America’s underserved populations suffer from a dental care deficit, and community-based dentistry is the cure.
That’s the biggest takeaway from year one of the Robert Wood Johnson Foundation (RWJF)-funded Dental Pipeline National Learning Institute (NLI) program.
Led by the University of the Pacific’s Arthur A. Dugoni School of Dentistry and the American Dental Education Association (ADEA), NLI awards grants to projects that support community-based oral health education and recruitment of culturally diverse students. Grantees must have both a dental college and a community partner to qualify.
“The people who can afford care tend to need it least,” says Paul Glassman, DDS, director of both NLI and the community oral health program at Dugoni. “Meanwhile, those with the highest incidence of dental disease either can’t access treatment or can’t pay for it—often both.”
The result is a growing epidemic of oral health disparities and disease-related deaths in underrepresented communities. The remedy? Bring dental care directly to the communities most in need.
Across the country, NLI projects are removing obstacles for patients and providers. As Glassman puts it, “we’re bridging the gap between divergent needs, cultural values, and resources.”
In Georgia, that means a partnership between Area Health Education Centers (AHEC) and the state’s only dental college that grew into a program to introduce underprivileged youth from rural areas to the dental professions. At the University of Nevada, Las Vegas, an NLI project deepens students’ connection to their own cultures, motivating them to take their newfound skills and cultural competency back to their communities.
On Martha’s Vineyard, Harvard dental students bring oral health care to the Aquinnah Wampanoag tribe, working in local clinics and conducting screenings at pow-wows.
And in Detroit, where a once-unionized workforce now finds itself in low-paying jobs with inadequate health coverage—and a shortage of dentists—the Dental Imprint project has exposed more than 600 disadvantaged young people to a career in dentistry.
The need for such projects is profound. “Many underserved populations still see our dental care system as unavailable for people like them,” Glassman says. Only 9 percent of the 181,000 practicing dentists in the United States are Black, Hispanic, or American Indian.
Moreover, in many states Medicaid and other public health programs don’t provide adult dental coverage. “Even those with commercial dental benefit programs are finding that the coverage pays for a lot less than it used to,” he notes.
According to Kim D’Abreu, ADEA’s senior vice president for access, diversity, and inclusion, in-person sessions between project leaders netted the biggest gains in year one. “The personal interaction and intense background sharing was powerful,” she says—so powerful that participants have stayed connected beyond the program.
“People working on access and diversity often feel isolated in their institutions,” Glassman explains. Many dental schools give these issues low priority, focusing instead on other aspects of clinical practice. “NLI enables participants to interact across schools, share solutions, and send those solutions out into communities.”
Kim McFarland, DDS, an NLI advisory board member, applauds the way NLI projects met objectives on a modest budget. “Giving schools even a small amount of funding can accomplish substantial goals,” she says.
What Didn’t Work
One issue that arose the first year was the time commitment, which presented challenges for several partner schools.
“Some individuals had unrealistic expectations about how much time was required, or felt they didn’t have adequate support,” D’Abreu says. “Faculty need the institution’s support to cover their activities.”
Gwendolyn Brown, DMD, dental coordinator for the South Carolina AHEC Summer Careers Academy, observed a corresponding reluctance among faculty to participate in access and diversity efforts. “I think it was a combination of the time required and, frankly, some apathy. They’re expected to do so much with so little, and that can be exhausting.”
For year two, NLI was rigorous about letting schools know what participation entails. “We changed the application process this time,” D’Abreu says. “We identified a top 10 list from the first round, then called and explained exactly what they were signing up for.”
There were also some curveballs, such as a disproportionate emphasis on recruitment over community-based dental education (CBDE).
“We got much more traction with diversity leaders than with CBDE projects. That surprised us,” says D’Abreu, adding, “I’d like to see us enlist more schools that are involved in CBDE.”
A happier surprise was the penetration of RWJF oral health dollars in the country’s midsection. “The original pipeline had a strong presence on the East and West Coasts,” she says. “This time, we’ve added an array of schools in the Midwest and Southwest.”
Heading into year two, program leaders and grantees will have more digital tools at their disposal. “We’re expanding online learning opportunities,” D’Abreu says. “We’re also enhancing our social media presence.”
“Our society interacts now through social media, but older professionals aren’t accustomed to using it,” Glassman explains. “These tools help them connect with each other and become more comfortable using social media with their students. For recruitment and community engagement,” he adds, “social media fluency is an imperative.”
But amplifying NLI’s voice on Facebook and Twitter is just one component of the larger strategy. Equally indispensable: changing the underserved populations’ view of the dental professions.
For Sheila Stover, DDS, director of an NLI-funded program at Marquette University, that means reaching beyond students. Stover, who works with Wisconsin’s American Indian population, says, “you have to get community leaders involved.”
Contemplating dental care’s future, D’Abreu advocates a coordinated effort between colleges and K-12 STEM programs to increase awareness of all the health professions.
“Plenty of resources have been directed to the post-secondary pipeline, but not in partnership with K-12 efforts,” she says. “National STEM initiatives need to be brought in.”
Glassman describes a statewide demonstration project that’s reaching underserved children (as well as adults) throughout California. “Hygienists are delivering preventive and early intervention care in elementary schools and at Head Start centers, in residential facilities for people with disabilities, and to older adults in nursing homes,” he says.
“Not only are the children getting care, but the project is also changing their mental image of dentistry. Both kids and parents have expressed interest in learning more about dental careers.”
It’s through efforts like these that NLI may ultimately have the greatest impact: by delivering tangible proof of community-based education’s value.
As Glassman points out, “it’s impossible to make these big changes alone; we’ve got to work through community partnerships. NLI participants are making a tremendous difference by doing just that.”