Putting the mouth in primary care

An interprofessional team of physician assistant and nurse practitioner graduate students at the Betty Irene Moore School of Nursing at UC Davis develop iFloss ― an innovative approach to make oral health preventive care more accessible.

Poor oral health correlates with many systemic ailments, such as cardiovascular and gastrointestinal diseases. Yet students in most health care professions report that they lack the necessary education and training to conduct basic oral exams. Keith Byrd, a physician assistant student at the Betty Irene Moore School of Nursing at UC Davis, set out to document the issue and spark a new enthusiasm for the topic in UC Davis student-run clinics.

“I was just amazed in doing research that most schools don’t provide much information about oral health, and those that do, it’s very minimal,” Byrd explained. “This presents a big problem. Sometimes these oral manifestations are secondary to medical problems that go unchecked. The elements are interconnected.”

Byrd recognized that UC Davis student-run clinics offer a real-world learning environment to incorporate an oral health awareness program. These clinics and their physicians train UC Davis medical students in delivering primary care services while simultaneously improving access to care in underserved communities. Research indicated only two of the seven clinics offered oral health services. So, working with his project chair, Gerald Kayingo, he developed a teaching module, including a 3-hour didactic training with medical students on oral health and a hands-on training Dental Day in clinics.

“The whole point was to get the students encouraged enough to see the value in continuing such a program,” Byrd said. “The patients thought it was great. It prompted conversations beyond just their exams and the patients’ excitement promoted interest in driving the program further.”

Confronting implicit biasPhysician assistant student Keith Byrd, back left, partnered with fellow graduate students to develop an innovative interprofessional project focused on oral health.

“In alignment with the school's vision to advance health, a primary goal of the physician assistant program is to improve the availability of culturally relevant primary care to underserved populations and educate clinicians to deliver care as members of health care teams,” added Kayingo, director of the physician assistant program. “Keith’s project on oral health in the underserved communities of Sacramento exemplifies this mission.”

Byrd collected pre- and post-course evaluations of both the oral health seminar and Dental Day events. Byrd, other participants and dental professionals determined project successes and missteps. The revised program is now ready for dissemination and future testing of its effectiveness.

“The long-term goal is to produce a cadre of oral health care professionals with a skill set to improve oral health awareness in underserved communities of California,” Kayingo said.