Grant Promotes Diversity of State’s Dental Work Force

The California Endowment recently approved a $6.3 million grant to fund up to four California dental schools to increase the enrollment of minority and low-income students. The project also aims to improve access to dental care for underserved populations through dental resident and student rotations in community clinics and practices that provide care to disadvantaged patients.

In 2000, less than 5 percent of California dental students were African-American, Hispanic, or Native American, and only 8 percent of California dentists are from these minority communities. Oral Health in America: A Report of the Surgeon General pointed out the need to increase the diversity of the dental workforce and linked this to improving the health of minority populations.

California has 68 dental health professional shortage areas, many in rural areas. Along with financial and administrative limitations in public and private insurance programs, these access problems are the primary reasons for the low percentage of California Medi-Cal eligible children who visit the dentist.

To address these workforce and access issues, California dental schools that receive support from the Endowment will participate in Pipeline, Profession & Practice: Community-Based Dental Education, a nationwide, 11-school initiative started by the Robert Wood Johnson Foundation in September 2002. Dental schools eligible to apply for these $1.3 million grants are Loma Linda University, University of the Pacific, University of California at Los Angeles, and University of Southern California. The University of California at San Francisco School of Dentistry is one of the 11 schools in the Robert Wood Johnson Foundation’s $19 million “Dental Pipeline” project.

“It is critical for one of the nation’s most diverse states to have an equally diverse health care work force. We are pleased to join forces with the Robert Wood Johnson Foundation in this important endeavor, and look forward to increasing the number of minority and low-income students enrolled in California dental schools,” said Jai Lee Wong, senior program officer for the Endowment.

“What a tremendous opportunity for the California Endowment and the Robert Wood Johnson Foundation, to mesh our individual philanthropic efforts into a focused area of concern,” added Judith S. Stavisky, MPH, MEd, senior program officer at the Robert Wood Johnson Foundation.

The “Dental Pipeline” program office is based at Columbia University’s Center for Community Health Partnerships under the direction of Allan Formicola, DDS, MS, at Columbia and Howard Bailit, DMD, PhD, from the University of Connecticut Health Center and Hartford Hospital. Kim D’Abreu Herbert, MPH, also at Columbia, serves as the program’s deputy director.

“Since there is such a limited pool of minority and low-income dental school applicants, it will be critical for all of the Dental Pipeline schools to work collaboratively; not only to increase their minority recruitment and enrollment efforts, but also to review policies affecting dental education and the attractiveness of the dental profession to underrepresented students,” Formicola said.

Bailit stated that “outreach by dental schools to underserved communities has a twofold purpose: It provides more care to disadvantaged patients and gives dental students and residents experience in caring for a diverse group of patients in community settings.”

The Center for Community Health Partnerships is a resource center than enables physicians, dentists, nurses, and public health professionals at Columbia University to collaborate with community-based organization on projects that reduce health care disparities.

For more information about Pipeline, Profession and Practice: Community-Based Dental Education visit http://dentalpipeline.columbia.edu.

The California Endowment was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians. The Endowment has regional offices in Los Angeles, San Francisco, Sacramento, Fresno, and San Diego with staff working throughout the state. The Endowment makes grants to organizations and institutions that directly benefit the health and well-being of the people of California. For more information, visit their Web site at www.calendow.org

On the Cover
The First Operation Under Ether (detail)

Robert C. Hinckley

The First Operation Under Ether, an oil on canvas by Robert C. Hinckley (1853-1940), depicts the introduction of anesthesia into surgery. It is actually an amalgamation of the three operations that were required to convince the medical community of Boston that painless surgery was possible. The painting, known worldwide as one of the best depictions of a surgical operation, shows actual surgeons who attended at least one of the three surgeries, though not necessarily the first. The painting was completed in 1894 and acquired by the Boston Medical Library in 1903. Used with permission of the Boston Medical Library in the Francis A. Countway Library of Medicine

Link Found Between Perio Disease and Oral Lesions

Dental researchers from the University at Buffalo have found a significant association between one measure of periodontal disease and oral precancerous lesions and tumors.

Analyzing data from the Third National Health and Nutrition Examination Survey, researchers found that people with serious periodontal disease were at double the risk of having a precancerous lesion and at four times the risk of having an oral tumor of any kind than people without serious gum disease.

Results of the study were presented at the American Association of Dental Research meeting in San Antonio in March.

“This is the first finding of a potential link between oral cancer and oral infection,” said Sara Grossi, DDS, a co-author on the study, “but there is evidence of an infection link in other cancers.” She noted research showing an association between Helicobacter pylori and stomach cancer, human papillomavirus and cervical cancer, and cytomegalovirus and Kaposi’s sarcoma.

“The potential implications of this association of gum disease and oral cancer is enormous,” said Grossi, clinical assistant professor of oral biology at the University of Buffalo School of Dental Medicine.

“Survival from oral cancer, as with most cancers, depends on the stage of the disease at diagnosis. If further studies demonstrate that periodontal disease is a significant risk and a warning sign, screening and examinations for oral cancer can be targeted in order to improve prevention and early detection of oral cancer.”

NHANES III was conducted in the general U.S. population from 1988 to ’94 by the Centers for Disease Control and Prevention. Physical examinations of participants included an assessment of oral health, including the amount of clinical attachment loss, a measure of gum detachment from the underlying bone, and a standard indicator of periodontal disease.

For this study, people in the NHANES III database who were at least 20 years old and had a minimum of six natural teeth -- a total of 13,798 -- were placed into one of two groups based on clinical attachment loss: less or more than an average of 1.5 mm for all teeth..

Researchers then determined the presence of oral tumors (any unusual growth), precancerous lesions, or any kind of soft tissue lesion (including canker sores, abrasions, redness, irritations, and general sore spots) in the two groups.

Results showed that oral tumors were four times more prevalent and precancerous lesions were twice as prevalent in people with periodontal disease (as assessed by clinical attachment loss) than in those without periodontal disease.

Researchers controlled for various conditions known to be risk factors for oral cancer, such as smoking, alcohol consumption, age, gender, race, education, occupation, diet, and number of dental visits.

“These findings suggest strongly that infection is associated with oral cancer,” Grossi said, “but they don’t prove that oral infection is causally related to oral cancer. If clinical studies prove that to be true, the implications for public health would be tremendous. Additional research in this area could significantly improve oral-cancer screening and early detection programs, and help reduce mortality from oral cancer.”

Bilingual Helpline Connects Hispanic Families With Health Services

A new bilingual health helpline has been opened to help Hispanic families get basic health information to help them prevent and manage chronic conditions, and to refer them to local health providers and federally supported programs.

The National Hispanic Family Health Helpline Su Familia, (866) 783-2645 or (866) SU-FAMILIA, is open Monday through Friday, 9 a.m. to 6 p.m. Eastern Time. It was developed and is operated by the National Alliance for Hispanic Health and is supported by the U.S. Department of Health and Human Services’ Health Resources and Services Administration and Office of Minority Health.

“Hispanics continue to face health disparities. This is unacceptable,” Health and Human Services Secretary Tommy G. Thompson said. “That’s why we are committed to getting information and resources to those communities where the health gap exists. By establishing the Su Familia helpline, we are helping families get access to the best health information.”

Su Familia bilingual information specialists are able to refer callers to one of more than 16,000 local health providers, including community and migrant health centers, by using the callers’ zip code. Callers can also request basic health information, referrals to information sources, or receive consumer-friendly, bilingual Su Familia fact sheets. Fact sheets are available for a wide variety of topics including asthma, cancer screening, cardiovascular disease, child and adult immunizations, diabetes, domestic violence, and HIV/AIDS.

Audiologists Say Dental Staff May Need Hearing Protection

Recent clinical experience and related research reveal that dentistry may be an at-risk profession for hearing loss, wrote audiologists at the Medical College of Georgia in an article in the December 2002 GDA Action, journal of the Georgia Dental Association.

They noted that dentists and their staffs have joined the ranks of others who are vulnerable to hearing loss: rock musicians, railroad and construction workers, and military personnel.

According to the National Institute for Occupational Safety and Health, noise-induced hearing loss is the most common occupational injury, the researchers write. The majority of the recent studies suggest that the noise levels experienced by the dental team have the potential to result in hearing loss and/or tinnitus (ringing or buzzing in the ears) for dentists and their staff who work with high-speed air turbine handpieces.

The articles cited one survey of California dentists that showed that every dentist who had purchased a high-speed handpiece also had some measurable degree of hearing loss, and that over half experienced moderate to severe tinnitus.

The researchers noted that loud noise levels in the dental environment can also affect patients. For some patients, the high noise levels can add to overall anxiety. Patients with sensorineural hearing loss often experience an acoustic phenomenon known as “recruitment,” an abnormal perceptual increase in loudness due to the hearing loss. These patients, the authors said, may be extremely sensitive to even moderately loud sounds.

The audiologists suggest that hearing protection and conservation needs to become a regular part of dental office protocol, especially for those directly exposed to noise-generating equipment.

Treatment Acceptance Hinges on Relationship With Patient

Dentists need to understand more about the total care of patients, addressing not only their physical needs but also their emotional or psychological needs, wrote Cathy Jameson, PhD, in Dental Practice Management, winter 2002 edition.

The days of telling a person what they need and having them immediately accept have come to an end, Jameson wrote. Informed patients want to participate in treatment planning and decision making. She stressed that each person on the dental team plays a significant role in making effective presentations.

Case presentations provide the challenge of educating and motivating people. Jameson said the purpose of the consultation is to make it possible for patients to go ahead with the dental treatment.

Jameson says there are six steps in a successful case presentation:

* Build the relationship. Confidence and trust must first be established before people will accept a service

* Establish the need. To establish the need, careful and caring listening is required to understand how patients feel about their dental needs.

* Educate and motivate. These are ongoing but are most critical at the time of the consultation.

* Ask for a commitment. Jameson said it is necessary to ask for a commitment or people can walk out without deciding. Asking for a commitment also determines whether patients have any objections or barriers.

* Make a financial arrangement. This should be done before scheduling appointments, Jameson said.

* Schedule appointments.

Jameson said that dentists who follow this six-step process of case presentation will find acceptance rates will increase.

Tooth Loss Can Be Emotional Experience for Some Patients

A study by Canadian researchers found that 53 percent of partially dentate people found it difficult to come to terms with their tooth loss, according to an article in the November 2002 Oral Health.

The study investigated the reactions to tooth loss in a partially dentate group of 100 people using a questionnaire-based study.

The researchers found that partially dentate people who experienced difficulties in accepting their tooth loss were more likely than those who had no difficulties to feel less confident, restrict food choice, enjoy food less, avoid laughing in public, and avoid forming close relationships.

Of the 100 people in the study, 91 completed the questionnaire, 38 men and 53 women. In 78 percent of the cases, people had missing anterior teeth and 22 percent had only posterior teeth missing. Of the participants, 81 were wearing partial dentures and 10 were in the process of having their first partial dentures constructed.

When asked if they found it difficult to accept losing teeth, 53 percent reported difficulty accepting tooth loss and 41 percent said they had no difficulty accepting it. The overriding emotion felt by those who had no difficulty in accepting the loss of their teeth was one of relief. People who experienced difficulties expressed a wider and more complex range of emotions. The most common were sadness, depression, and feeling old.

The researchers also found that 51 percent of those who experienced difficulties with tooth loss felt that they had been unprepared for the effects that tooth loss had on them. Those people said that an explanation from the dentist would have helped.

Hygienists Speak up on What Makes Them Stay at Their Jobs

Dental staff members who think their employers are fair and generous are happier than those who don’t, wrote Janyce Hamilton in the January/February 2003 CDS Review, journal of the Chicago Dental Society. And, Hamilton added, when staff is happy, retention and recruitment is not a problem.

Hamilton’s article detailed the responses from hygienists across the country who were asked: What do dentists have to do to make their staff happy? The responses came in the form of first-hand stories of what the hygienists love about their employers.

In their responses, the hygienists noted many reasons for liking their employers, including:

* Excellent pay;

* Better-than-average benefits;

* Easy to talk to;

* Pride in their work and compassion for patients; and

* Day-to-day kindness and mutual respect.

Hamilton wrote that many of those who responded to the survey noted that small things matter. Little kindnesses do not go unnoticed, according to many of the respondents.

Honor

Carl G. Lundgren, DDS, of Rolling Hills Estates, Calif., has been installed as president of the USA Section of the International College of Dentists. He was concurrently selected to serve as the president of the Foundation of the Pierre Fauchard Academy. (photo)

Upcoming Meetings

2003

June 6-8 Academy of Dental Sleep Medicine 12th Annual Meeting, Chicago, (708) 273-9335, www.dentalsleepmed.org.

June 13-14 38th Annual Allyn D. Burke Dental Symposium, Naval Postgraduate School, Monterey, Calif., (831) 394-2435.

June 19-22 OSAP 2003 Symposium, Tucson, Ariz., 800-298-OSAP.

July 17-20 Academy of General Dentistry Annual Meeting, Nashville, (888) AGD-DENT, www.agd.org.

Oct. 23-26, ADA Annual Session, San Francisco, (800) 232-1432.

Nov. 8-9 International Conference on Evidence-Based Dentistry, Chicago, j.ryley@elsevier.com

Dec. 5-7 California Academy of General Dentistry Annual Meeting, San Diego, (877) 408-0738, www.cagd.org.

2004

Sept. 8-11 International Federation of Endodontic Associations Sixth Endodontic World Congress, Brisbane, Queensland, Australia, www.ifea2004.im.com.au.

Sept. 10-12 CDA Fall Scientific Session, San Francisco, (916) 443-3382, Ext. 4470.

Sept. 30-Oct. 3 ADA Annual Session, Orlando, Fla., (312) 440-2500.

Nov. 1-9 U.S. Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524.

To have an event included on this list of nonprofit association meetings, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.