Reducing Oral Health Disparities Requires a Multidisciplinary and Community-Focused Approach
Amid Ismail, BDS, MPH, MBA, DrPH
Dean of Temple University’s Maurice H. Kornberg School of Dentistry
Oral health disparities persist in the United States especially among members of racial and ethnic minorities, the unemployed, and people of low socioeconomic status. Disparities in oral health are determined by a complex mix of biological, behavioral, cultural, social, economic, and political factors. Social determinants of health include availability of health services, social support, income, education, occupation, and structural inequality, as well as cultural beliefs and attitudes.1
Two populations with the greatest health, social, and oral health disparities are homeless elderly adults and refugees. To improve the health of these populations, programs need to be holistic and use multidisciplinary teams to provide not only dental care but also medical, nursing, and mental health care as well as social work and nutrition education.
The featured innovation, Cross-Training of Medical, Dental, and Psychiatric Fellows Enhances Access to Comprehensive Care for Homeless and Formerly Homeless Older Adults, reflects an interdisciplinary approach to providing care for underserved older adults. Fellows from medicine, psychiatry, and dentistry complete a 6-week rotation and collaborate on consultations and care to homeless or formerly homeless adults. The fellows also enhance their learning and skills by participating in weekly didactic sessions and reviewing cases during monthly conferences.
The multidisciplinary team would be enhanced by recruiting social workers to work with the fellows and address social disparities experienced by the homeless population. For example, a social worker in a MSW program could participate in the training during a clinical rotation or serve as the liaison to the homeless community by coordinating care with the dental team, finding people in need of dental care, and promoting the program. The social worker could also communicate feedback from the homeless population to the fellowship program. This type of multidisciplinary geriatric fellowship is a good model for other geriatric training programs in medicine, dentistry, and psychiatry.
The featured innovation, Oral Health Program Offers Screening, Education, and Referrals for Followup Care, Enhancing Access to Culturally Sensitive Dental Care for Refugees and Asylum Seekers, targets recent refugees (regardless of their legal status) that don’t typically seek dental treatment due to social stigma attached to their minority status, limited English proficiency, cost of care, and fear of unfamiliar medical procedures.
The Boston Center for Refugee Health and Human Rights at Boston Medical Center established the oral health program to ensure that refugees had access to dental services and refers patients to the program. One strength of the program is the training that dentists receive to be culturally sensitive and understand common experiences that refugees and asylum seekers endure—including torture. This training increases the patient’s comfort level and facilitates identifying issues affecting the patient’s oral health. Dentists also use interpreter services to ensure cultural and linguistic appropriateness.
A weakness of the program is that it relies solely on dentists and doesn’t use community health workers from the refugee communities to conduct outreach and elicit their input into the program design. A recent study of community health worker interventions by the Agency for Healthcare Research and Quality found that community health worker interventions can improve participant knowledge when compared with alternative approaches such as no intervention, media, mail, or usual care plus pamphlets.2
Ideally, the community health workers would also coordinate referrals to other dental providers, and serve as the liaison between the dental program and the Center’s medical, mental health, legal and social services.
References
1Patrick DL, RS Lee, M Nucci et al. Reducing oral health disparities: a focus on social and cultural determinants. BMC Oral Health. 2006 Jun 15;6 Suppl 1:S4. [PubMed] Available at: http://www.biomedcentral.com/1472-6831/6/S1/S4.
2Outcomes of Community Health Worker Interventions, Structured Abstract. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/clinic/tp/comhworktp.htm.
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Original publication: October 28, 2009.
Last updated: October 28, 2009.
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Associated QualityTool:
Oral Health Exam
(10/28/09)
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