Jul 28 2011
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Second in a Series: A Call to Action on Oral Health Care

On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. Esther Lopez, D.D.S., a graduate of the Robert Wood Johnson Foundation (RWJF) Dental Pipeline program, gave the following interview to the Human Capital Blog on the reports, as part of our ongoing Voices from the Field series. Lopez is a volunteer dentist and member of the Dental Advisory Committee at Goldie’s Place, a support center for the homeless in Chicago which houses a dental clinic. See all the posts in this series.

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Human Capital Blog: The IOM report recommends the integration of oral health care into overall health care by training non-dental health care professionals to screen for oral disease and administer preventive care. What do you think of this approach to reaching underserved populations?

Esther Lopez: I definitely agree with this, mostly for the obvious reason that people who are losing out in dental health care are children and the elderly. Those two populations are the ones that visit primary providers the most – for a simple cold, the flu, a slip and fall accident – so having exposure to primary providers and non-dental health care professionals would be easier and more accessible. In order for this to happen we have to have more training available for these non-dental professionals. I see a lot of patients who come to Goldie’s Place with dental abscesses and things that need to be drained, that could be drained at a hospital. They go to a hospital are told that nothing can be done for them.

Wellness exams for children, for instance, are a very important time to explain to parents how to care for their children’s teeth. I have a two year old, and as we went through all the check-ups during the first year the pediatrician would ask me what he should look out for in children’s teeth. If we could create some sort of integrated curriculum for non-dental health professionals, especially for people in emergency departments, that would alleviate a lot of the problems that we have.

There are a couple of issues, though. For people who have no insurance and are using public aid, it’s often hard for them to find providers who accept that. In Illinois, for example, we do have dental coverage for adults through Medicaid, but very few providers accept it because the reimbursement rates are so low – a double whammy for those types of patients.

HCB: In addition to employment assistance and support services, Goldie’s Place offers dental services to the homeless in Chicago. Why is oral health important for this population?

Lopez: Oral health is connected to overall health. I’d say about 60 percent of our patients have chronic periodontal disease. Periodontal disease has a strong connection to cardiovascular diseases, and it can affect glucose levels if you are diabetic.

Goldie’s Place also works to find jobs for the homeless, and nothing kills an interview like a missing tooth. We give them prosthetics to replace missing teeth so when they go to look for jobs they can put their best foot forward.

HCB: How does Goldie’s Place recruit its volunteer dentists? Have most of them worked with underserved populations before?

Lopez: However we can. We participate in the Chicago Dental Society’s mid-winter meetings, where we have a booth to talk about Goldie’s Place and let other dentists know what we do in the hopes that they’ll want to volunteer their time. We also participate in a clinic and research day at UIC to recruit students and faculty. We send out mailings, go to local chapter meetings, and work with the American Dental Association. We recruit any way we can.

Most of our volunteer dentists typically have not worked with underserved populations. We have about 20 volunteer dentists right now, and I think maybe three of them accept Medicaid in their private practice. It’s one of the reasons they come to volunteer. They want to give back to the community, but find it difficult to do so in private practice.

HCB: The report also suggests changes to the dental education system, like including residencies and clinical experience with vulnerable and underserved populations. What do you think about this recommendation?

Lopez: I agree with having a year-long residency for all general dentists. I think that’s a phenomenal idea, especially for gaining experience working with children and the medically compromised. Those are the most affected patients, who have more detrimental effects if they don’t receive needed dental care. I gained a lot of experience I needed working with vulnerable populations and the medically compromised at Goldie’s Place, both during and after dental school. I also worked at a pediatric clinic two years out of dental school so I could get experience working with children.

HCB: Do local dental students ever help out at Goldie’s Place?

Lopez: When I was still a student at the University of Illinois, Chicago (UIC), we started the country’s first student chapter of the American Association of Public Health Dentistry, and started a student-run dental clinic. We used Goldie’s Place as our facility, and had our instructors supervise us providing care there once a month. The student-run clinic now operates three times a month, and we have more than 75 dental students (first through fourth year) participating. It’s one of the very unique things about Goldie’s Place. These students are able to get experience working with vulnerable populations and the medically compromised, and they gain cultural competency experience. We hope the end result is for them to come back and volunteer at places like Goldie’s or accept underserved patients in their private practice.

Any experience we can provide students with underserved populations is key. Working at Goldie’s Place is a totally different experience from working with patients at the University. We’ve only been doing it for three years now but I really believe we’ve motivated students to give back to the community. We have to have more clinics like Goldie’s Place that can offer that experience.

Tags: Access and barriers to care, At-risk and vulnerable people, Dental, Dental Pipeline, Health & Health Care Policy, Human Capital, IOM Oral Health Care Report, Medical, Nursing & Dental Workforce, Oral health, Publications, Research & Analysis, Underserved Populations, Voices from the Field