Category Archives: Dental
Kim D’Abreu is Senior Vice President for Access, Diversity, and Inclusion in the Policy Center at the American Dental Education Association. D’Abreu was previously the deputy director for the Pipeline Profession and Practice: Community-Based Dental Education program of the Robert Wood Johnson Foundation. This is part of a series of posts looking at diversity in the health care workforce.
The words we use matter. That’s why the American Dental Education Association (ADEA) is shifting the conversation away from the “deficit model” for recruiting students from underserved backgrounds. ADEA is specifically avoiding language that suggests “the numbers just aren’t there” or “the pool is not qualified.” When we describe underserved students as low-income or less prepared educationally, it suggests that the problem lies with them. It undervalues the students and ignores the wealth that they bring to the table in terms of cultural competence, initiative, and willingness to provide care to communities that need it most. But far worse, the deficit model allows the real institutional obstacles that these students face to remain in place.
Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.
I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.
Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.
The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.
Dentists and nurses are the occupations that will offer the best employment opportunity, salary, work-life balance, and job security in 2013, according to an annual ranking released by U.S. News & World Report. Other health care jobs also made the top tier, including physicians at number five, out of 100 occupations listed.
The dental profession should grow 21.1 percent by 2020, the piece says, and physicians will see “abundant job growth” in that same period. Nurses will also be in greater demand as the population ages, but the rankings note that nurses “will almost always have great hiring opportunity” because of the expanse of the profession.
U.S. News gives each profession is given an overall score calculated from seven component measures: 10-year growth volume, 10-year growth percentage, median salary, employment rate, future job prospects, stress level, and work-life balance.
Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.
The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”
In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”
The Affordable Care Act will allow more Americans to access dental health services, former Surgeon General and Robert Wood Johnson Foundation Clinical Scholars almnus David Satcher, MD, PhD, said recently at forum on unmet oral health needs, but there are concerns that the current dental workforce will not be able to meet the increase in demand. Satcher spoke at “Unmet Oral Health Needs, Underserved Populations, and New Workforce Models: An Urgent Dialogue,” a July 17 forum sponsored by the Morehouse School of Medicine and the Sullivan Alliance.
“We now have an opportunity to dramatically increase coverage,” he said. “But adding dental benefits will not translate into access to care if we do not have providers in place to offer treatment.” More than five million additional children will be entitled to dental health benefits under the Affordable Care Act, according to a news release from the Morehouse School of Medicine.
“I think we need more dentists and I think we need more professionals who are not dentists but who can contribute to oral health care services,” Satcher said. He was referring to mid-level dental providers, known as dental therapists.
Though improvements have been made in the 12 years since then-Surgeon General Satcher issued a report offering a framework for improving access to oral health, problems persist. Tooth decay is still common among children, he said, and many people do not have easy access to oral health providers.
This is the first in a series of blog posts introducing programs that are part of the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio. Funded by RWJF, the Summer Medical and Dental Education Program (SMDEP) offers intensive and personalized medical and dental school preparation to freshman and sophomore college students from underrepresented groups and disadvantaged backgrounds. The goal is to help them overcome barriers to medical or dental school.
Meet 26-year-old Carmen Young, a May 2012 graduate of the University of Louisville, School of Medicine who begins her obstetrics and gynecology residency at St. Mary’s Hospital in St. Louis this summer. Her 8th grade commitment—from dream to destination—has been realized with a boost from the Summer Medical and Dental Education Program (SMDEP). Carmen pledges to build a practice that improves outcomes for Black mothers and their babies.
Meet Adrienne Perry, 23, whose eyes were opened to the vast oral health problems faced by adults and children during a trip to Guatemala. That trip, coupled with six weeks of intensive classes through SMDEP, awakened the third-year Howard University School of Dentistry student to similar oral health gaps faced by people in urban communities surrounding her campus in Washington, D.C. When she gets her degree, this Conyers, Georgia native plans to address the oral health crisis among underserved communities both here and abroad. Today, just 12 percent of the nation’s dentists are from minority populations.
And meet Drew Gehring, 24, from rural Garrison, North Dakota. He also participated in SMDEP and was inspired to dive into research probing the causes of colon cancer, hoping to contribute to curing the disease.
SMDEP gave these and other students from economically disadvantaged or medically underserved communities a jumpstart to open educational opportunities and clear career paths to medicine or dentistry. They are among the more than 20,000 alumni of the program.
Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.
The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”
He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.
Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.
A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.
By David Krol, MD, MPH, FAAP, Robert Wood Johnson Foundation Human Capital Portfolio Team Director and Senior Program Officer
For many Americans, a visit to the dentist is a rarity—not by choice, but because their health plans don’t cover dental care, they can’t afford it, or because there is no dentist anywhere near where they live or work. If you’re on Medicare, you know that dental isn’t covered. If you’re part of the VA system, you know that dental benefits are treated differently. If you’re an adult on Medicaid or serve adult patients who are on Medicaid, you know the chances are slim that there’s great coverage for dental care, unless you are lucky to be in a state that still covers it. Why does this happen and what can result?
A study recently released by the Pew Center on the States offers startling data on the scope of the problem and its consequences. In 2009, some 830,000 Americans visited an emergency department for a preventable dental condition. It should be obvious that the emergency department isn’t the best place to seek dental care. The same year, 56 percent of Medicaid-enrolled children got no dental care whatsoever, not even a routine exam. That’s no care even with insurance for it!
Those numbers are alarming for many reasons, but mostly because they reveal a significant public health challenge confronting the nation: Many Americans simply aren’t getting the oral care they need, at any age, including the basic preventive services and education that can detect oral disease in early stages. They are putting their health at risk, and increasing the strain on an already-overwhelmed health care system.
February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.
Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?
John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.
HCB: Tell us about the school-based programs you put in place.
Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.
We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.
HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.
Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.
The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.
By Nina Ardery, Deputy Director, Harold Amos Medical Faculty Development Program
The Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program has long been working to increase the number of medical school faculty from historically disadvantaged backgrounds who are committed to advancing the understanding and elimination of health disparities and serving as role models for students and faculty of similar background. In 2012 the program will expand its scope to include those clinician scientists who work in dental medicine.
This is a natural extension of the program. Oral health is integral to overall health. New research is pointing to associations between chronic oral infections and heart and lung diseases, stroke, and low-birth-weight, premature births, according to the Surgeon General’s report “Oral Health in America,” and associations between periodontal disease and diabetes have long been noted.
The broadened meaning of oral health parallels the broadened meaning of health. In 1948 the World Health Organization expanded the definition of health to mean “a complete state of physical, mental, and social well-being, and not just the absence of infirmity.” It follows that oral health must also include well-being. Just as we now understand that nature and nurture are inextricably linked, and mind and body are both expressions of our human biology, so, too, we must recognize that oral health and general health are inseparable. We ignore signs and symptoms of oral disease and dysfunction to our detriment.
The wider meanings of oral and health in no way diminish the relevance and importance of the two leading dental diseases, caries and the periodontal diseases. They remain common and widespread, affecting nearly everyone at some point in the life span. Nearly one in four adults between the ages of 20 and 64 have untreated tooth decay, and rates are higher among Black and Hispanic adults, younger adults, and those with lower incomes and less education. There are probably more disparities in oral health care in the United States than in overall health care.
I think we will start to see more integration of medicine and dentistry at the community level, in clinical practice and in research as providers integrate general and oral health, so this is a good time for us at the Harold Amos program to embrace a wider definition of medicine.