PAs can help busy MDs better address patients' oral health and meet meaningful use and other quality initiatives.
In medical school most physicians learned that oral health is a basic prerequisite to overall health. It is basic to our ability to speak and smile - to interact with others. Yet, in today's busy medical practice, we often hear that there's simply not enough time to address oral hygiene. There is a groundswell movement in the physician assistant (PA) profession to advance the belief that all practices need to find ways to make that time. Not only is it important to the patient's health, it's important to medical groups and healthcare systems striving to meet meaningful use and other quality measurement initiatives.
Consider just a few of the facts:
• Dental caries is the most common chronic disease in children, five times more common than asthma.
• Half of adolescents ages 12 years old to 15 years old and one-quarter of children ages 2 years old to 5 years old have tooth decay.
• More than 47 million people in the U. S. live in places where it is difficult to access dental care.
• Chronic periodontitis is linked via inflammation to diabetes, stroke, coronary artery disease, adverse pregnancy outcomes, obesity, and lower respiratory disease.
• Oral cancers are rising due to smoking and chewing tobacco.
• Illnesses related to oral health result in 6.1 million days of bed disability and 20.5 million lost workdays each year.
As a certified PA who has been involved in oral health initiatives for many years, it amazes me how many medical providers still think of the oral cavity as the "dentist's domain." An oral exam as a part of both the complete and problem-focused physical is quick and easy, and can have immediate impact on children and patients with chronic disease. PAs are logical providers to ensure oral health screens take place on every patient. Why?
1. PAs can make the time. An oral health screening only takes three minutes, but the discussion on prevention and curative measures will take longer. A busy physician may not have time. It is not uncommon for PAs to perform these screenings not only at annual visits, but anytime a patient presents with symptoms that could be representative of oral disease.
2. PAs focus on prevention. Our education provides us with the appropriate knowledge and skills to look for carries, signs of periodontal disease, or even cancer, and to make referrals for significant issues. Prevention pays for itself. The cost of fluoride varnish is about $1, significantly less than fillings and other restorative treatments.
3. PAs consider the oral-systemic connection. One aspect of meaningful use is meeting standards of care and outcomes. An oral assessment helps identify plaque and tartar, which can alert PAs to consider how that will affect their patients - whether it's glycemic control in diabetic patients or the overall health of pregnant, cardiac, or pre-surgical patients.
4. PAs' interpersonal skills are strong. We are educated in prevention and wellness, how to ask questions and counsel patients. Oral health is a subject we are very comfortable addressing with patients.
5. PAs speak "team" and coordination of care. The very essence of PAs is team care and communicating with both the patient and the physician to coordinate care and follow up. It is natural for us to help physicians make the connection between oral and overall health .
6. PAs generate revenue. Because many states will reimburse for oral health screenings, PAs who perform them can actually increase practice revenue. In 2014 alone, Medicaid paid providers in 43 states for addressing children's oral health.
Great strides have been made in oral health since the wide adoption of fluoride, but there is an ongoing need to be vigilant about screening, counseling, and prevention - all items that fit within the scope of PA practice and that will bring greater value to physician practices. The nccPA Health Foundation is helping certified PAs recognize the oral-systemic connection and embrace oral health promotion strategies in healthcare delivery.
This year's PA Oral Health Summit, supported by the National Interprofessional Initiative on Oral Health (NIIOH), focused on measurable gains in PA education and the vision to support the integration of oral health in PA practice regardless of setting or specialty. So while long-term goals to eradicate dental and other oral diseases may seem lofty, certified PAs can make a big difference everyday by considering oral health during their patient encounters.
*For more information and free Category 1 CME, visit Smiles for Life.
Cynthia Booth Lord, MHS, PA-C,is the founding director of the PA program at Case Western Reserve University. She has spent much of her career working in family medicine and academia. She is a past president and chairman of the board for AAPA and currently serves as chair of the nccPA Health Foundation.
This blog was provided in partnership with the National Commission on Certification of Physician Assistants.