Category Archives: Dental
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.
Although the number of students applying to dental schools has risen in the last decade, the number of minority students has not risen proportionately. Simply increasing the applicant pool does not guarantee that diversity in the student body will increase, because underrepresented students often struggle to compete as the number of applicants increases and other students may have higher grade point averages and Dental Admission Test scores.
In 2005, the American Dental Education Association (ADEA), with support from the Robert Wood Johnson Foundation (RWJF) Pipeline, Professions, and Practice: Community-Based Dental Education program, created a workshop program to help dental schools foster admissions practices that increase diversity. To date, nearly half of all U.S. dental schools have hosted the ADEA Admissions Committee Workshop.
Now, to further the reach of these promising practices, with support from RWJF, ADEA has developed a web-based resource to generate discussion among admission committee members and to encourage a more diverse student body. Transforming Admissions: A Practical Guide to Fostering Student Diversity in Dental Students includes information on the importance of diversity in higher education and dentistry, tips and discussion topics for admission committees, and data and resources including PowerPoint slides from the ADEA Admissions Committee Workshop.
“We’ve seen from researchers, educators, policy-makers, and even courts that diversity provides a better educational experience for all students and leads to improved access to care,” ADEA President Leo E. Rouse, D.D.S., said in a statement. “This new tool for ADEA members will aid in admissions and accreditation, processes that are absolutely critical to academic dental institutions.”
By David Krol, M.D., M.P.H., F.A.A.P.
RWJF Human Capital Portfolio Team Director and Senior Program Officer
“Everyone has access to quality oral health care across the life cycle.”
That was the vision formed by a varied group of individuals from dentistry, dental hygiene, medicine, public health, nursing, economics, law, social work and philanthropy as they wrote the second of the Institute of Medicine’s reports on oral health, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations.” I had the privilege of being a member of that committee. Our report was released on July 13th, 2011.
Our task was an expansive one. We were asked to:
- Assess the current U.S. oral health system of care;
- Explore its strengths, weaknesses and future challenges for the delivery of oral health care to vulnerable and underserved populations;
- Describe a desired vision for how oral health care for these populations should be addressed by public and private providers (including innovative programs) with a focus on safety net programs serving populations across the lifecycle and Maternal and Child Health Bureau programs serving vulnerable women and children; and
- Recommend strategies to achieve that vision.
Piece of cake right?!
Well, as you might guess, we found numerous, persistent and systemic barriers and challenges that vulnerable and underserved populations face in accessing oral health care. Those barriers include social, cultural, economic, structural, and geographic factors. We also recognized that these barriers contribute to profound and enduring oral health disparities in the United States. Americans who are poor, minority, or have special health care needs suffer disproportionately from dental disease and receive less care than the general population. It’s a sobering reality in that many of us take oral health care for granted or don’t even think about it at all until we are forced to.
Fourth in a Series: A Call to Action on Oral Health Care, Bringing Dentistry to Children Who Need It
On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Kris Volcheck, D.D.S., M.B.A., a 2010 Robert Wood Johnson Foundation Community Health Leader, discusses community-specific solutions to oral health care disparities. Volcheck is director of the CASS Dental Clinic for the homeless and the Murphy Kids Dental Clinic in Phoenix, Arizona. See all the posts in this series.
Just down the street from the CASS Dental Clinic for the Homeless in Phoenix are four elementary schools, in the very impoverished Murphy school district. Although this is the urban core, it might as well be rural America. The families in these neighborhoods live on minimal incomes and don’t have transportation, making everything a long distance hike – grocery stores with fresh produce, medical centers and, not surprisingly, dentists. When basic health care is secondary to just surviving, oral health care falls by the wayside.
Last year we decided to open a dental clinic for impoverished children, as an extension of the homeless clinic we’ve had in place for more than 10 years, and in collaboration with a community funded health center already in the works. But the tough economic times meant the Murphy elementary schools we had planned to serve were unable to pay for transportation and chaperones to bring students to our clinic. And because the schools’ funding is closely tied to student performance, they were hesitant to disrupt the school day to bring children to our site.
So we refocused, and decided to bring the dental clinic straight to the children.
We now operate a portable, school-based dental clinic in the elementary schools twice a year. The Murphy Kids Dental Clinic brings oral health professionals, supplies and technology into the elementary schools to provide comprehensive dental care to children who would otherwise go without it.
The care available to underserved and vulnerable populations –in rural settings and in the middle of a city alike – lags behind those available in middle- and high-income communities. There’s a high density of dentists in high-dollar areas, but we’re scarce in the urban core.
On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Paul Glassman, D.D.S., M.A., M.B.A., a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry, discusses innovative models for improving the oral health of vulnerable and underserved populations. See all the posts in this series.
With the release of the Institute of Medicine (IOM) report on Improving Access to Oral Health Care for Vulnerable and Underserved Populations oral health is again highlighted on the national stage. This report, together with the IOM’s report on Advancing Oral Health in America released earlier this year, represent landmark calls to action on improving the oral health of the nation. I was privileged to serve on the IOM Committee on Oral Health Access to Services that produced the “Improving Access” report.
In a time when resources are dwindling, and public programs are being reduced, I find hope and opportunity for the future of oral health care for vulnerable and underserved populations. Generally in times when things are going well, people become complacent with the status quo and policy-makers are reluctant to contemplate big changes. Now, however, there is strong desire to find innovative solutions that will improve quality and lower costs.
At the highest level, the Affordable Care Act established the Center for Medicare and Medicaid Innovations (CMMI) at the Centers for Medicare and Medicaid Services (CMS). The new Center has $10 billion to “test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for those who get Medicare, Medicaid or CHIP (Children’s Health Insurance Program) benefits.” Oral health advocates inside and outside CMS are urging the Center to include oral health innovations in its portfolio of activities.
The IOM reports also urge expanding use of previously tested models and further testing of innovative models for improving oral health of vulnerable and underserved populations. There are a number of models that have been developed that can potentially help more people get better oral health at lower cost. In this blog posting, I’ll briefly describe several I am familiar with although there are many others that are ongoing as well.
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.
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.
On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Denise Davis, Dr.P.H, M.P.A., an RWJF program officer and the guiding force behind the Robert Wood Johnson Foundation (RWJF) Dental Pipeline program, discusses the consequences of a decade of inaction, the most promising courses at this time of fiscal constraint at the federal and state levels, and invites readers to share their views. See all the posts in this series.
Ten years after the release of the Surgeon General’s report describing the oral health crisis in America, little has changed. This year, in an effort to bring this critical issue back into the spotlight for policy-makers, clinicians and the American public, the Institute of Medicine (IOM), released two reports – one in concert with the National Research Council.
These reports, Advancing Oral Health in America and Improving Access to Oral Health Care for Vulnerable and Underserved Populations, build on the Surgeon General’s report of 2000 highlighting the importance and centrality of good oral health to overall health. The former highlights the need for leadership in this area by the U.S. Department of Health and Human Services and presents a set of organized ideals for creating improvement while the latter provides a vision for oral health access and quality for all Americans.
These reports reiterate where persistent gaps in oral health access and care delivery exist and suggest what organized principles and system-level changes should be adopted to improve the current status of many underserved and vulnerable groups.
Unfortunately, progress in the area of oral health for the most vulnerable within our population is painstakingly slow, as evidenced by the previous decade of inaction. Given the current fiscal constraints at the federal and state levels, it will be critically important to give consideration to the recommendations in these reports while simultaneously looking into other approaches such as foundation studies, creative multi-stakeholder innovative demonstrations, state-level projects, etc. in order to stimulate future progress.
The Institute of Medicine (IOM) and the National Research Council released a report Wednesday that makes a compelling and urgent case for expanding access to basic oral health care for vulnerable and underserved populations. Commissioned by the Health Resources and Services Administration and the California HealthCare Foundation, the report assesses the oral health care system and offers recommendations for ways to improve oral health care for children, seniors, minorities and other underserved populations.
Among its recommendations is 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. The report also recommends an improved dental education system that includes residencies and clinical experience with vulnerable and underserved populations, and increased recruitment to bring more people from minority, low-income and rural populations into the oral care field.
The Robert Wood Johnson Foundation (RWJF) is working to promote and increase diversity in the dental workforce. Its Summer Medical and Dental Education Program works with college freshmen and sophomores from underrepresented populations to increase the competitiveness of their applications for dental or medical school. The free, six-week summer academic enrichment program operates at 12 sites across the country. RWJF’s Pipeline, Profession & Practice: Community Based Dental Education Program (the Dental Pipeline program) operated until 2010, reaching dental schools all across the country with strategies that increased diversity in the profession and increased access to oral health care among underserved populations.
Denise Davis, Dr.P.H., is an RWJF program officer, and the guiding force behind RWJF’s Pipeline, Profession & Practice: Community Based Dental Education program (the Dental Pipeline program). The program ran from 2001 to 2010, working to increase diversity in the dental profession and to increase access to oral health care among underserved populations. Davis gave the following interview to the Human Capital Blog on May 16, 2011, as part of our RWJF Leaders series of blog posts.
Human Capital Blog: Now that RWJF’s Dental Pipeline program has been completed, how would you assess its impact?
Denise Davis: One focus of the program was to expand the pipeline of diverse applicants to dental schools. Among the most important things we did was to look carefully at admissions committee processes. We hoped to discover how we could retool and retrain admissions committees. And, in fact, we’re still funding the work of the American Dental Education Association in that area, even after the Dental Pipeline program has ended. In any event, we succeeded in this first goal of extending access to a more diverse group of applicants. Quite simply, the number of minority students went up.
The other thing we focused on was expanding the clinical rotations of dental students. Dental schools have their own clinics, and they typically require students in their junior and senior years to practice what they’ve learned there. But they rarely extend those rotations to community clinics. So we required schools participating in the program to create contractual relationships with community clinics, and extend the time that students were engaged in these rotations.