Advancing Oral Health Research: A Conversation with Sarah B. Hoerler, RDH, MS

Sarah B. Hoerler, RDH, MS, is a dental hygienist in the Department of Dental Specialties, Division of Periodontics and an assistant professor of dentistry at the Mayo Clinic in Rochester, Minnesota, and a dental hygiene educator at Metropolitan State University in Minneapolis, Minnesota, and Rochester Community and Technical College. She has 18 years of clinical experience and has focused her research efforts on the oral healthcare of pregnant women and implant survival and/or pathology in relationship to consistency of dental hygiene therapy.

Highly regarded in the field, Hoerler received the Irene Newman Outstanding Clinician Award from the American Dental Hygienists’ Association in 2023. She is admired by her students and colleagues for her knowledge, clinical skills, compassion, and determination to meet the needs of all patients. She has also served on the Mayo Clinic Enterprise Oral Health Multidisciplinary Workgroup as a dental hygiene advocate, working to develop and implement an oral hygiene initiative to prevent hospital-acquired pneumonias. Hoerler recently published a research article on the topic in the highly regarded journal Critical Care Nurse with a nurse colleague. She kindly discussed her work with Sunstar Ebrief.

• What motivated you to become a dental hygienist at Mayo Clinic?

My passion for promoting optimal oral hygiene and overall health led me here. Walking through the doors of Mayo Clinic nearly two decades ago, I envisioned unique career opportunities, unaware as to where the journey would lead. As research increasingly supports the oral-systemic connection, integrating medical and dental care is crucial for delivering comprehensive patient care. While treating a diverse patient population with complex medical needs at Mayo Clinic, many patients undergo multiple surgical procedures, requiring hospitalizations. During their subsequent dental hygiene visits, many of these patients reported a recurring theme during their hospital stays: neglect of oral hygiene. This issue became personal when family and close friends faced similar challenges during their hospital stays.

Mayo Clinic is a unique institution that incorporates dental professionals into its overall healthcare setting. Traditionally, nurses or other healthcare providers have provided oral hygiene in hospitals. However, dental hygienists possess the specialized knowledge and practical experience to deliver high-quality oral hygiene to high-risk patients in these settings. Although evidence is limited, studies indicate that oral hygiene interventions by dental professionals can reduce mortality from hospital-acquired pneumonia and lower the prevalence of respiratory bacteria. Furthermore, having dental hygienists in hospital units allows nursing staff to concentrate on other critical patient care needs.

• What sparked your interest in studying ventilator-associated pneumonia?

Ventilator-associated pneumonia (VAP) is a critical concern in healthcare because it significantly affects patient outcomes, particularly in hospital settings. Poor oral hygiene is a known risk factor for developing VAP in intubated patients, making this area of study essential for preventing complications and enhancing patient care. Recognizing the close connection between oral hygiene and the reduction of VAP, medical-dental initiatives are starting to emerge.

Previously, I was appointed to the Mayo Clinic Enterprise Oral Health Multidisciplinary Workgroup, which aimed to develop and implement an oral care initiative to prevent non-ventilator hospital-acquired pneumonia (NV-HAP). Research has shown that comprehensive oral care is the most modifiable intervention to help prevent NV-HAP. According to evidence-based nursing guidelines, patients should receive oral hygiene twice a day, ideally four times a day. For patients at risk of aspiration, oral care should be performed five times a day using a suction toothbrush.

As part of the workgroup’s mission, a comprehensive oral hygiene plan was developed. This plan included standardizing oral hygiene supplies to those with the American Dental Association Seal of Acceptance, documenting oral hygiene in the patient’s electronic health record, and creating oral hygiene educational tools. Despite the workgroup’s efforts, maintaining oral hygiene compliance faces numerous challenges due to the high acuity of patients’ needs.

• Please share about your experience collaborating with other health professionals.

I am honored to be a part of an institution modeling its mission, “To inspire hope, and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.” I’ve observed the strong commitment of medical colleagues to enhance the oral hygiene of hospitalized patients, but they encounter significant barriers. The two main barriers are lack of time and the prioritization of patient care based on acuity, which often demotes oral hygiene to a lower priority.

To address this, a pilot program was initiated, embedding a dental hygienist into a cardiovascular surgical intensive care unit with the sole purpose of providing high-quality oral hygiene to patients every 2 to 4 hours. This initiative fostered collaboration with medical colleagues and heightened awareness of the importance of quality oral hygiene. The success of this collaboration has led to the development of interdisciplinary dental hygiene student rotations within the hospital setting. This opportunity not only enhances the oral hygiene of hospitalized patients but also provides dental hygiene students with experiential learning. They gain confidence in managing a variety of medical conditions and exposure to diverse oral conditions and prostheses while promoting comprehensive patient care.