ISSUE
               
Access to Care
The Role of Dental Schools in Expanding Access to Oral Health Care
- Ms. Lauren Meyers, Ms. Rachel Hill, Dr. Stuart M. Hirsch


Ms. Lauren Meyers
Director, Global Outreach Programs, New York University College of Dentistry




Ms. Rachel Hill
Assistant Director, Global Outreach Programs, New York University College of Dentistry




Stuart M. Hirsch, DDS
Vice Dean for International Initiatives and Development, New York University College of Dentistry








For the past several years, the NYU College of Dentistry (NYUCD) and Henry Schein Cares, the company's global corporate social responsibility program, have partnered on a program known as the NYUCD-Henry Schein Cares Global Student Outreach Program to increase the availability of dental services within underserved areas of the United States and Latin America, especially for children. Through these outreaches, the program not only addresses the pressing issue of access to care in the immediate future, but also has the potential to influence future generations of dentists.

Participating team volunteers from the NYUCD-Henry Schein Cares Global Student Outreach Program include NYUCD faculty, residents, students of dentistry and dental hygiene, alumni, and, in some instances, students and faculty from other dental schools. Through outreach, collaborative relationships are fostered between the dentist, the patient, and the community, thereby redefining the dental profession within the context of a public health model and transforming the role of a provider for students, faculty, and alumni.

Background

Despite the wealth and resources of our nation, there is a grave disparity in access to health care, especially oral health care. Disadvantaged populations on Medicaid or with no insurance have very limited access to dental professionals who are able to treat them. The US Public Health Service recognizes 3,600 Dental Health Profession Shortage Areas, in which approximately 49 million Americans live. This disparity affects people of all ages since children develop poor oral health behaviors that they carry into adulthood. These children develop low self-esteem, become reclusive, and modify their diets to accommodate the pain and infection that becomes an unavoidable part of their lives. In addition, more than 51 million documented school hours are missed in the US annually as a result of progressive oral disease in children. Beyond our borders, the statistics are even more disturbing.

The current public health model is not working and begs the question: "What role can dental schools play in reducing or eliminating the gap in care?"

Transforming Dentists' Attitudes Toward Public Health Service Through Dental Student Outreach Experiences

NYUCD recognizes that predoctoral students can be transformed by their experiences in dental school in ways that may shape lifelong behaviors. To that end, NYUCD is commited to providing dental students with the opportunity to understand inequalities in access to care and to recognize their own abilities to address this pressing issue. The fact that NYUCD alumni are returning to their alma mater to participate in outreach programs proves that early exposure to oral public health opportunities instills in graduates a desire to incorporate public health service into their private practices. We anticipate that 25 alumni will participate in NYUCD outreaches this year, up from 20 in the previous year.

A recent outreach to Machias, Maine, exemplifies the collaborative nature of the NYUCD-Henry Schein Cares Global Student Outreach Program. The outreach provided oral health care to children and adults without a dental home. Services were provided at no cost to the patient, but Maine-Care (Medicaid) was accepted when available. The event was held in collaboration with Caring Hands of Maine, a nonprofit dental clinic operating out of Ellsworth, the Washington County Children's Program (WCCP), their "Tooth Ferry" mobile dental van, Child and Family Opportunities, Washington Hancock Community Agency, and Down East Community Hospital. Delta Dental Plan of Maine is the primary funder of this program. To view a documentary of the Machias, Maine, outreach, please go to http://www.nyu.edu/dental/news/nyucdtv/maine.html.

A Sustainable Care Model

Twice a year, the NYUCD-Henry Schein Cares Global Student Outreach Program in Machias, Maine, provides oral healthcare education, emergency dental services, screenings, prevention, sealant application, and restorative treatment to underserved communities; assesses the oral health needs of each targeted community; and works to implement a sustainable oral health system, including the identification and training of local members of the community who can sustain oral health education and care on an ongoing basis. At the same time, the program vigorously pursues partnerships with local organizations that are able to provide financial support and other resources. This focus on prevention and partnerships is key to the model's success.

Because NYUCD is a university-based academic dental center dedicated to education, research, and community service, we are committed to providing a didactic component to our outreach programs, as well as a clinical training experience. Our ultimate goal is to develop and disseminate both a curriculum and a clinical outreach model throughout the US and internationally, thereby taking both a short- and a long-term proactive approach to the issue of access to care.

This is important because the curricula used by dental schools across the US generally focus on preparing graduates to enter private practice. These curricula fail to address the power of exposure to public health methodologies designed to transform dental practitioners into change agents capable of decreasing disparities in access to oral health care. An educational experience emphasizing access to care can introduce evidence-based practices that will prepare students to advocate for and implement public health strategies in their future dental practices.

Impact on Multiple Levels

Notably, it is not only current students and alumni who report being transformed by the outreach experience and express a desire to return for future outreaches, but participating faculty as well. Returning from a recent outreach to Machias, Maine, Dr. Andrew I. Spielman, associate dean for academic affairs and professor of basic science and craniofacial biology, said that he had experienced a major transformation in his personal attitudes and values.

"Having devoted myself virtually exclusively to academic administration since 1985, first as a professor and the chair of the Department of Basic Science and Craniofacial Biology, and for over 10 years as the associate dean for academic affairs, this outreach experience made me want to practice clinical dentistry again. This was my first outreach and it immersed me personally in a social context of overwhelming need, something that remains conceptual when you are talking about it in a classroom or even overseeing care in a modern clinic. The conditions we faced and the desperation of the patients we saw were sobering. And this was in the US, not a developing country. One patient, for example, was holding his teeth together with Krazy Glue. Another patient, in desperate pain, arrived at our makeshift clinic at 6:20 am for an 8:00 am opening.

"Fortunately, even without actually practicing dentistry, you don't lose your ability to diagnose. My responsibility was to do triage, which had to be done in five minutes per patient. Each day, using only nine chairs and in extremely rudimentary conditions, we saw over 100 patients, and 700 adults in all. The humility, gratitude, and satisfaction that I felt was equaled by the ability to connect with and mentor students beyond the classroom, and to help teach them some very important life lessons. Namely, that there are personal rewards in providing care to people in need that far outweigh financial rewards. Having had this experience, I plan to participate in at least three outreaches each year."

In addition to the outreach in Machias, Maine, geographic areas targeted annually by the NYUCD-Henry Schein Cares Global Student Outreach Program include Santo Domingo, Dominican Republic; Grenada (see related story); Hudson, New York; Bluefields, Nicaragua (see related story); and villages of the Yukon Flats in Alaska, where NYUCD has partnered with Loma Linda University School of Dentistry, Louisiana State University School of Dentistry, University of Washington School of Dentistry, and the Arizona School of Dentistry and Oral Health.

An Exciting Agenda

There are nearly 60 dental schools in the US that train more than 4,500 dentists each year. As a result, academic dental centers have the potential to shape the way in which dentists see their role in the profession and to have a tremendous impact on the future delivery of oral health care in America.

NYUCD anticipates that by 2016, an expanding relationship will have been established throughout the northeast region of the US, both with dental schools and key community stakeholders, with approximately 200 dental students from the northeast region participating in both a didactic curriculum and a clinical outreach annually. The programs will be carefully documented and used as a model for other regions throughout the US. Assuming a comparable model is set up in each of four regions within the US, 800 dental students will be exposed to public health dentistry and education annually during the program's initial development phase, with the ultimate goal of all US dental students having this exposure prior to graduation.

The NYUCD-Henry Schein Cares Global Student Outreach Program is committed to building on the unique outreach experiences of recent NYU dental graduates. The fact that our graduates are interested in returning to NYUCD to participate in outreaches to underserved areas says much about the ability of exposure to outreach to transform one's practice philosophy. Our goal in the next several years is to demonstrate not only that an outreach experience can be transformative for dental students, but also that a collaborative approach on the part of our nation's dental schools can have a multiplier effect in improving and sustaining oral health at the national level by changing the way providers view their role within the profession.