Paul Hoffmann , administrative director of community clinics and co-investigator for both grants explains , “ This program is designed to impact the interconnected social determinants of health .”
Educating for the future
The new focus on a patient-centered whole health model also means that new practitioners will need to be educated for the future . The five-year grant allows TAMBCD to make impactful changes to dental education by re-designing the Dental Public Health residency program with a new emphasis on interprofessional health . The graduate program , which once required a master ’ s degree in public health in order to enroll , now allows select residency students to pursue a M . P . H . in combination with residency training . This expansion benefits all pediatric dentistry residents , including those who do not intend to pursue the M . P . H . The transition will begin with rotations at North Dallas Shared Ministries and gradually expand to all of the College ’ s communitybased training centers .
As this new model of care emerges , the health needs of the most vulnerable patients will finally be met more effectively and dental students will be prepared to provide the care that is needed , not in isolation , but as part of a professional whole-health team .
Putting patients at the center of interprofessional care
For patients with orofacial clefts , the interprofessional model overcomes a myriad of obstacles to quality care .
Although the stereotypic image of a patient with orofacial cleft is that of a young toddler , the exceptional medical and dental needs of individuals who were born with cleft lip and palate do not always end in childhood . Even after treatment , they may continue to have swallowing complications , speech difficulty , and psychosocial concerns . Medicare is cut off at age 19 , which puts necessary care out of reach for many patients once they are officially classified as adults . The lifetime medical cost for a child with an orofacial cleft hovers around $ 100,000 .
Survey data from orofacial cleft patients is now being collected as a foundation for a proposed cleft and craniofacial clinic at TAMBCD that would serve adults in collaboration with neighboring hospitals and health education programs . The intent is to coordinate half-day clinic sessions at TAMBCD twice a year , supported by expertise from restorative sciences , oral and maxillofacial surgery and orthodontics residents and faculty , as well as plastic surgeons , speech therapists and social workers .
All human fetuses have a cleft lip and palate in the earliest days of development . When growth proceeds normally , the clefts fuse together between the 6th and 11th week of pregnancy . If one or both of these clefts fuse incompletely , babies are born with a craniofacial anomaly known as an oral cleft .
Orofacial clefts are one of the most common birth defects . On an average day in the U . S ., about 20 newborns enter the world with an orofacial cleft . In North Texas , one out of every 570 babies is affected by this condition . Up to 13 percent of cases involve cooccurring birth defects .
Babies with orofacial cleft have varying degrees of anatomical defect , ranging from a small malformation in the lip to a large separation of the palate . These children usually require several surgical procedures to normalize appearance and improve breathing , hearing , and speech and language development . Many need additional surgical procedures as they grow , and require long-term follow up .
Children born with orofacial clefts can often benefit from other types of treatments and services , such as special dental or orthodontic care or speech therapy . The American Cleft Palate - Craniofacial Association recommends that a child with cleft lip or palate should be treated by a multidisciplinary craniofacial team including an otolaryngologist , plastic surgeon , oral surgeon , speech pathologist , pediatric dentist , orthodontist , audiologist , geneticist , pediatrician , nutritionist , and psychologist .
Children with orofacial clefts require coordinated multidisciplinary services throughout childhood and adolescence . They sometimes have hearing problems resulting from frequent ear infections caused by fluid that builds up in the middle ear due to improperly formed Eustachian tubes . This can be addressed by an otolaryngologist , who may place tubes to drain the fluid . If a cleft involves the jaw , the growth of teeth and jaw alignment are often affected . In this case , evaluation and treatment by a pediatric dentist or orthodontist may be necessary . Severe clefts can interfere with eating , speaking , and breathing . When normal breathing is difficult because of palate and jaw malformations , surgery and oral appliances may be required . If feeding and speaking are impacted , a nutritionist and speech therapist who specialize in swallowing may be helpful .
In the past , orofacial cleft patients and their families would travel to appointments with numerous independent specialists in different locations , accruing hundreds of visits across a lifetime . The innovative approach taken by the Pediatric Plastic and Craniofacial Surgery Team at Children ’ s Medical Center of Dallas treats cleft lip and palate more efficiently and effectively by making patients the literal center of leading-edge interprofessional care . Patients come to CMC for outpatient sessions , during which a bevy of specialist providers rotate through to see and evaluate each patient individually , and then work closely as a team to develop a treatment plan .
The adult cleft and craniofacial clinic at TAMBCD would allow residents , who are already involved in caring for pediatric cleft patients at CMC , to come together and provide grafts , dental bridges and lip and nose surgery revisions for adult cleft patients as part of an interprofessional team .
This innovative model effectively turns the circle of care inside out , repositioning patients at the center . At the same time , dental students are receiving hands-on educational experience that will prepare them for the future . The change yields an impressive reward that benefits both patients and practitioners who seek to provide the best possible care .
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