If the eyes are the window into the soul, then the mouth is the window into the body.
The condition of the mouth often speaks to the state of the rest of the body; health problems in gums, teeth or other parts of the mouth, for example, have been associated with current or future problems in the heart, the lungs, the body's metabolism, even a fetus in a woman's womb.
"Many of us take oral health for granted," said David Krol, MD, MPH, FAAP, Human Capital Portfolio team director and senior program officer at the Robert Wood Johnson Foundation (RWJF) and leader of the Foundation's efforts to develop and maintain a diverse, well-trained workforce in health and health care. "But vulnerable populations—children, seniors, minorities, low-income and rural people and other underserved groups—are suffering from an epidemic of dental and oral disease."
The RWJF Harold Amos Medical Faculty Development Program is responding to this epidemic with an expansion into academic dentistry.
In 2012, the Harold Amos program will accept one or more dental scholars to its four-year program. In doing so, it aims to begin doing for the dental profession what it has done for medicine for more than a quarter century: foster diversity in academia and in the workforce by supporting faculty from historically disadvantaged backgrounds who can achieve senior rank and encourage and cultivate succeeding classes of scholars.
Diversity in dental education and practice is a key way to improve access to dental care for vulnerable and underserved populations, according to a report released this year by the Institute of Medicine.
Lavizzo-Mourey: Harold Amos Expansion Aims to Narrow "Serious Diversity Gap"
RWJF and Harold Amos program officials agree. "Our nation's dental schools face a serious diversity gap," said RWJF CEO and President Risa Lavizzo-Mourey, MD, MBA. "By expanding the mission of the Harold Amos Medical Faculty Development Program, we aim to narrow this gap, help meet the oral health needs of the country's most vulnerable individuals, and contribute to pioneering oral health research."
Dental school students and faculty remain overwhelmingly White. Five percent of full-time faculty members at U.S. dental schools are African American, and 7 percent are Latino, according to the American Dental Education Association. Of the 4,600 graduates from U.S. dental schools, only 10.9 percent are Latino, African American, or American Indian. Fewer than 8 percent of the nation's dentists are underrepresented minorities.
The Harold Amos program will take an important step toward narrowing these gaps next year by opening its doors to one or more dental scholars who, like their medical counterparts, will receive an annual stipend of up to $75,000 and an annual $30,000 grant to support research activities.
To support the expansion, two academic dental scholars have joined the program's National Advisory Committee (NAC): Francisco Ramos-Gomez, DDS, MS, MPH, a professor of pediatric dentistry at the University of California at Los Angeles School of Dentistry; and George W. Taylor, DMD, DrPH, a professor of dentistry and chair of the department of preventive and restorative dental sciences at the University of California San Francisco School of Dentistry.
"The Harold Amos program will provide our new dental scholars who are interested in faculty and leadership roles a professionally supportive environment and new opportunities to pursue innovative research that will advance oral health and dental care, and help reduce disparities in oral health," said Harold Amos National Program Director James R. Gavin III, MD, PhD.
The move, Taylor said, is a beacon to the dental profession and to the patients they serve. "It sends out an important message that a major foundation recognizes that it is important to invest in research in oral health." That message, he hopes, will lead others to pay more attention to the critical issue of oral health, and the need to expand the cadre of committed scholars investigating questions and finding solutions, especially for vulnerable populations.
Tooth decay is a largely preventable disease and the most prevalent chronic infectious disease of childhood, more common than asthma and diabetes, according to the Centers for Disease Control and Prevention (CDC). Studies indicate that 28 percent of children between the ages of 2 and 4 already have tooth decay, Ramos-Gomez notes. So do 53 percent of children between the ages of 6 and 8, and 51 percent of children between the ages of 12 and 15.
Vulnerable minority and low-income children are two-to-three times more likely to develop the disease. Most alarming, Ramos-Gomez says, is that these rates reflect a 4 percent increase for children under 5 years old and that the disease has begun to affect children who have previously been considered at low risk for decayed teeth.
Tooth decay should not be taken lightly, Ramos-Gomez cautioned. It causes problems ranging from pain to absence from school to difficulty concentrating. It can undermine self-image and self-esteem. "If you are in terrible pain, how can you focus in school and behave in the classroom?" Ramos-Gomez said. "It's a huge impediment that can affect learning, speech and development."
Other oral health problems include birth defects, tooth loss, gum disease, oral infections like cold sores, chronic facial pain conditions and oral cancers. Poor oral health can lead to malnutrition, childhood speech problems and serious, sometimes fatal, infections, according to the Institute of Medicine. It can also interfere with breathing, eating, swallowing and speaking and diminish overall quality of life. Oral health problems are linked to general health problems such as diabetes, heart and lung disease, pre-term births and low birth weight babies.
Yet despite the importance of oral health care, it is often considered to be separate from—and often less valuable than—general health care. Dentists and physicians are trained in separate education systems, oral health is often not covered by health insurance plans, and policy-makers do not always include oral health in legislation relating to general health care.
And the barriers to care are many; patients or parents may not be able to afford dental care for themselves or their children, may not have dental insurance, may not be able to access a dentist near their homes, or may not know how to prevent disease or access care.
The mouth is a critical part of the body that needs be recognized as such, Ramos-Gomez said, and the Harold Amos program dental expansion will help do that. "Dentistry is an integral component of primary care," he said. "We have to become physicians of the mouth."