHAVIOR Developacommunitydental resourcenetworkand • DocumentHEENOTfindingsinelectronichealthrecord • Refer at risk,Refer at first-timepregnantwomentothelocal Evaluation of periodontal pathogens inamniotic ofperiodontal pathogens Evaluation woman withperiodontaldisease plan ofcareforthemotherandbaby, forapregnant presentation, including comprehensiveantepartum NFP program birth and low birth weight birth andlow fluid andtheroleofperiodontaldisease inpre-term representative. speech topresentthispolicy toyourlocal oral healthcare. Prepareabriefevidence-based areaovercomebarrierstoaccessing your catchment Putting theMouthBackinHead: HEENTto patients those whoacceptMedicaid, toofferyourpregnant alistofaccessibledentalproviders,have including HEENOT (Haber etal, 2015) (Ercanetal., 2013)

INTER-PROFESSIONAL PARTNERSHIP & COLLABORATIVE PRACTICE FOR OPTIMIZATION OF PATIENT HEALTH OUTCOMES APPENDIX 1 Ambulatory Care of Women

Smiles for Life Module1) 5 EXPOSURE: Quiz: Oral INTRODUCTIONHealth in Pregnancy 2) IMMERSION 3) COMPETENCE

1. Which of the following is a C. Dental treatment should only be done during 8. If a pregnant woman has an oral abscess FALSE statement? the second trimester for comfort and safety in the first trimester, what should she do A. Gingivitis is very common in pregnancy reasons regarding its treatment? B. Periodontitis is associated with preterm birth D. Dental treatment can be done A. Take antibiotics and pain medication only and C. Treatment of periodontitis in pregnancy during any trimester wait until her second trimester to see the decreases the risk of preterm birth dentist 5. What guidance should you give a pregnant D. Deep root scaling to improve periodontitis B. Avoid x-rays for further diagnosis is safe during pregnancy patient about having dental x-rays during her pregnancy? C. Have the tooth treated or extracted under 2. Which of the following is a TRUE statement: A. Dental x-rays should be avoided during local anesthesia immediately A. Mothers with caries pass their genetic pregnancy D. Delay definitive treatment until predisposition for caries on to their babies B. Dental x-ray should be limited to only one after delivering her baby B. Mother with caries pass caries-causing film per pregnancy 9. Amalgam restorations placed during bacteria to their babies in utero C. Dental x-rays should be taken as pregnancy can lead to which negative C. Mother with caries pass caries-causing bacteria necessary to reach a full diagnosis outcome in the fetus? to their infants early in life via saliva D. Dental x-rays are rarely needed during A. Birth defects transmission pregnancy D. All of the above B. Neurologic sequelae 6. What oral health guidance should C. Spontaneous abortions 3. A pregnancy granuloma: you give a pregnant patient? D. None of the above A. Has malignant potential and should be biopsied A. Brush twice daily with fluoridated toothpaste B. Should be excised during pregnancy even if B. Use chlorhexidene mouthwash three times per 10. What could pregnant women do after asymptomatic to avoid complications day vomiting to reduce the risk of enamel erosion? C. Can be observed C. Avoid sugary drinks and snacks between meals A. Swish with baking soda and water D. Is not likely to recur if excised D. Take fluoride dietary supplements B. Vigorously brush her teeth E. A and C only 4. A pregnant patient asks you for guidance C. Immediately take a dose of a proton pump about having dental treatment during her inhibitor pregnancy. What would you say? 7. All of the following conditions can cause D. Immediately take 3-4 antacid tablets A. Dental treatment should only be done worsening gingivitis EXCEPT: during the second and third trimester A. Onset of puberty B. Dental treatment should only be done B. Monthly menses during the third trimester because C. Menopause organogenesis is complete D. Use of oral contraceptives E. Pregnancy

(Clark et al., 2010) APPENDIX 1 Ambulatory Care of Women

Smiles for Life Module1) 5 EXPOSURE: Quiz Answer INTRODUCTION Key 2) IMMERSION 3) COMPETENCE

Module 5:

1. C 2. C 3. C 4. D 5. C 6. E 7. C 8. C 9. D 10. A

(Clark et al., 2010) APPENDIX 2 Ambulatory Care of Women

Smiles for Life Prenatal1) EXPOSURE:Oral Health INTRODUCTION Pocket Card, Side 1 2) IMMERSION 3) COMPETENCE

(Silk, Douglass, & Douglass, 2012) APPENDIX 2 Ambulatory Care of Women

Smiles for Life Prenatal1) EXPOSURE:Oral Health INTRODUCTION Pocket Card, Side 2 2) IMMERSION 3) COMPETENCE

(Silk, Douglass, & Douglass, 2012) APPENDIX 3 Ambulatory Care of Women

Oral Health Care During1) EXPOSURE: Pregnancy: INTRODUCTION A National Consensus2) IMMERSION Statement 3) COMPETENCE

(Oral Health Care During Pregnancy Expert Workgroup, 2012) APPENDIX 4 Ambulatory Care of Women

Smiles for Life Module1) 5 EXPOSURE: Case 1, Part INTRODUCTION 1 2) IMMERSION 3) COMPETENCE

(Clark et al., 2010) APPENDIX 4 Ambulatory Care of Women

Smiles for Life Module1) 5 EXPOSURE: Case 1, Part INTRODUCTION 2 2) IMMERSION 3) COMPETENCE

(Clark et al., 2010) APPENDIX 4 Ambulatory Care of Women

Smiles for Life Module1) 5 EXPOSURE: Case 1, Part INTRODUCTION 3 2) IMMERSION 3) COMPETENCE

(Clark et al., 2010) APPENDIX 5 Ambulatory Care of Women

Two Healthy Smiles Brochure,1) EXPOSURE: Side INTRODUCTION 1 2) IMMERSION 3) COMPETENCE

(Holt, Clark, & Barzel, 2009) APPENDIX 5 Ambulatory Care of Women

Two Healthy Smiles Brochure,1) EXPOSURE: Side INTRODUCTION 2 2) IMMERSION 3) COMPETENCE

(Holt, Clark, & Barzel, 2009) APPENDIX 6 Ambulatory Care of Women

Tips for Good Oral Health1) EXPOSURE: During PregnancyINTRODUCTION Handout, Side2) IMMERSION 1 3) COMPETENCE

(Oral Health Care During Pregnancy Expert Workgroup, 2012) APPENDIX 6 Ambulatory Care of Women

Tips for Good Oral Health1) EXPOSURE: During PregnancyINTRODUCTION Handout, Side2) IMMERSION 2 3) COMPETENCE

(Oral Health Care During Pregnancy Expert Workgroup, 2012) WHNP CurriculumIntegrationof identified healthcarerisk and/or referralbasedon counseling, management lifespan; Provides and illnessacross physical andmentalhealth women’s responsesto approaches thataddress to developclinical based practiceknowledge theory andevidence- Integrates research, NONPF Competencies: IP Collaboration and Education, Communication Intervention, Preventive Oral Health Evaluation, Health Assessment, Oral Health Risk Competencies: Oral HRSA OralHealth Teams & Teamwork Communication, Interprofessional Responsibilities Ethics, Rolesand Values and IPEC Competencies: OF WOMEN INTEGRATED CARE C © Oral Health© Oral Nursing Education and (OHNEP) Practice ONSTRUC TS

M N N E E Y R S S S S T T V E A E E L L • • • • mother andbaby Goal: Describeimportanceoforalhealthfor NEW MOTHERS KNOWLEDGE: INFANT ORALHEALTH EDUCATION FOR )EXPOSURE 1) Focus OnSub-specialtiesFrenotomy forbreastfed (Mayer, 2012) tongue-tied infants: anoldprocedure afreshlookat Guidelines onInfantOralHealthCare American Academy ofPediatrics Watch Presentation (Password:Presentation nyu2014) (AAPD, 2014) Policy onBreastfeeding Statement • KNOWLEDGE: OLDER ADULT PRIMARY CARE • Read: Goal: Goal: Read: during menopause Goal: Understandoralhealthissues MENOPAUSE KNOWLEDGE: ORALHEALTH CARE DURING Ensuring OralHealthforOlderIndividualswith Reducing care-resistant behaviors duringoral Reducing care-resistantbehaviors al, 2011) (Waldman &Perlman, 2012) Intellectual andDevelopmentDisabilities hygiene inpersonswithdementia Recognize oralhealthneedsofolderadults Teeth for Two • • Menopause andoralhealth Crosstalk between (Suri &., 2014) (Grover etal, 2014) in themid-lifeofwomen hormones andoralhealth OnlineEducational Interprofessional (2012) (Jablonski et • women inmenopause assessment andHEENOTwhencaringfor Goal: Include oralhealthhistory, risk SKILL/BEHAVIOR • • • • about infantoralhealthcare Goal: newmothers foreducating Identifystrategies SKILL/BEHAVIOR SKILL/BEHAVIOR )IMMERSION 2) • • togetheronDiscussionBoardon:Collaborate toolderadults services Goal: Goal: Watch A HealthyMouthfor Your Babyvideo Review Review LifttheLipPamphlet 1) (Appendix Read: toreducetheincidence Nursingstrategies (NIDCR, 2013) Tools (WDSF, 2014) populations populations of earlychildhoodcariesinculturallydiverse Following health literacy principles, develop women inmenopause problemsandsolutionsfor associated an oralhealthFAQ sheetoforalhealth- Diabetes case study (Appendix 3 (Appendix Diabetes casestudy 2) (Appendix Cardiovascular casestudy Provide comprehensivehealthmaintenance Free Kids Kids Free Cavity OralHealthCompetenciesinIntegratedCareofWomen (Hallas etal., 2011) Family Engagement ) M M M N U E E T S S S S V A A E T S I )COMPETENCY 3) • planforpostpartummother health education Goal: Developacomprehensive, infantoral collaborative SKILL/BEHAVIOR • • case withcognitivedecline andoralhealthneeds Goal: COLLABORATIVE CASE STUDY WHNP andP pediatric clinicpediatric guidanceforparentofnewbornat anticipatory and toprovideoralhealtheducation collaborate • tomenopause with oralhealthproblemsrelated Goal: careplanforwomen Identifyacollaborative SKILL/BEHAVIOR Read WHNP and dental students to collaborate on WHNP anddentalstudentstocollaborate Opportunities forNursing-Dental older adultswithcognitivedecline andoral plansfor developing amanagement health needs Among theElderly Collaboration: Addressing OralHealth Needs on geriatric interprofessionallyongeriatric Collaborate WHNP and dental students to collaborate oncase WHNP anddentalstudentstocollaborate treatment andreferral treatment includingpresentation education, prevention, ediatric NursePractitionerstudent ediatric (case studies) (Coleman, 2005)

INTER-PROFESSIONALPARTNERSHIP & COLLABORATIVE PRACTICE FOR OPTIMIZATION OF PATIENT HEALTH OUTCOMES

APPENDIX 1 Integrated Care of Women

Lift the Lip Brochure 1) EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE

(Herschel S. Horowitz Center for Health Literacy, 2013) APPENDIX 2 Integrated Care of Women

Cardiovascular Disease1) Case EXPOSURE: Study INTRODUCTION 2) IMMERSION 3) COMPETENCE

Design an oral exam and treatment plan for a 61 year old woman with a prosthetic mitral valve who will undergo deep cleaning of her gingival and gingival pockets.

What are your treatment plans if this patient is allergic to PCN? APPENDIX 3 Integrated Care of Women

Diabetes Case Study 1) EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE

A 65 year old Hispanic female Mrs. M. was referred by the Dental clinic because of early evidence of • Oral Health History periodontal disease. The patient has family history of Type 2 Diabetes (T2D) and history of caring for her • Physical Health Exam diabetic grandfather for many years. She described herself as an expert in diabetes because of the years of caring for her ailing diabetic grandfather. During the • Oral-Systemic Risk Assessment health history, she complained of symptoms of hyperglycemia: fatigue, thirst, and weight loss. On • Action Plan physical exam, her blood pressure was 160/95, BMI of 31, random blood sugar of 332 mg/dl, and HgbA1c > • Preventive Interventions 13%. She was diagnosed with T2D and obesity. She was started on Metformin twice a day and was counseled on diet and physical activity. The patient was • Interventions referred back to dentistry for continued periodontal care in light of her new diagnosis of T2D. • Collaboration

What is the follow-up nursing primary care action plan for Mrs. M.? • Referrals What are the 3 months follow-up outcomes?

RESOURCES

1) EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE

Alfano, D. M. (2014). Human papillomavirus laryngeal tracheal papillomatosis. Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Smiles for Life: Associates & Practitioners, 28(5), 451–5. doi:10.1016/j.pedhc.2014.04.003 A National Oral Health Curriculum American Academy of Pediatrics. (n.d.). Children’s oral health. Retrieved from http:// www.smilesforlifeoralhealth.org www2.aap.org/commpeds/dochs/oralhealth/index.html Healthy People 2020: Oral Health American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, https://www.healthypeople.gov/2020/ 129(3), e827–41. doi:10.1542/peds.2011-3552 topics-objectives/topic/oral-health American Academy of Pediatric Dentistry, Clinical Affairs Committee-Infant Oral Health I N Subcommittee. (2012). Guideline on infant oral health care. Pediatr Dent; 34(5):148-52. T Association for Prevention Teaching and Review. PubMed PMID: 23211901. E Research (APTR) Oral Health Across the R American College of Obstetricians and Gynecologists Women's Health Care Physicians, Oral N Lifespan Learning Module E Health Care During Pregnancy Advisory Committee. (2013). Committee Opinion No. 569: T http://www.aptrweb.org/?PHLM_15

oral health care during pregnancy and through the lifespan. Obstet Gynecol, 122 (2 Pt 1): R 417-22. doi: 10.1097/01.AOG.0000433007.16843.10. E National Maternal and Child Oral Health S Resource Center (OHRC) Berry, J., Griffiths, M., & Westcott, C. (2012). A double-blind, randomized, controlled trial of O U http://www.mchoralhealth.org/index.html tongue-tie division and its immediate effect on breastfeeding. Breastfeeding Medicine : R C The Official Journal of the Academy of Breastfeeding Medicine, 7(3), 189–93. doi: E Interprofessional Education Collaborative 10.1089/bfm.2011.0030 S (IPEC) Boggess, K. A. (2008). Maternal oral health in pregnancy. Obstetrics and Gynecology, 111(4), https://ipecollaborative.org/ 976–86. doi:10.1097/AOG.0b013e31816a49d3 Boggess, K. A., & Edelstein, B. L. (2006). Oral health in women during preconception and University of Toronto Centre for pregnancy: implications for birth outcomes and infant oral health. Maternal and Child Interprofessional Education Health Journal, 10(5 Suppl), S169–74. doi:10.1007/s10995-006-0095-x http://ipe.utoronto.ca/

Bruce, A. J., & Rogers, R. S. (2004). Oral manifestations of sexually transmitted diseases. Clinics in Dermatology, 22(6), 520–7. doi:10.1016/j.clindermatol.2004.07.005 Buryk, M., Bloom, D., & Shope, T. (2011). Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics, 128(2), 280–8. doi:10.1542/peds.2011-0077 RESOURCES

1) EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE California Dental Association Foundation, & American College of Obstetricians and Gynecologists, District IX. (2010). Oral health during pregnancy and early childhood: evidence-based guidelines for health professionals. J Calif Dent Assoc, 38(6):391-403, 405-40. Clark M.B., Douglass A.B., Maier R., Deutchman M., Douglass J.M., Gonsalves W., Silk H.,Tysinger J.W., Wrightson A.S., & Quinonez R. (2010). Smiles for life: a national oral health curriculum. 3rd Edition. Society of Teachers of Family Medicine. Retrieved from www.smilesforlifeoralhealth.com De Moor, R. J. G. (2004). Eating disorder-induced dental complications: a case report. Journal of Oral Rehabilitation, 31(7), 725–32. doi:10.1111/j. 1365-2842.2004.01282.x DePaola, L. G. (2013). Oral Manifestations of Sexually Transmitted Infections. Retrieved from http://www.richmondinstitute.com/article/infection-control/oral- manifestations-of-sexually-transmitted-infections Ercan, E., Eratalay, K., Deren, O., Gur, D., Ozyuncu, O., Altun, B.,… Akincibay, H. (2013). Evaluation of periodontal pathogens in amniotic fluid and the role of periodontal disease in pre-term birth and low birth weight. Acta Odontologica Scandinavica, 71(3-4), 553–9. doi:10.3109/00016357.2012.697576 Grover, C. M., More, V. P., Singh, N., & Grover, S. (2014). Crosstalk between hormones and oral health in the mid-life of women: A comprehensive review. Journal of International Society of Preventive & Community Dentistry, 4(Suppl 1), S5. doi: 10.4103/2231-0762.144559. Hagan J.F., Shaw J.S., & Duncan P.M. (2008). Bright futures: guidelines for health supervision of infants, children, and adolescents (3rd, Ed). Elk Grove Village, IL: American Academy of Pediatrics. Haber, J. (2014). Building a culture of collaboration: Interprofessional education and practice. Journal of the Academy of Distinguished Educators, 2(1):12-14. Haber, J. Hartnett, E. Allen, K., Hallas, D., Dorsen C., Lange-Kessler, J., Lloyd M., Thomas, E., Wholihan D. (2015). Putting the Mouth Back in the Head: HEENT to HEENOT. Am J Public Health. e1–e5. doi:10.2105/AJPH.2014.302495 Hallas, D., Fernandez, J., Lim, L., & Carobene, M. (2011). Nursing strategies to reduce the incidence of early childhood caries in culturally diverse populations. Journal of Pediatric Nursing, 26(3), 248–56. doi:10.1016/j.pedn.2009.07.010 Hartnett, E., Lange Kessler, J., Moursi, A., & Hallas, D. (2014). Teeth for Two: Oral Health in Pregnancy and Early Childhood Online Educational Presentation. Retrieved from http://wp.nyu.edu/teethfortwo/ Herschel S. Horowitz Center for Health Literacy, School of Public Health, University of Maryland. (2013). Lift the Lip [Brochure]. College Park, MD. Holt, K., Clark, M., & Barzel, R. (2009). Two Healthy Smiles: Tips to Keep You and Your Baby Healthy (rev). Washington, DC: National Maternal and Child Oral Health Resource Center. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Retrieved from http://www.aacn.nche.edu/Education/pdf/IPECReport.pdf Institute of Medicine. (2011a). Advancing oral health in America. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/Advancing-Oral-Health-in-America.aspx

RESOURCES

1) EXPOSURE: INTRODUCTION 2) IMMERSION 3) COMPETENCE

Institute of Medicine. (2011b). Improving access to oral health care for vulnerable and underserved populations. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/Improving-Access-to-Oral-Health-Care-for-Vulnerable-and-Underserved-Populations.aspx Kim, J., DeBate, R. D., & Daley, E. (2013). Dietary behaviors and oral-systemic health in women. Dental Clinics of North America, 57(2), 211–31. doi:10.1016/j.cden.2013.01.004 Mayer, D. R. (2012). Focus On Subspecialties Frenotomy for breastfed tongue-tied infant: a fresh look at an old procedure. doi:10.1542/aapnews.2012331-12 Moritz, A., & Mealey, B. (2006). Periodontal disease, insulin resistance, and diabetes mellitus: a review and clinical implications. Grand Rounds Oral-Sys Med, 2:13-20. National Center on Health.(2014). Healthy Habits for Happy Smiles. Series of Handouts for Parents of Infants and Young Children. Elk Grove Village, IL National Center on Health. Retrieved from http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/oral-health/education-activities/healthy-habits.html National Institute of Dental and Craniofacial Research (NIDCR). (2013, February 5). A healthy mouth for your baby [Video file]. Retrieved from https://www.youtube.com/watch?v=QW7Px5mLbbI Niessen, L. C., Gibson, G., & Kinnunen, T. H. (2013). Women’s oral health: why sex and gender matter. Dental Clinics of North America, 57(2), 181–94. doi: 10.1016/j.cden.2013.02.004 Oral Health Care During Pregnancy Expert Workgroup. (2012). Oral health care during pregnancy: a national consensus statement— summary of an expert workgroup meeting. Washington, DC: National Maternal and Child Oral Health Resource Center. Oral Health Care During Pregnancy Expert Workgroup. (2012). Tips for Good Oral Health During Pregnancy. Washington, DC: National Maternal and Child Oral Health Resource Center. Ranjitkar, S., Smales, R. J., & Kaidonis, J. A. (2012). Oral manifestations of gastroesophageal reflux disease. Journal of Gastroenterology and Hepatology, 27(1), 21–7. doi:10.1111/j.1440-1746.2011.06945.x Shanel-Hogan, K. A., Mouden, L. D., Muftu, G.G., & Roth, J. R. (2005). Enhancing dental professionals' response to domestic violence [Brochure]. San Francisco, CA: Family Violence Prevention Fund, National Health Resource Center on Domestic Violence. Silk, H. (2014). Letters on preconception counseling and care. Am Fam Physician, 89(11):847. PubMed PMID: 25077382. Silk, H., Douglass, A., Douglass, J., & Silk, L. (2008). Oral health during pregnancy. Am Fam Physician, 77(8):1139-44. Silk H, Douglass A, Douglass, J. (2012). Prenatal oral health pocket card. Suri, V. & Suri, V. (2014). Menopause and Oral Health. J. Midlife Health. Jul;5(3):115-20. doi: 10.4103/0976-7800.141187. United States Department of Health and Human Services. (2010). Oral Health, Healthy People 2020. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=32 U.S. Department of Health and Human Services, Health Resources and Services Administration. (2014). Integration of oral health and primary care practice. Rockville, MD: Health Resources and Services Administration. Retrieved from http://www.hrsa.gov/publichealth/clinical/oralhealth/primarycare/integrationoforalhealth.pdf Washington Dental Service Foundation. (2014). Cavity free kids: oral health education for pregnant women, children birth to age five, and their families – a resource for home visitors.