Oral health is integral to overall health yet remains largely absent from family medicine training. Fewer than 10% of family medicine residency programs include oral health in their curricula, a missed opportunity for early detection and intervention.¹⁻³ This gap is especially consequential in underserved areas, where patients rely on primary care physicians as their only healthcare contact and may lack dental access.⁴˒⁵

The oral-systemic connection is well established, with periodontal disease linked to cardiovascular disease, diabetes complications, adverse pregnancy outcomes, and respiratory infections.⁶˒⁷ Yet most residents report minimal training and limited confidence performing oral examinations.⁸˒⁹ Accreditation Council for Graduate Medical Education (ACGME) competencies offer a framework for integration, but practical models remain scarce.¹⁰

We developed a brief, replicable workshop drawing on the content domains of the Smiles for Life National Oral Health Curriculum, adapting selected modules with examples tailored to our patient population. Our objectives were to (1) assess baseline oral health knowledge, (2) implement a targeted intervention combining didactic and case-based learning, and (3) evaluate its effect on knowledge and confidence.

This prospective, single-center pilot enrolled first- and second-year family medicine residents (N=30) at the University of Florida. The one-hour workshop had three components:

• Didactic learning (~20 minutes): tooth anatomy and development, caries pathogenesis, local anesthesia, periodontal disease recognition, restorative procedures, and dental radiology basics.
• Clinical skills training (~25 minutes): oral examination technique and common conditions, such as caries, pulpitis, periapical abscess, gingivitis, and periodontal disease.
• Case discussions (~15 minutes): the oral-systemic connection, prenatal oral health, and dental referral pathways.

A simulated dental extraction illustrated procedural concepts relevant to emergency presentations; because baseline knowledge was lower than anticipated, it was delivered as a guided, case-based image walkthrough rather than a hands-on exercise. Evaluation used pre- and post-intervention surveys with multiple-choice knowledge items and 5-point Likert confidence ratings (Appendix). A one-month follow-up survey was planned to assess retention.

Of 30 eligible residents, 8 (26.7%) completed the baseline survey and 22 (73.3%) did not respond. Mean baseline knowledge score was 64%, and nearly all respondents reported looking up answers during the assessment. Baseline oral pathology identification scores and examination confidence were low. Post-intervention, respondents reported higher confidence in oral examination skills and high satisfaction with the format. The one-month follow-up survey had a 0% completion rate.

This pilot suggests a brief, structured workshop can improve family medicine residents' confidence in oral health skills, addressing a persistent curricular gap. The combined didactic and case-based format aligned with adult learning principles and mapped to ACGME competency domains, facilitating adoption elsewhere.¹⁰ Qualitative feedback favored recurring, longitudinal exposure and more hands-on practice. 

Nearly all baseline respondents looked up answers indicates a clinical impulse to seek information and points to the need for a proctored or timed assessment. Self-reported confidence does not equate to clinical performance; objective structured clinical examinations or direct observation should be incorporated. Feasible next steps include integrating core oral health modules into existing curricula, cultivating faculty champions, fostering interprofessional experiences with dentistry, and tracking competency through clinical encounters.

These findings must be interpreted considering the study's limitations. The principal limitation was the low baseline response rate (8/30, 26.7%), likely to reflect competing clinical duties, email fatigue, and the voluntary, non-embedded nature of the survey. Embedding surveys within mandatory touchpoints (e.g., QR codes at didactics) may improve completion. The low response, answer look-up, and 0% follow-up completion limit conclusions about knowledge gain and retention and should guide a larger study.

Knowledge items (multiple choice; administered pre and post):

1. Which of the following is the primary etiologic factor in dental caries?
2. Which systemic condition is most strongly associated with periodontal disease?
3. Identify the condition shown: localized swelling with purulent drainage at the gumline (image).
4. First-line management of a symptomatic periapical abscess in primary care includes:
5. Recommended timing of routine oral health screening during pregnancy is:
6. Which finding warrants urgent dental referral?
7. Which local anesthetic technique is appropriate for a mandibular procedure?
8. Which radiographic view best demonstrates interproximal caries?

Confidence items (5-point Likert, 1 = not at all confident to 5 = very confident; administered pre and post):

1. I can perform a basic oral examination.
2. I can identify common dental pathology (caries, gingivitis, abscess).
3. I can counsel patients on preventive oral health.
4. I can determine when a patient needs dental referral.
5. I can address oral health concerns in pregnant patients.

Workshop feedback (post only):

1. The workshop improved my knowledge of oral health. (Likert)
2. The workshop improved my confidence in oral examination. (Likert)
3. What did you find most useful? (free text)
4. What would you change or add? (free text)
5. Preferred frequency of future sessions. (free text)

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10. Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). 2026. Accessed September 9, 2026. https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/cprresidency_2026.pdf

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