Promoting Oral Health: The Family Physician's Role


Am Fam Physician. 2008 Oct 1;78(7):814-815.

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Poor oral health is a major public health problem in America.1,2 Caries is the most common chronic oral condition of early childhood. Adults often seek medical care because of oral pain, and periodontal disease has been linked to premature birth, diabetes, stroke, and heart disease. In this issue of American Family Physician, Gonsalves and colleagues point out that older adults are at risk of oral infections; tooth loss; and many forms of oral pathology, including cancer.3

Although most Americans have a medical home, many do not have access to regular dental care. Family physicians care for about one quarter of the nation's population4 and are well positioned to reduce the impact of a wide variety of oral conditions, including caries, periodontal disease, tumors, and trauma. This can be accomplished in all age groups through counseling, oral hygiene instruction, screening, and appropriate dental referral. Additionally, having an ongoing relationship with a primary care physician has been independently associated with improved access to preventive dental care.2

Surveys show that 90 percent of physicians support the incorporation of oral health interventions into wellness visits, but 40 percent report receiving no medical school or residency training in oral health.57 Progress is being made, however. Since 2006, oral health education has been a required component of family medicine residency training.

The Society of Teachers of Family Medicine (STFM) Group on Oral Health was formed in 2004 to merge independently developed, peer-reviewed educational materials810; disseminate them as a complete, integrated curriculum; and coordinate future educational endeavors in oral health. The outcome of this collaboration is Smiles for Life: A National Oral Health Curriculum for Family Medicine.11 The curriculum was initially released in October 2005, but has since been significantly expanded and enhanced. The second edition was released in July 2008.

The second edition of the Smiles for Life curriculum consists of seven 45-minute Powerpoint lecture modules; users' guides; and comprehensive, referenced speaker's notes. The modules cover: (1) oral health and its relationship to systemic health; (2) early childhood caries, infant oral health, and fluoride; (3) adult dental health, including caries, periodontal disease, common oral lesions, and endocarditis prophylaxis; (4) acute dental problems, including infections and trauma; (5) oral health in pregnant patients; (6) application of topical fluoride varnish; and (7) the oral examination.

The curriculum also includes videos, pocket cards, personal digital assistant (PDA) applications, resources for further learning, and patient education materials. All resources are available for free at http://www.smilesforlife2.org.

Smiles for Life has become the preferred oral health curriculum in most of the nation's 460 family medicine residency programs, and in at least 30 of the 125 allopathic medical schools. It has formed the basis for statewide physician education initiatives in eight states. Smiles for Life recently received STFM's 2007 Innovative Program Award. Curricular components have been downloaded more than 50,000 times.

Family physicians owe it to patients to be educated about oral health and to incorporate oral health care into their everyday practice. Smiles for Life can help. Reviewing a few Powerpoint modules, downloading a PDA application, and putting patient education materials in examination rooms can have positive short- and long-term effects on the oral and systemic health of patients.

Address correspondence to Alan B. Douglass, MD, at adouglass@midhosp.org. Reprints are not available from the authors.

Author Disclosure: Nothing to disclose.

Editor's note: Drs. Douglass and Maier are cochairs of the STFM Group on Oral Health. Development of the Smiles for Life curriculum was funded by grants from the Washington Dental Services Foundation, Connecticut Health Foundation, South Carolina Department of Health, Oral Health Foundation of Massachusetts, Delta Dental of Kentucky Foundation, Delta Dental of Colorado Foundation, and Central Massachusetts Oral Health Coalition.


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1. Oral Health in America: a Report of the Surgeon General. Rockville, Md.: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000....

2. Lewis CW, Johnston BD, Linsenmeyar KA, Williams A, Mouradian W. Preventive dental care for children in the United States: a national perspective. Pediatrics. 2007;119(3):e544–e553.

3. Gonsalves WC, Wrightson AS, Henry RG. Common oral conditions in older persons. Am Fam Physician. 2008;78(7):845–852.

4. Centers for Disease Control and Prevention, National Center for Health Statistics. National Ambulatory Medical Care Survey. Analysis by the Robert Graham Center, 2004.

5. Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the pediatrician in the oral health of children: a national survey. Pediatrics. 2000;106(6):e84.

6. Lewis CW, Cantrell DC, Domoto PK. Oral health in the pediatric practice setting: a survey of Washington State pediatricians. J Public Health Dent. 2004;64(2):111–114.

7. Krol DM. Educating pediatricians on children's oral health: past, present, and future. Pediatrics. 2004;113(5):e487–e492.

8. Douglass JM, Douglass AB, Silk HJ. Infant oral health education for pediatric and family practice residents. Pediatr Dent. 2005;27(4):284–291.

9. Gonsalves WC, Skelton J, Smith T, Hardison D, Ferretti G. Physicians' oral health education in Kentucky. Fam Med. 2004;36(8):544–546.

10. Mouradian WE, Reeves A, Kim S, et al. A new oral health elective for medical students at the University of Washington. Teach Learn Med. 2006;18(4):336–342.

11. Douglass AB, Gonsalves W, Maier R, et al. Smiles for Life: A National Oral Health Curriculum for Family Medicine. A model for curriculum development by STFM groups. Fam Med. 2007;39(2):88–90.



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