By Nicole Fauteux
Last year's point/counterpoint
format was so enthusiastically received that ADEA decided to reprise it for
this year’s ADEA President's Symposium as a session on social injustice in oral
health care. Dr. Leo E. Rouse, ADEA Past President and Dean of the Howard
University College of Dentistry, invited seven widely respected ADEA members to
join him on the stage for a lively discussion centered around two questions:
- While interprofessional education (IPE) is
necessary to provide better treatment to patients, will it be sufficient to
improve access to oral health care?
- Should we be teaching our students to be social
entrepreneurs as well?
Dr. Marilyn W. Woolfolk,
Professor of Dentistry and Assistant Dean for Student Services at the
University of Michigan School of Dentistry, asserted that the time is ripe for
promoting a view of oral health care as a social good. She pointed out that
schools have redrafted their mission statements to reflect this understanding,
and they have responded to calls to diversify the workforce. She noted that
community-based education has become a “central pillar of the dental school
experience” and that new schools have opened to serve specific underserved
areas. She believes that policymakers demanding more accountability from the
profession will push it even farther in these directions.
Dr. Cheryl Westphal Theile,
Assistant Dean for Allied Health Programs at New York University College of
Dentistry, called for a new approach to educating our students. "We need
to look at our skills as primary care providers," she said, pointing to
the role we can play in identifying conditions such as obesity, sleep apnea,
and diabetes. In her view, interprofessional education provides an action plan,
but it is not sufficient. "We also need to promote intra-professional
practice," she maintained, urging others to consider how collaboration
between dentistry and dental hygiene can be enhanced.
Dr. Caswell A. Evans, Jr.,
Associate Dean of Prevention and Public Health Sciences at the University of
Illinois at Chicago College of Dentistry and a faculty member in the UIC School
of Public Health, thinks IPE is inescapable. "10,000 people a day will
turn 65 over the next 15 years," he told the audience, pointing out that
their problems cannot be addressed without collaboration among health
Dr. R. Ivan Lugo, Regional
Manager of Professional and Scientific Relations in North America and Puerto
Rico for The Procter & Gamble Company, called the new Interprofessional
Education Collaborative (IPEC) guidelines a great step forward, but reminded
the audience that breaking the silos is never easy. He lamented the pace of
change to date, noting that since the Surgeon General's 2000 report on oral
health, the system as a whole has not responded as it would in a crisis.
"We would move with a sense of urgency, we would collaborate with each
other no matter our degrees and specialties, and if we didn’t have all of the
instruments and equipment, we would improvise and innovate,” he told the crowd.
Dr. Frank A. Catalanotto,
Professor and Chair of the Department of Community Dentistry and Behavioral
Science at the University of Florida College of Dentistry, informed the
audience that not all dental associations appreciate the value and impact of interprofessional
education and practice. He expressed concerns at the notion that federal
government support is unwarranted given the lack of evidence on IPE, and
countered that developing the evidence base would be an appropriate use of
federal funds. "If we believe that interprofessional practice and
education is one of the solutions to access," he said, "we have to be
vocal about opposing their position."
Dr. McKinley T. Self, Assistant Professor in Residence of
Clinical Sciences, University of Nevada, Las Vegas (UNLV), School of Dental
Medicine, spoke about how students are influencing this debate. UNLV has
student run clinics that emphasize service to the community. He believes these
are turning students into agents of change. "This generation enters with
the will to do good," he stressed. "We should harness that energy
rather than trying to remold them into a system that no longer works."
Despite his enthusiasm for
service learning, Dr. Lugo noted that this alone has not “moved the
needle" in terms of improving access to care. He believes that the
solution lies in attracting students from the communities to be served.
Toward the end of the program,
Dr. Catalanotto summed up his thoughts on what is needed to further our
institutions’ efforts in this area. He listed a holistic approach to
admissions, community-based clinical rotations, in-depth experiences in
cultural competency, and faculty development in guiding these activities and
mentoring students in these complex endeavors. He also shared advice gleaned
from an insurance benefits industry representative at a recent meeting:
dentistry should rebrand itself with a focus on prevention and move away from
its emphasis on repairing teeth.
Dr. Evelyn Lucas-Perry, Public
Health Research Fellow at the National Institute of Dental and Craniofacial
Research and a recent dental school graduate, seconded several of Dr.
Catalanotto's suggestions and reminded her fellow panelists that students’
sense of social obligation is often tempered by the realities of burdensome
Dr. Rouse's final question to
the group asked, "What is to stop other professions from expanding their
scopes of practice to include oral health?"
Several replies pointed out
that this has already happened. Physicians, physician assistants, and advanced
practice registered nurses are already being reimbursed by Medicaid to provide
oral healthcare to 100,000 children under the age of four. Dr. Evans reminded
the audience that the Smiles for Life curriculum is specifically designed to
educate non-dental professionals in oral health care.
"I love these
movements," he said, “but we as a profession haven't yet fully embraced
these efforts. We should seize these opportunities for collaboration."
ADEA’s sister associations respect our leadership in IPE,
but as Dr. Rouse reminded the audience at the close of the session, "On
Capitol Hill, there are those who are watching this conversation within dental
education very closely and asking, are you truly making a move toward
interprofessional collaboration?" His implication was that dental education
stands to lose out if the answer is, “no.”