1. Fulmer, Terry PhD, RN, FAAN

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All of us can agree that we need new paradigms to examine methods of improving the health of the public. The New York University College of Nursing at the College of Dentistry has taken on the challenge of innovation by becoming the first university to integrate the unique strengths and complementarities of nursing and dentistry and develop a wholly new model of care. How can we better capture untapped synergies in the healthcare system in a way that focuses on health promotion and disease prevention? The Institute of Medicine's report "Crossing the Quality Chasm: A New Health System for the 21st Century" (2001) underscores the need for evidence related to interdisciplinary teaming, new ways to deliver care, and challenges for a better healthcare system: (1) re-engineered care processes, (2) effective use of information technologies, (3) knowledge and skills management, (4) development of effective teams, and (5) coordination of care across patient conditions, services, and sites of care over time. When reading this report, how many of us even considered dental care as a part of the solution?


At our College, we view nursing and dentistry, both primary care practices, as natural partners for creating new models for better healthcare. The College of Nursing faculty practice at the College of Dentistry has the opportunity to have an impact on more than 300,000 patient visits a year currently coming to the College of Dentistry. Because approximately 17 million people in the United States annually see a dentist but do not see a physician and more than 40 million individuals currently do not have health insurance, a model in which patients seeking oral healthcare can be immediately referred to nurse practitioners for systemic healthcare seems like an excellent solution to close gaps in access to care (Spielman, Fulmer, Eisenberg, & Alfano, 2005). Our nurse practitioners provide ongoing primary care, immunizations, cholesterol screening, and other health promotion/disease prevention activities to these dental patients and refer them for specialty care as needed.


As nurses, we see the connection between oral health and systemic health; we know that our patients cannot be comfortable when they have oral pain or discomfort. Recently, the oral health/systemic health connection received long overdue attention because researchers have linked oral diseases to many systemic health problems such as premature births and cardiac valve disease. From the acute care perspective, nurses know that it is essential to assist patients with dry, cracked lips, dirty teeth, and leftover food in the oral cavity after eating, but few resources or guidelines for practice are really available. As hospitals have cut back on their budgets, some have chosen to eliminate oral healthcare supplies from stock carts, leaving nurses with poor options for oral cleaning/health interventions. We have much to learn about appropriate, evidenced-base care protocols for frail and critically ill patients.


To date, there has been little dialogue between nursing and dentistry; New York University College of Nursing is changing that and seizing this opportunity to share knowledge for better patient care. When individuals visit their dentist, why not use that opportunity to check their blood pressure, blood sugar, and cholesterol and refer them for further care if necessary? These ideas can be unsettling to a healthcare system steeped in tradition and used to existing systems. To anticipate the aging of our population and the crisis in healthcare workforce shortages, however, we all need to think differently. At New York University, we thrive on new paradigms that advance the opportunity to create visionary new ideas. We appreciate the opportunity to participate in this important special issue of MCN, another example of our devotion to fostering the collaboration between nurses and dentists to improve the health of Americans. We look forward to your feedback.




Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.


Spielman, A. I., Fulmer, T., Eisenberg, E. S., & Alfano, M. C. (2005). Dentistry, nursing, and medicine: A comparison of core competencies. Journal of Dental Education. 69, 1257-1271. [Context Link]