When it comes to dental caries in very young children, Jessica Y. Lee, D.D.S., M.P.H., draws a blunt conclusion. "Dental cavities
in young children are preventable," she insists. "The disconnect in the way we communicate with our patients and what they understand
is the problem."
To support her contention, this Associate Professor from the University of North Carolina (UNC) at Chapel Hill School of Dentistry cites evidence from the National Assessment of Adult Literacy, which reports that only 30% of patients fully understand what they are told by health care providers.
"If you have ever sat through an appointment with a fourth-year dental student or a dentist, for that matter, you cannot believe some of what comes out of our mouths," she confides, citing the frequent use of dental terminology far beyond the reach of even well-educated patients. "We are good at teaching students to cut the perfect cavity preparation, but we don't do enough in the area of patient communication."
Dr. Lee recognizes that solving this problem does not rest solely with dental educators. Inadequate literacy of all types is a national problem, too large for the dental community to tackle on its own, but she believes it is possible for health professions schools to make an impact in the area of health literacy. Even with the basic sciences, clinical dentistry, and numerous other topics competing for space in the curriculum, she makes the argument that patient communication is used every day with every patient and is "equally, if not more, important."
Dr. Lee's quest to improve oral health literacy targets the caregivers upon whom young children rely. She is the principal investigator for a $3 million study addressing how the oral health literacy of caregivers and parents affects the oral health outcomes of preschool-aged children. The National Institute of Dental and Craniofacial Research (NIDCR) is supporting her research with a $1.8 million R01 grant and additional funding through a Presidential Early Career Award for Scientists and Engineers (PECASE) that Dr. Lee received in 2010. The study is a collaboration with the Department of Psychology at UNC's College of Arts and Sciences and the Department of Health Policy and Management at UNC's Gillings School of Global Public Health.
Dr. Lee's team has enrolled 1,400 caregiver/child dyads in the study and plans to follow most of the children through age 5. Using the REALD-30, an instrument developed earlier by Dr. Lee and her colleagues, the team has assessed caregivers on their levels of health literacy, health status, health behaviors, and oral health knowledge. Among the interventions the team plans to use are motivational interviewing and its abbreviated cousin, brief motivational interviewing. Some of their baseline results have been published in Pediatrics,American Journal of Public Health,Journal of Dental Research,and Journal of Public Health Dentistry.
Dr. Lee believes the day may not be far off when health literacy becomes part of the standard dental curriculum. "I am impressed with how readily the physician community and its associations have embraced health literacy," she says, "so maybe we're not too far behind. People see the benefits of communicating differently. They enjoy getting through to their patients."
Health literacy is already integrated in several dentistry and dental hygiene courses at UNC. What's more, the university offers training-through its Carolina Geriatric Education Center-to faculty from all of its health professions schools in how to integrate health literacy in a clinical setting. Dr. Lee takes heart from the fact that NIDCR and the American Dental Association (ADA) have also made health literacy a priority, and that within the dental community, at ADEA and at the American Association of Public Health Dentistry (AAPHD), as well as elsewhere, the topic is actively discussed.
In addition to furthering knowledge and developing tools that dentists can use to improve their patients' understanding of oral health, Dr. Lee's activities are generating increased visibility for this issue. This year, her efforts earned her the 2011 Pediatric Dentist of the Year Award from the American Academy of Pediatric Dentistry (AAPD). She was recognized with the association's "Jerome B. Miller "˜For the Kids'" Award in 2008.