1. Gennaro, Susan DSN, RN, FAAN

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Popular culture abounds in songs about smiles. We are told to "smile though your heart is breaking." We reminisce about lost love and the "shadow of your smile." We are heartened to know just what might be hiding in our pocket that belongs across our face, that we keep very close to us in a most important place (in case you cannot guess it, if you guess a long, long while, I could take it out and put it on and, as the song informs us, it would be a great big smile).


Our interest in smiles is not limited to song. We have all been admonished about how many more muscles it takes to frown than to smile. The implication of this caution is that smiling is energy saving and much more pleasant for everyone than frowning.


Smiles are important to us because they communicate our mood to the world and even tell something about our personality. They let people know if we are optimistic or pessimistic, reserved or open. They are also an important part of our appearance. Who hasn't chuckled at the unsuspecting person with a piece of colorful food stuck in his or her teeth? Although we all respond to a warm smile, as nurses, unfortunately we don't always look at what is behind that smile to assess oral health. As a nurse I was never taught to do a simple oral assessment. I relegated preventative oral health care to dentists and dental hygienists without ever realizing that poor oral health could increase my patients' risk for developing chronic diseases. I did not routinely look for oral lesions, assess gum status, or ensure that my patients had teeth that were able to chew and ensure adequate nutrition.


As a perinatal nurse, I did not know when pregnant women should seek dental care and I did not realize that periodontitis may be related to poor pregnancy outcomes. When I cared for patients who were hospitalized, I was glad to give them those unpleasant lemon glycerin swabs but I did not provide much other oral care. I never realized that a lack of oral care could lead to diseases such as ventilator-dependent pneumonia. I had no idea that women were more likely to suffer from dry mouth than men, and I certainly did not know how to spell xerostomia (dry mouth) much less how I could help patients decrease the unpleasant side effects of this condition. As a mother, I understood the importance of taking my children for regular dental visits. However, I had no idea that by cleaning up their face with a tiny bit of my own saliva (which I only did in emergencies when no other fluid was available and they had just managed to smear something across their face a nanosecond before meeting someone new), I was colonizing their mouth with what was growing in my mouth. When my children grew to be adolescents, I understood that I needed to encourage them to work on their oral hygiene, and I certainly spent a lot of time taking them to the orthodontist. But I never stopped to think about ensuring that they were not having oral health problems related to tobacco use or oral sex. Again, I was more involved in appearance (a nice smile) than health (performing adequate oral health assessments so that I could also engage in health promotion and risk reduction). I did not realize that oral health is an integral part of systemic health.


I am heartened by the attention that oral health is now getting both from a policy perspective and in new practice models of nursing and dental collaboration. I hope that you read all of the articles in this special issue of MCN because I believe I am not alone as a nurse in my past history of undervaluing oral health. Forget about worrying about the "shadow of your smile." I want us all armed to the teeth with knowledge about oral health so we can take care of our patients' oral and systemic health needs. Now that would really be something to make us smile.