Approaches to Curriculum Development in Nutrition and Dental Education

1. Registered Dietitian (RD)
Clinical setting
• Conduct intra-/extraoral screening and cranial nerve screening as part of nutrition-focused physical exams (NFPE)
• Integrate oral health screening as a component of NFPE (i.e., cranial nerve function, occlusion, edentulism, masticatory ability, swallowing, salivary adequacy)
• Recognize oral manifestations of systemic diseases and provide patients with guidelines to maximize oral intake
• Confer with and refer patients (via consults) to oral health care professionals (OHCP) for management of oral symptoms of diseases and/or risk factors for oral diseases
• Consult with OHCPs in interpretation of oral screen findings and planning in the long-term care setting
Community setting
• Establish partnerships with OHCPs in community and private practice settings
• Develop and implement collaborative oral health and nutrition screening/education programs in schools, worksites, and health maintenance organizations
• Promote collaborative education on nutrition and oral health among dietetics and OHCPs
• Develop nutrition education messages that encourage oral health
• Promote oral health in school and community nutrition programs
Research setting
• Promote collaborative nutrition and oral health research initiatives
• Design and conduct nutrition/diet components of oral health research initiatives
• Identify and support integration of oral health issues (e.g., screening, disease, management, education) as a component of nutrition research
2. Oral health care professionals
Clinical setting
• Include diet and nutrition screening, education, and referral for oral infectious disease prevention/control, optimal masticatory function, and management of other oral diseases/treatments as a component of comprehensive dental care
• Collaborate with RDs in delivery of MNT and provision of oral healthcare in long-term care settings
• Provide diet and nutrition guidelines for health promotion and disease prevention to patients and provide guidelines for diet to maximize oral intake
• Consult with and refer patients (via consult) to RDs for management of nutrition risk caused by compromised oral health (e.g., caries, immunosuppressive disorders, xerostomia, diabetes, oral surgery, cancer)
Community setting
• Establish partnerships with RDs in community and private practice settings to promote nutrition/diet screening and education in dental practice
• Develop and implement collaborative oral health and nutrition screening/education initiatives in schools, worksites, and healthcare organizations
• Promote collaborative education on nutrition and oral health among RDs and OHCPs
• Develop oral health messages that integrate nutrition and diet education
• Promote diet and nutrition as a component of school and community oral health programs
Research setting
• Promote collaborative oral health and nutrition research initiatives
• Design and conduct oral health component of nutrition/diet research initiatives
• Identify and support integration of nutrition topics as a component of oral health research as appropriate
Adapted from ref [29]
Various approaches to achieve this paradigm have been advocated by the IOM [2], Pew Health Professions Commission [7], Lancet Commissions [1] and the World Health Organization (WHO) [8] for almost two decades. The 1998 Pew Health Professions Commission Report recommended that relationships between dentists and allied health professionals be developed and expanded and that interdisciplinary competence be required of all health professionals [7]. The 2010 Lancet Commissions report on Education of Health Professionals for the twenty-first century: A global independent commission promoted a “redesign of professional health education” (p5) that addresses the shifting economic, health, environmental, and behavioral environments that challenged “the tribalism of the professions—i.e., the tendency of the various professions to act in isolation from or even in competition with each other” (p5) which is similar to the call in the late 1990s to breakdown the ‘silos’ of health professions and practice and promote team-based care [1]. Fostering the core knowledge starting on the preprofessional level is a critical first step to finalize the recommendations made by these groups. Basic levels of care skills, including screening and risk identification and referral for intervention, are essential for health professionals [2] as clients seek comprehensive health care. Consistent with this approach, the IOM supports comprehensive training of dental professionals to ensure that they can “assess and treat the whole patient, not just the mouth” [2] as well as training non-OHCPs with a core of competencies in oral screening and referral [2]. The 2011 IOM report recommends that accrediting agencies for health professions education integrate these competencies into accreditation standards and require compliance [2]. The 2011 WHO Report, Transforming Health Professions Education addresses three distinct “dimensions of the challenge” (p4), quantity, quality, and relevance that are at core components of the transformation of health professions education which includes dentistry [2]. Change and transformation have been very slow [4]; this chapter addresses feasible approaches to integrating interprofessional education and training.

Nutrition in Dental Education

Dental accreditation standards and the 2010 Competencies for the New General Dentist (ADEA) do not specify predoctoral nutrition education competencies [9]. Although the 1990 standards for nutrition in dental education specifically addressed knowledge of basic nutrition, the role of diet and nutrients in health and oral diseases, and nutrition counseling as it relates to oral health, standards since the late 1990s have focused on broad-based competency statements and emphasized technical skills. Throughout several areas of the competencies and standards, diet and nutrition content is implied in risk assessment and patient treatment planning functions. The biomedical sciences standards do not address specific sciences; rather, they must “ensure an in-depth understanding of basic biological principles, consisting of a core of information on fundamental structures, functions and interrelationships of the body systems” [10]. Similarly, “in-depth information” must be provided to develop understanding of oral health, oral disease, oral epidemiology, and the role of diet and nutrition in the etiology, diagnosis, prevention, and treatment of oral disease. Knowledge of principles of nutrition and diet and their clinical application in practice is implied throughout the document [9] because it provides the underpinning for achievement of several of the competencies. The accreditation standards for the majority of advanced specialty postdoctoral education programs vary in the specificity with which they address nutrition. The specialty postdoctoral program in periodontics does address knowledge of “principles of nutrition, especially as they relate to patient evaluation, disease processes, and wound healing” [11]. The effects of proper diet nutrition, fluoride therapy, and sealants in the prevention of oral disease is specifically addressed in the pediatric dentistry postdoctoral specialty program, along with practices that include patient management of children with metabolic disorders and with special needs [10]. Other postdoctoral programs include competencies focusing on management of medically compromised patients, those with chronic and terminal diseases, and those who have undergone surgical interventions. Implied in these required competencies is knowledge of diet and nutrition as they relate to comprehensive dental management [11, 12]. Interprofessional competencies are likewise supported by the Commission and Institute reports cited in this chapter. The Commission on Dental Education Standards published in 2010 includes a greater focus on humanitarian and technological issues and an increased emphasis on community service, interprofessional education, and student research opportunities [13]. Nutrition is integral to each of these areas.
Historically, the focus on nutrition education in dental schools was on oral infectious disease management. Although there is a lack of published research on the number of hours of nutrition and dietetics in the dental curriculum for the twenty-first century, nutrition topics in dental school in this century are increasingly addressing diet and nutrition in regards to health promotion, weight screening and chronic disease screening, control and referral in part in response to shifts in the practice arena. The 2013 American Dental Association “Call to Action for Oral Health” [14] calls for OHCPs to be advocates for disease prevention and health lifestyles inclusive of providing nutrition guidelines.
The absence of sufficient published data on how nutrition and diet are addressed in dental education in the USA and globally merits attention [15]. While individual school data known to these authors are described herein, quantifiable data are needed. Some dental schools include nutrition as a separate course whereas others integrate lectures, assignments, and seminars into existing courses in biochemistry, prevention, infectious diseases, clinical dentistry, health promotion, oral medicine, and oral surgery. Others, notably the Rutgers School of Dental Medicine, University of Nevada at Las Vegas Dental School, University of Iowa Dental School, and New York University’s College of Dentistry also include clinical competency requirements in screening, diet assessment, and counseling. These combined didactic and clinical requirements provide students with the opportunity to transfer knowledge learned in the didactic courses into practice applications [16]. Figure 20.1 provides a model of how dental schools can integrate nutrition topics addressed in Table 20.2 into their didactic and clinical curricula.

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Fig. 20.1

Model for integration of nutrition into didactic and clinical courses in dental school
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Nov 6, 2015 | Posted by in General Dentistry | Comments Off on Approaches to Curriculum Development in Nutrition and Dental Education
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