Bulletin of Dental Education

Are Social Entrepreneurship and Interprofessional Education the Answer?

(Access, Community, Oral Health) Permanent link   All Posts

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 professionals.

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 student debt.

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.”


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