ADA reaches out to underserved

Oklahoma City—When the University of Oklahoma College of Dentistry set out to recruit candidates to participate in a pilot program to become the first Community Dental Health Coordinators in the nation, program directors went into some of the most rural, medically underserved counties in the state.

“We profiled needs and socioeconomics and identified counties that were underrepresented by dentists, then sought out federally qualified health centers that already had dental components,” said Dr. Dunn Cumby, chair of community dentistry. “At most of the facilities, the average wait for a dental appointment was three to seven months.”

Through the centers, Dr. Cumby and Rosita Long, Ph.D., assistant professor of research, found community health workers who could effectively bridge the gap between local cultures and dental health care systems and help diverse populations overcome barriers that prevent them from accessing dental health services. In fact, some were already working in dentistry.

The CDHC workforce model officially launched March 6-7 with a series of kickoff meetings at the University of Oklahoma. CDHCs in pilot training programs at the College of Dentistry and the University of California-Los Angeles School of Dentistry/Salish Kootenai College are now beginning online and distance education through Rio Salado College in Tempe, Ariz., that lasts for one year, followed by a six-month internship.

Jessica Johnson from Clayton, Okla. (population 700), is one of the students selected by Drs. Cumby and Long to become Community Dental Health Coordinators, integrated members of the dental team with community health worker skills who have the potential to enable the existing dental workforce to expand its reach deep into underserved communities. CDHCs may one day be employed by federally qualified health centers, the Indian Health Service and tribal clinics, state or county public health clinics, or private dental practices.

“Jessica is already doing the sort of things that the CDHCs will do, such as going out to the schools for health education programs and visiting Head Start centers,” said Dr. Cumby. “She’s already established in the community and has a commitment to the community. What we’ll be able to do through this program is provide community health worker and dental skills for people like Jessica.”

The Community Dental Health Coordinator workforce model has been in development for several years. The 2008 ADA House of Delegates passed a resolution that committed funding for a five-year study of the CDHC.

“The CDHC signifies the ADA’s strong commitment to America’s oral health, and it also demonstrates that our profession is serious about finding real solutions to the access to care problem,” ADA President John S. Findley said in remarks to the group that included program directors and 12 CDHCs-in-training.

“We’re not interested in symbolic actions or political theories,” added Dr. Findley. “We’re determined to test our approach in the real world, refine our methods and build a professional model for this new member of the dental health team that is consistent with our profession’s commitment to high quality care and ethical standards.”

Dr. Carol Turner, a retired U.S. Navy admiral who chairs the CDHC Implementation and Evaluation Committee, called the kickoff event a “tremendous success.”

“The students going through this groundbreaking project are the focus,” Dr. Turner said March 6. “These students were hand selected and come from various backgrounds—some had no previous dental experience to those with a dental hygiene license. All have the focus and enthusiasm to lead to a successful outcome for this project.”

The ADA is studying the CDHC workforce model in three locations to determine its effect on bringing oral health care to underserved communities. The University of Oklahoma College of Dentistry is the program’s rural site. The UCLA School of Dentistry and Salish Kootenai College are piloting the Native American program, co-directed by Dr. Nancy Reifel, UCLA School of Dentistry, and Donna Kotyk, SKC, with hands-on clinical training occurring in Indian Health Service and tribal facilities in several different states.

Indian dental programs nationwide have a shortage of dentists, said Dr. Reifel, UCLA assistant researcher, public health and community dentistry.

“As a result, only 25-30 percent of the people in the community have access to dental care during the year,” said Dr. Reifel.

“Indian health programs have pioneered the use of community based practitioners to reach the most remote communities, and American Indian dental clinics already have outreach programs at tribal Head Starts, elementary schools, and senior centers where dental auxiliaries are doing the some of the same sort of services the CDHC will do,” said Dr. Reifel. “With this program we will be able to give more of our Indian clinics the skills they need to use telemedicine, deliver preventive services and plan oral health programs in even the most remote communities.”

One change in the ADA’s pilot program involves the urban pilot training site. A federally qualified health center clinic in Detroit where the study was to take place closed down last year. Dr. Amid Ismail, a member of the ADA Workforce Models National Coordinating and Development Committee and formerly a faculty member at the University of Michigan School of Dentistry, became dean of the Temple University Maurice H. Kornberg School of Dentistry in 2008 and sought to bring the program to Temple in Philadelphia.

“North Philadelphia is an ideal place for the Community Dental Health Coordinator,” said Dr. Ismail.

Ann Deinhardt, a social worker who consults with Temple University, said that areas bordering Temple University have either been designated as dental health professional shortage areas or are currently being redesignated as HPSAs. “The university is in an area with a lot of health disparities,” she said.

There are 210,162 people living in the area the CDHC project will serve, which is predominantly African American (66 percent); almost 20 percent of the population is Hispanic. More than 62 percent of the population lives below 200 percent of the federal poverty index. There are over 60,000 children in the service area, almost half of whom live in poverty.
“We are hoping to start a pilot training site this summer,” added Dr. Ismail. “At this time, we are focusing on the development of a program where the CDHC would provide care and education to expectant mothers, children age 0-5 and adults.”

With a practice scope that emphasizes prevention of oral disease, CDHCs will work either under a dentist’s supervision or possibly under remote supervision. For the duration of the pilot training, all students will be supervised by practicing dentists.

CDHCs will be trained to promote oral health and provide preventive services including screenings, fluoride treatments, placement of sealants and temporary fillings, and simple teeth cleanings (selective scaling for plaque-induced gingivitis) until the patient can receive comprehensive services from a dentist or dental hygienist.

They will not excavate caries but could place temporary restorations in caries with a dentist’s approval after the dentist has made a diagnosis. Community Dental Health Coordinators will be in a position to link patients who would not or could not otherwise access care with health providers by coordinating the logistics of appointments and helping patients become eligible for charitable dental programs.

To read more about the CDHC pilot training programs, visit www.ada.org/public/careers/ team/cdhc.asp.