Smiles for Life

Guest Post by Cindy Lord, Clinical Associate Professor and Director of the Physician Assistant Program at Quinnipiac University, and Oral Health Champion with the National Interprofessional Initiative on Oral Health. The activities of the National Interprofessional Initiative on Oral Health are made possible as a result of funding from The DentaQuest Foundation, the Washington Dental Service Foundation, and the Connecticut Health Foundation.

My “aha” moment came when I realized that physician assistants (PAs) and primary care providers can not only play an integral role in improving oral health, but that we have an obligation to do so.  Dental disease is the most common chronic disease in children, and it presents frequently in pregnant and elderly patients, yet doctors and PAs too often look beyond the mouth to the back of the throat to see if a patient’s tonsils are red or swollen or if they have post-nasal drip.

So, how do we change this? At Quinnipiac, where I am the Director of the Physician Assistant Program, we have begun to integrate oral health into our overall PA curriculum. We know that collaboration between the medical and dental professions is crucial to the overall health of every patient, so we are working with our PA students to ensure that they have a full oral health education that they can apply to their day-to-day work with patients. We want them to be able to evaluate the full health of each patient they see, and that includes the patient’s oral health, especially if they are part of a high-risk group.

We’ve been using the Smiles for Life curriculum to seamlessly include oral health into our PA training. Our PA students in their pediatric rotation do the pediatric Smiles for Life module and PA students in their internal medicine and geriatric rotation do the internal medicine and geriatric modules. While at first we received some hesitation (“oral health is for dentists!”), today our students are thrilled to be part of this important movement to make oral health part of overall health.  As part of this training, student PAs learn when to help the patients understand what they can do through education and advisory guidance and when to refer the patient to a dentist for more detailed evaluation and follow up.

As the health care system continues to evolve and change, it is our responsibility, as health care providers, to take charge of health care and use our position to encourage prevention, health literacy and the best possible overall health for all our patients.

Editor’s Note: In recognition of her work, Cindy received the Outstanding PA of the Year Award from the American Academy of Physicians Assistants. See more here: http://www.niioh.org/news. 

Dentists Pioneer Way for HIV/AIDS Patients

Currently, the AIDS 2012, the international HIV/AIDS conference, is running July 22 through 27 in Washington, DC.   

With some exceptions, dentists were among the first providers to recognize some of the physical manifestations of HIV/AIDS and come to the forefront of care for these patients.

Take for example, Dr. David Reznik, D.D.S., president of HIVDent, a nationally recognized Internet resource for people with HIV/AIDS. Dr. Reznick also serves as the Dental Director of the Southeast AIDS Education and Training Center and Director of the Oral Health Center at Infectious Disease Program of Grady Health Systems in Atlanta, Georgia.

Dr. Reznick was inspired to create HIVDent after hearing from a patient that no one would see him because of his AIDS diagnosis. Dr. Reznick immediately scheduled an appointment for him. After hearing this patient’s story, and seeing the discrimination in the dental field towards people with HIV/AIDS, Dr. Reznick was inspired to expand dental care to these patients.

Sandy Thurman, President Bill Clinton’s former AIDS czar, asked Dr. Resnik to take patients with HIV/AIDS on a sliding scale, making available dental services for this population at a lower cost. Dr. Reznick took on this initiative and provided care free of charge, working around the clock to ensure that the population was cared for.

In 1993, Dr. Reznick opened Ponce De Leon Center, the largest, most comprehensive dental clinic in Atlanta for advanced HIV/AIDS, which continues to provide care today. Dr. Reznick’s work continues today. He is constantly asking: How can I communicate oral health messages to people with so much else going on in their life? How do I gain trust?

Dr. Reznick and dentists like him brought this important issue to the forefront of the national discussion. They are now providing rapid HIV testing through saliva in dental practices to help ensure newly infected patients get care in a timely way and assure that they are not denied oral health care access.

As Dr. Reznick says, “Knowledge is power and allows us to increase understanding of those we serve. We can reach out, touch someone’s hand and make their world a little better.”

Mission of Mercy: Extending the Umbrella of Coverage

Guest post by Matthew Bond, Grants and Programs Associate, DentaQuest Foundation

Hundreds of people lined up to receive relief from toothaches, routine cleanings, extractions and more at the first annual Rhode Island Mission of Mercy (RIMOM) Free Dental Care Clinic, where I joined 600 people who volunteered their time, talent, and clinical expertise to make this event a success. The RI Mission of Mercy is one of the programs in the portfolio of grants that I manage. I was extremely grateful to have had the opportunity to see the impact of the DentaQuest Foundation’s work first hand.

I arrived early in the morning, around 4:45a.m., to a line of people wrapped around the building, already waiting for care. I spent most of the event running food and water to patients and volunteers and escorting patients from place to place. 

For each patient, getting the care they needed each meant something different.

For one woman, it meant being able to celebrate milestones with a smile. A lady shared with me that her daughter, the first in her family to graduate from college, was too embarrassed to smile in graduation pictures. After receiving the proper dental care, her daughter can now smile and celebrate one of the most important moments in her life.

For another man, it meant a sense of hope. Observing the massive line of people awaiting dental care, I overheard him say to someone else in line, “I thought I was the only one. I can’t believe it!”

What really struck me was when I was walking down the line in the pouring rain, one of the patients graciously offered me his umbrella. At first, I resisted, and he replied, “Listen, buddy I haven’t been able eat for 4 months, so if I can get that problem fixed, it doesn’t matter if I get wet.” The patients were so appreciative of the dental work they were receiving. 

All in all, 800 deserving patients received free dental services totaling over $375,000.00. Volunteers performed over 300 fillings, 450 extractions, 200 teeth cleanings, 30 root canals and 45 removable partial dentures were fabricated and inserted. 

Missions of Mercy free care clinics serve an important need in helping people who have no other options for dental care. They are a stop gap, not a solution. But we are working on it. The DentaQuest Foundation and its partners in communities across the United States are working to make sure people across America are able to get oral health education and care.

Working Together for Oral Health

By Ralph Fuccillo

In recent months, oral health has been getting considerable attention from major news outlets like ABC News, The New York Times, and the PBS Frontline program.  The emphasis of this coverage-- the inability of young Medicaid patients to get dental care, the rise in preschoolers with cavities, and the lack of dental coverage sending patients to the ER illustrates how far we still have to go to eradicate a very preventable disease.

Too many still think oral diseases are related to something not done, actions not taken.  The truth is dental disease is a chronic, infectious illness.  It is caused by bacteria and other factors. It is preventable. Working together, we can create a shared understanding of this disease among those who provide care, those who write health policies, those who finance care, and those who teach health education and prevention.

As the recent news coverage has made clear, there is a pressing need to erase disparities in access to care to improve the oral health of our nation. The good news is that people are working together to do this -- individually and collectively, in public and private partnerships, in communities, companies, and philanthropies, in health centers and dental offices, across states, and at the highest levels in government.

When communities work together, powerful change can happen. In 2007, Maryland suffered the very public death of a 12 year-old child to a dental infection that spread to his brain.  This tragedy spurred a level of action in Maryland and around the country that the oral health community had not seen previously. Thanks to the efforts of many in government and the community, the state of Maryland is now a national model of how communities can work together to ensure everyone has access to dental care.   Stakeholders in Maryland have come together and launched a $1.2 million oral health public service campaign to educate the community, and just recently Maryland Governor Martin O’Malley signed SB bills authorizing the Maryland State Department of Education to oral health literacy a component of school health education.

Maryland is just one example. There is important progress going on in many sectors.

Beginning in 2009, the U.S. Department of Health and Human Services reactivated a cross-agency focus on oral health and requested that the Institute of Medicine study the state of oral health. The resulting reports confirmed what many believed: the systems that impact oral health in America are broken. One-third of the population lives in areas where they can’t get dental care due either due to the scarcity of providers or a lack of coverage.

The new U.S. National Oral Health Alliance is using a model of collaboration across stakeholders to elevate oral health to the top of the nation’s health agenda --where it belongs. The Alliance is succeeding because people want to work together.  Its national leadership gatherings (Colloquia) have stimulated respectful and thoughtful conversations, leading to unified messages on priority issues.  The active participation of so many committed individuals working from a position of common ground offers hope that we will soon have a unified national strategy to improve oral health.

The DentaQuest Foundation, through its Oral Health 2014 Initiative, is supporting a complementary collaborative approach in 20 states.  Local leaders of the Oral health 2014 Initiative are bringing their communities together and creating new oral health champions. These champions are aligning actions in Arizona, North Dakota, Florida, Maryland, California, Colorado, Idaho, Michigan, Mississippi, New Jersey, Massachusetts, Alabama, the District of Columbia, Maine, Pennsylvania, Rhode Island, Oregon, Virginia, South Carolina and West Virginia with oral health priorities nationwide.

It’s the ripple-effects of these initiatives that are critical. People are coming together with common goals -- creating conditions where individuals and groups with different perspectives feel comfortable working together. Together, they are changing how people respond to a preventable disease.

Ralph Fuccillo is the President of the DentaQuest Foundation.