Internal Publications

Haber J, Dole MC, Hartnett E, Savageau JA, Altman S, Kessler JL, and Silk H. 7/2019. “Integrating Oral Health Curricula into Midwifery Graduate Programs: Results of a US Survey.” Journal of Midwifery & Women's Health, 64, 4, Pp. 462-471.Abstract
Midwives are a significant segment of the US maternal and primary health care workforce and play a pivotal role in addressing women's oral health care needs during pregnancy and throughout their life span. The purpose of this research was to assess oral health curricular integration in midwifery programs and examine factors that influence integration and satisfaction with graduates' level of oral health competence.
Savageau JA, Sullivan K, Sawosik G, Sullivan E, and Silk H. 8/2019. “Status of Oral Health Training in U.S. Primary Care Programs: A Qualitative Study to Define Characteristics and Outcomes.” Journal of Dental Education , 83, 8, Pp. 865-877.Abstract
With increasing recognition of the important relationship between oral and systemic health, non-dental health professions schools and programs are now teaching their students about oral health in various ways. This study built on surveys of medical schools, primary care residency and fellowship programs, and other health professions programs conducted by the authors in 2017, which found some had made significant progress in integrating oral health into primary care training, while others lagged behind. The aim of the current study was to better understand the characteristics and climate of oral health education in non-dental health professions schools by conducting interviews with leaders of programs who had self-identified in the surveys as having a robust oral health curriculum. Hour-long interviews were conducted between October 2017 and March 2018 with 31 program directors or deans of medical specialty and allied health professions programs using a semi-structured interview guide. These interviewees were from 13 health disciplines. The coding of interview transcripts identified seven major themes: motivations to develop an oral health curriculum; rationale for curriculum topics covered; best aspects of the curriculum; evaluation and assessment strategies; relationships with dental providers and residents and dental hygienists; barriers and challenges; and advice and lessons learned. The interviewees reported a strong belief that oral health is an important health topic. Key elements that interviewees identified as helping them build robust oral health programs in their primary care curricula were the following: having an oral health champion; having some funding; building relationships with dental professionals; using local, state, and national resources; using curricular materials from existing sources; incorporating skills-based sessions; taking an IPE approach; and making oral health part of what the program already does. These findings should be useful for primary care schools and programs that are beginning to add oral health to their curricula and those seeking to improve their existing oral health education for their students.
Dalal M, Savageau JA, Silk H, and Isong I. 6/2019. “Oral Health Training in Pediatric Residency Programs: Pediatric Program Directors' Perspectives.” Journal of Dental Education , 83, 6, Pp. 630-637.Abstract
A 2011 study evaluating oral health training in pediatric medical residency programs highlighted opportunities to improve residents’ oral health competence. The aim of this 2017 follow-up study was to assess progress since 2011 in promoting development of pediatric residents’ oral health competence. A survey was sent to all 281 pediatric and med-peds medical residency program directors to assess the structure and determinants of oral health training in their programs. A total of 110 program directors responded to the 2017 survey (response rate 40%). Just over half (54%) of the respondents reported that their residents received one to two hours of oral health education during residency, while 38% received ≥3 hours (compared to 47% and 48%, respectively, in 2011). There was improvement in the proportion of respondents reporting that their residents integrated fluoride varnish application training in 2017 vs. 2011 (83% vs. 43%; p<0.001). Departmental support for integrating oral health and having an oral health elective were significantly associated with satisfaction with residents’ oral health competence. These findings suggest that pediatric and med-peds medical residency programs have improved their residents’ oral health awareness and training through integration of at least one hour of oral health education and fluoride varnish training. However, given deficiencies in program structure and uneven perceptions of residents’ oral health competence found in this study, opportunities remain to improve pediatric residency programs’ oral health curricula.
Kathleen Dwiel, Martell Hesketh, Jessica Alpert, Jacqueline Cellini, Kristen Goodell, Russell Phillips, and Erin Sullivan. 2019. “The Impact of Oral Health Training for Primary Care Clinicians: A Systematic Review.” STFM Journals, 51, 3, Pp. 251-261.Abstract

BACKGROUND AND OBJECTIVES: Despite recent improvements in access to health care, many Americans still lack access to dental care. There has been a national focus on interprofessional education and team-based care to work toward the integration of services including dental care into primary care. The purpose of this systematic review is to understand the impact of implementing oral health curricula in primary care training on measurable changes in primary care practice.

METHODS: Researchers utilized a two-step process, first a scoping review and then using the PRISMA systematic review method to develop inclusion and exclusion criteria around audience, curricula, and outcomes to identify practice change due to oral health education curricula delivered in primary care clinician training. Researchers assessed titles, abstracts, and full texts and abstracted data for the review.

RESULTS: Researchers reviewed 2,749 articles and found 12 meeting the systematic review criteria. The reported outcomes and evaluations differed for each of the 12 studies identified. Over 40% utilized self-reporting. Seven of the included studies tracked outcomes by checklists embedded in electronic health records changes to well-child visit forms, or chart audits, one of which also tracked billing reimbursements.

CONCLUSIONS: Oral health curricula for primary care clinicians are too heterogeneous to determine the effects on practice behavior. Future research should focus on developing a clear evaluation framework for measuring practice level changes in primary care settings as a result of implementing an oral health curriculum.

Lisa Thompson, Tien Jiang, Judith Savageau, Hugh Silk, and Christine Riedy. 1/29/2019. “An Assessment of Oral Health Training Among Geriatric Fellowship Programs: A National Survey.” Journal of American Geriatrics Society.Abstract
Oral health (OH) has profound effects on the overall health of elderly people. While oral disease is prevalent in the geriatric population and access to care is a major issue, it is unclear the extent of OH training among US geriatric fellowship programs. A 19‐item electronic survey was sent to all 148 accredited geriatric fellowship training programs via the Association of Directors of Geriatric Medicine. Directors were asked about hours of trainings, barriers, and evaluation of trainees among other topics. Univariate and bivariate analyses were performed. Seventy‐five directors completed the survey (51% response rate). Sixty‐three percent (46/73) report their fellows receive 1 to 2 hours of OH instruction (ie, lectures, workshops) during their training. Almost a quarter (23%; 17/73) reported 0 hours of OH content. Only 17% (13/75) have clinical experiences in a dental setting. Barriers to more OH education include competing priorities or lack of time (57%; 43/75), lack of faculty expertise (55%; 41/75), and no clear geriatric national educational competencies (44%; 33/75). Programs with an OH champion or dental school/residency affiliation had more hours of OH instruction. Geriatric fellowships appear to need more OH training, which could be achieved by creating OH champions and connecting fellowships with dental schools/residencies. Barriers could be overcome by exposing fellowships to existing resources and creating national competencies.
Dolce MC, Haber J, Savageau JA, Hartnett E, and Riedy CA. 11/30/2018. “Integrating oral health curricula into nurse practitioner graduate programs: Results of a US survey.” PubMed, 30, 11, Pp. 638-647. Publisher's VersionAbstract


Nurse practitioners (NPs) are a significant segment of the US primary care workforce and have a pivotal role in improving access to oral health (OH) care. The purpose of this research was to assess OH curricular integration in primary care NP programs and to examine factors that influence integration and satisfaction with graduates' level of OH competence.


A cross-sectional, national survey of NP programs (N = 466) was conducted using an electronically distributed 19-item, self-administered questionnaire. Data analysis included univariate, bivariate, multivariate statistics, and logistic regression modeling.


The large majority of pediatric, family, and adult-gerontology primary care programs are educating NP graduates about OH. Significant factors promoting integration and satisfaction with graduates' level of competence included the presence of a faculty champion and routine teaching by a dental professional or nondental OH expert.


With adequate OH education, NPs are ideally positioned to integrate OH and primary care services in practice, thereby, improving access to OH care.

Hugh Silk, Judith A. Savageau, Kate Sullivan, Gail Sawosik, and Min Wang. 6/2018. “An Update of Oral Health Curricula in US Family Medicine Residency Programs.” Family Medicine, 50, 6, Pp. 437-443. Publisher's VersionAbstract

BACKGROUND AND OBJECTIVES: National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011.

METHODS: Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics.

RESULTS: Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates’ level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001).

CONCLUSIONS: Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.

Oral health (OH) has received increased recognition for almost 2 decades as an important health topic. Dental caries cause local pain and infections, have important social implications such as missed school and failure to gain employment, and can even lead to death.1 In addition, periodontitis influences systemic illness such as heart disease, pregnancy outcomes, and autoimmune disorders.2 In fact, one study shows that dental treatment of periodontitis alone can reduce hospitalizations for diabetic patients by 39%.3

In 2000, the Surgeon General Report stimulated interest in oral health.4 David Satcher concluded with a clear statement, “You are not healthy without good oral health.” In 2003, another report, A National Call to Action to Promote Oral Health, encouraged physicians to address oral health in their patients.5 By 2005, family medicine program directors (PDs) were acknowledging the importance of OH. In a nationwide study, 95% felt it was their responsibility to train residents to identify oral health problems; 87% indicated they would implement modules if they existed, and a 4-hour curriculum was the average amount of time PDs felt their residents should devote to OH training.6 Also in 2005, family doctors formed a Group on Oral Health at the Society of Teachers of Family Medicine (STFM), and created a curriculum called Smiles for Life: A National Oral Health Curriculum funded by DentaQuest Foundation and others.7 In 2011, family medicine residency PDs were resurveyed. While only 72% of PDs now felt it was important to address OH issues, 96% of programs had some OH curriculum. And while only 45% had 3 or more hours of OH training, 74% were aware of Smiles for Life (SFL) and 22% were using it for teaching.8

Meanwhile, national oral health efforts continued to evolve. In 2011, the Institute of Medicine (IOM) issued two reports on this subject amplifying that nondental health professional training programs should have well-defined OH competencies and curricula.9,10 The Accreditation Council for Graduate Medical Education (ACGME) added oral health care requirements for family medicine in 2006 with the aim of promoting increased resident training in oral health11 (but by 2015, they removed them when streamlining requirements).12 Meanwhile, other specific movements have positively affected family medicine. Qualis Health made it a priority for OH to have a key role in medical homes and piloted systems approaches in Federally Qualified Health Centers (FQHCs).13,14,15 STFM added oral health topics in the Family Medicine Residency Curriculum Resource and the American Academy of Family Physicians created an Oral Health Member Interest Group.16,17 Finally, in 2014 the US Preventive Services Task Force (USPSTF) designated the application of fluoride varnish by medical providers a level B recommendation for children under the age of 6 years,18 which led to all 50 states reimbursing pediatric primary care providers to perform fluoride varnish.19

Our study assesses the impact over the last 5 years of the above-noted efforts and the influence on oral health care training in family medicine residency programs nationwide. We are unaware of any other studies of this impact over this time period. We aimed to learn what OH topics family medicine residency programs are currently teaching, how much they are teaching, how they evaluate this teaching, influences on the quality and quantity of curriculum, and resource materials being used. Our research is a project of the recently formed Center for Integration of Primary Care and Oral Health (CIPCOH), a joint endeavor of the Harvard Schools of Medicine and Dental Medicine and the University of Massachusetts Medical School’s Department of Family Medicine and Community Health.

External Publications

Improving Access to Dental Care for Pregnant Women through Education, Integration of Health Services, Insurance Coverage, an Appropriate Dental Workforce, and Research. American Public Health Association. 2020.

John Ahern, Lisa Simon, Jane Barrow, and Hugh Silk. 9/2020. “Building bridges with dentistry: NICE guideline supports collaborative practice between GPs and dentists.” British Journal of General Practice, 70, 698. Publisher's Version

Sung Eun Choi, Lisa Simon, Christine Riedy, and Jane Barrow. 8/28/2020. “Modeling the Impact of COVID-19 on Dental Insurance Coverage and Utilization.” Journal of Dental Research. Publisher's Version

Benzian H, Beltrán-Aguilar E, Mathur MR, Niederman R. Pandemic Considerations on Essential Oral Health Care. Journal of Dental Research. 2020.

Haber J, Hartnett E, Allen K, Crowe R, Roitman J, Feldman L, Fletcher J, Ng G. Attaining interprofessional competencies by connecting oral health to overall health. Journal of Dental Education. November 2020.

System Transformation: A Three Domain Framework to Innovating Oral Health Care. DentaQuest [Internet]. 2020.

Simon, L., Singh Dhaliwal, G., Liu, C.-H., Sharma, P., Thomas, S., Bettag, S., … Nalliah, R. Characteristics of Patients Discontinuing CareDentistry Journal7(2), 31. (2019)

Weinstein, A. R., Reidy, P. A., Simon, L., Makosky, A., Merson, J., Williams, R., … Cohen, M. J. Creating interprofessional learning in practiceThe Clinical Teacher. (2018)

Simon, L., Tobey, M., & Wilson, M. Feasibility of integrating a dental hygienist into an inpatient medical team for patients with diabetes mellitusJournal of Public Health Dentistry, jphd.12320. (2019)

Hyewon Lee, Natalia Chalmers, Avery Brow, Sean Boynes, Lilly Engineer, Olivia Croom, Mark Doherty, and Michael Monopoli. 11/29/2018. “Person-centered care model in dentistry. BMC Oral Health.