Category Archives: Oral health

Mar 30 2012

The Role of the Workforce in Access to Oral Health Care

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.

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Mar 22 2012

Human Capital News Roundup: Dental care for underserved children, HIV/AIDS testing, "mixed-use" neighborhoods, and more.

Around the country, the news media is covering the groundbreaking work of Robert Wood Johnson Foundation scholars, fellows and grantees. Here are some examples.

“Louisville [Kentucky] is going high-tech to try to figure out what’s behind the city’s problem with asthma,” the Courier-Journal reports. The city will use technology developed by Robert Wood Johnson Foundation (RWJF) Health & Society Scholars alumnus David Van Sickle, PhD, MA, that uses global-positioning technology to capture where and when asthma patients use their inhalers. Read a Human Capital Blog Q&A with Van Sickle on his work and upcoming projects.

Lisa Berkman, PhD, a Health & Society Scholars program site director at Harvard University, spoke to U.S. News & World Report about “Why Good Friends Make You Happy.”

Lucy Marion, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program and dean of Georgia Health Sciences University (GHSU) College of Nursing, was recently interviewed by the Augusta Chronicle for two separate articles. She discussed the merger of the nursing programs at GHSU and Augusta State University, and the work of the Greater Augusta Healthcare Network, which she helped found.

"Just about everyone now has heard of someone they know who's done something online that they wish they hadn't done,” RWJF Clinical Scholars alumnus Ryan Greysen, MD, MA, told Health Day. Greysen is the lead author of a study that examined the pervasiveness of physician misconduct online and the repercussions of those actions. “I think the message is that medical professionals are responsible for what they put online—not only responsible for the information, but accountable,” he said.

The Pine Journal (Cloquet, Minn.) spoke to Executive Nurse Fellow Julie Myhre, MS, BA, RN, PHN, about a local initiative to provide reduced-cost dental services for underserved children. Myhre, who is part of the Northeast Minnesota Oral Health Project, said the lack of adequate dental care for children has reached an “epidemic level.”

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Feb 21 2012

How Central Massachusetts Increased Access to Oral Health Care for Low-Income Children

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.

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Feb 9 2012

Human Capital News Roundup: Taking the scare out of dental care for kids, stroke-related memory loss, and more.

Here’s a sampling of recent news coverage of the work of Robert Wood Johnson Foundation Scholars and Fellows:

“As a physician, I have seen the tremendous capabilities of nurses—capabilities that are essential to meeting patient needs,” Robert Wood Johnson Foundation (RWJF) President and CEO Risa Lavizzo-Mourey, MD, MBA, writes in Medscape [free subscription]. “But to ensure that they maximize their contributions to health and health care, nurses will need advanced skills and expertise in care management, interdisciplinary teamwork, problem solving, and more. This makes higher levels of education imperative. In addition, having a larger pool of highly educated nurses will be necessary to expand the ranks of nurse faculty, addressing the shortfall that now causes nursing schools to turn away thousands of qualified applicants each year. These advanced degree nurses are also needed to help ameliorate the worsening primary care shortage.”

RWJF Clinical Scholars program alumna Raina Merchant, MD, MSHP, continues to receive media coverage for her work to map Philadelphia’s automated external defibrillators (AEDs) through the MyHeartMap Challenge. The Philadelphia CBS bureau and the Daily Pennsylvanian are among the outlets to report on the project. Read a post Merchant wrote for the RWJF Human Capital Blog about the MyHeartMap Challenge.

RWJF Executive Nurse Fellows alumna Alexia Green, RN, PhD, FAAN, spoke to about how the Texas Action Coalition—which she co-leads—is working to advance the recommendations of the Institute of Medicine’s Future of Nursing report. Learn more about the Action Coalitions across the country, and watch a series of videos highlighting their goals and ongoing work.

Patient outcomes are better at hospitals with higher proportions of registered nurses, RWJF Nurse Faculty Scholar Matthew McHugh, PhD, JD, MPH, RN, CRNP, told the Philadelphia Inquirer, and hospitals should “foster a culture that encourages employees to get more training, have good communication among nurses, physicians and managers, have enough people to do the work, and provide nurses with the tools they need.”

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Aug 15 2011

Fifth in a Series: Advancing a Vision of Access to Quality Oral Health Care for Everyone

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.

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Aug 8 2011

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.

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Aug 3 2011

Third in a Series: Opportunities in Oral Health

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.

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Jul 28 2011

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.


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.

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Jul 25 2011

First 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. 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.

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Jul 14 2011

Expanding Access to Oral Care

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.

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