Executive Summary
Oral health has a significant impact on the overall health and well-being of individuals across
their life span. For example, employed adults lose more than 164 million hours of work each
year due to dental disease or dental visits. Twenty-two percent of adults reported some form of
oral-facial pain in the past 6 months. Dental caries (tooth decay) is the single most common
chronic childhood disease—five times more common than asthma; children lose 51 million
school hours annually due to oral health related illnesses. Among older adults poor oral health
is associated with pain, loss of teeth, poor nutrition, increased risk for systemic conditions and
serious morbidity and mortality in the case of oral cancer. The projected aging of the US
population coupled with the increasing number of adults retaining their teeth is creating an
unprecedented need for oral health care among older adults.
The burden of oral health problems is particularly severe in vulnerable populations. Poor
children suffer twice as many dental caries as their more affluent peers, and their disease is
more likely to be untreated. These poor-non poor differences continue into adolescence and
adulthood. As is true for other age groups, among older adults the burden of oral disease is
most significantly borne by minorities, the poor, and immigrants. According to the 2000
Surgeon General’s Report on Oral Health, oral health is key to overall health and all health
professions can play a role in reducing the burden of disease.
Over the past decade there has been growing interest in enhancing the role of non-dental
providers, including primary care providers, in the promotion of oral health for all age groups.
Several education and practice initiatives to address gaps in oral health education and practice
have been developed using an interprofessional approach, primarily by national organizations
in the fields of Pediatrics and Family Practice. In contrast, organized nursing has not focused on
gaps in oral health education and competency development. There is a need for greater
interprofessional collaboration and leadership at the national level to develop policies to
support curriculum changes and implementation of interprofessional oral health clinical
competencies for the nursing profession. Expanding nursing expertise in this area may
contribute to improving access to oral health screening and preventive oral health services for
those most at risk for poor oral health.
There are over 150,000 nurse practitioners, 11,000 midwives, and 3.1 million registered nurses
in the United States. Nurses play key roles in a wide range of health care settings and are more
likely than physicians to practice in underserved areas and to care for large numbers of patients
who are uninsured or on Medicaid. The Affordable Care Act has accelerated the timeliness for
the nursing profession to commit to participating in implementation of an interprofessional
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model for oral health promotion and prevention as access to primary care becomes available to
an additional 32 million people in the United States, many of whom are children.
Nurse practitioners and midwives, the majority of who practice in primary care settings, are
perfectly positioned to include oral health assessment, intervention, and appropriate referral in
their clinical armamentarium. Registered nurses, whose scope of practice also includes health
promotion and illness prevention, are qualified to collaborate with nurse practitioners,
midwives, physicians, and dentists to assess and treat oral health issues.
With funding from DentaQuest Foundation and Washington Dental Service Foundation, and the
Connecticut Health Foundation, NYU College of Nursing, in collaboration with key stakeholders,
is developing and demonstrating the impact of a replicable model for implementing and
disseminating a comprehensive interprofessional oral health curriculum in nursing schools
throughout the US, as well as “best practices” for oral health care in registered nurse and
advanced practice clinical settings.
The primary aims of the OHNEP initiative are to:
1) Implement an action plan to obtain licensure, accreditation, and certification policy changes
that support integration of interprofessional oral health related curriculum and clinical practice
competencies
2) Develop a strategy for integrating the interprofessional Smiles for Life oral health curriculum
and oral health clinical competencies in undergraduate and graduate nursing programs
3) Develop a strategy for implementing “best practices” in interprofessional oral health care in
registered nurse and advanced practice nurse clinical settings
4) Disseminate these strategies nationally including nursing programs, healthcare organizations,
primary care settings, and professional organizations.
Over the past two years we have made significant progress in achieving these aims. We
convened the first OHNEP National Nursing Oral Health Summit with 50 representatives from
national nursing organizations responsible for licensure, accreditation, certification and
education (LACE) to facilitate a national oral health agenda. We convened a National Nursing
Oral Health Workgroup to follow-up on the summit action plan and assist with dissemination of
findings from demonstration projects. We have provided faculty development programs for
over 2000 nursing faculty, NPs, Midwives, and Registered Nurses, as well as interprofessional
colleagues including physicians, dentists, dental hygienists, and physician assistants.
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The goals for the Second OHNEP National Oral Health summit are to:
1) Make the scientific case for integrating curriculum related to oral health and its links to
overall health in undergraduate and graduate nursing programs
2) Discuss the population health significance of supporting integration of interprofessional
oral health competencies for the nursing profession
3) Delineate the key role of the nursing profession in building interprofessional oral health
workforce capacity to improve access and improved oral health and general health
outcomes
4) Review lessons learned from interprofessional disciplines that are enhancing oral and
general health competencies through curriculum and policy changes
5) Examine current licensing, accreditation, and credentialing policies related to oral health
and identify gaps and opportunities
6) End the meeting with an action plan and commitments to advance interprofessional oral
health curriculum, “best practices”, and policy changes
Ten years ago the Surgeon General’s Report on Oral Health served as a call to action stating
that all health professions can play a role in reducing the burden of oral disease in America. The
2011 Institute of Medicine (IOM) Reports, Advancing Oral Health in America and Improving
Access to Oral Health Care for Vulnerable and Underserved Populations, reinforce the
importance of oral health and highlight the centrality of the nursing profession in improving
oral health outcomes. One of the recommendations included investing in “workforce
innovations to improve oral health that focus on core competency development, education and
training, to allow for the use of all health care professionals in oral health care”.
The IOM Committee’s vision for oral health care in the United States, “Everyone has access to
quality oral health care across the life cycle”, is perfectly aligned with the New York University
College of Nursing’s Oral Health Education and Practice initiative. The OHNEP initiative is
committed to developing a nursing workforce with the competencies to prioritize oral disease
prevention and health promotion; provide evidence-based oral health care in a variety of
settings; and collaborate in interprofessional teams across the health care system by becoming
key stakeholders in national efforts to reduce oral health disparities across the lifespan.
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