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The Dental Center of Northwest Ohio is a 106-year-old
organization providing high quality dental care for all,
especially for underserved populations. The Center’s great
work has largely continued under the radar despite its noble
commitment to addressing disparities in oral health and lack
of access to dental care for African Americans and other
minorities.
I
recently spoke with Melinda (Lindy) Cree, the Dental
Center’s executive director and Lisa Lawson-LaPointe,
development officer, about the Center’s work and of some of
the oral and systematic health challenges faced by African
Americans.
This is part two of our conversation.
Perryman:
We last talked about diversity in your organization and the
ability of minorities to make a living in the dental health
field.
Lindy:
Yes. Salaries are probably anywhere from $11 to $24 an hour
depending on the credentials that the assistant has, and
it’s not huge, but it’s a respectable salary without a
four-year college degree, and there is always work.
We’re also now working
with the Pathways Program, which is also a certificate
health program where community health workers work with
people who have chronic illnesses, heart disease, high blood
pressure, those kinds of things, to make that sure they can
get into a treatment plan, not only here, but elsewhere with
a primary care physician or maybe even a specialist.
And that’s one of the
dimensions that we offer our patients that the average
dentist doesn’t do. We can help connect people with a
primary care physician or, if they have housing issues, we
can help them deal with that. Just about any area where
disparities exist, we can help.
So we really do more than
just look at the mouth, we look at the whole person. Many
of our patients have barriers, whether its transportation or
childcare or income, our job is to make sure that we help
them overcome those barriers and get the care that they
need.
Perryman:
Can you talk a bit about structural issues within the
medical industry whereby reimbursement rates and insurance
don’t exist for oral healthcare as they do for other medical
needs? Why does this gap between medical health and
dentistry exist?
Lindy:
Dental schools and medical schools studied together for many
years. However, in the 1890s, the schools were separated.
Afterwards, it became like the mouth became disengaged from
the rest of the body, and MDs learned very little about
dental needs, dental disease, how the diseases spread, or
the various conditions of the mouth. And even though medical
doctors look in your mouth and look at your tonsils, they
just glance right past the teeth as though they didn’t
exist.
And so I think that was
the beginning of dental not being considered as part of
physical health. Teeth were just separated, and frequently
anything dealing with the head is separate from the rest of
the body. We talk a lot about systemic health, but whether
it is mental health, vision, otology or dental, they’re
separate from overall systemic health, and I think then the
insurance industry including the government, began to look
at them differently. And so, now these others are all
optional under Medicaid for adults, they’re not considered a
required service and are not part of the 10 essential health
benefits that must be offered under the Affordable Care
Act.
However, I think research
in the last 10-15 years is indicating that there is
definitely a relationship between systemic health and oral
health and that the mouth is the gateway to the body, and
over the next 20+ years, I suspect we will see more of an
integration of oral health back into systemic health.
They are looking now at
problems with preterm labor and delivery and how low birth
weight can be traced to periodontal disease. Also, if you
have a lot of plaque in your mouth, you’re more likely to
have heart disease because some people just make more plaque
than others, so you find it in their veins, so there’s a
connection there. If you have infection in your mouth and
you don’t treat it, it travels to other places in your
body. Do you remember several years ago, Deamonte Driver?
Perryman:
I do. Driver was the 12-year old seventh grader from Prince
George County, Maryland…
Lindy:
Okay, that poor child…
Perryman:
He died because of a tooth infection.
Lindy:
Right, but it took two surgeries and the removal of portions
of his brain for the MDs to realize that the source of the
infection in the brain came from the tooth. Even if he had
lived, they had removed parts of his brain that would have
necessitated a lot of rehab in order for him to learn to
speak and walk and write. And it’s just so sad that for the
lack of someone saying this child has a dental infection
that they couldn’t connect it.
And so that I think is one
of the motivators to doing more of this research. There was
a woman in northern Michigan, she had an oral surgeon that
was willing to extract a tooth that was abscessed, but
before they could find a hospital that would accept her
Medicaid, she died. That’s not right. It should not happen
in this country.
So it’s time, and I think
we’re seeing that momentum in health now, to bring the mouth
back to the rest of the body. There are now doctors,
dentists that are practicing here in Toledo that are both
MDs and DDS’s, and they’re bringing the areas back together
so that when we look at a person we look at the whole
person.
We are now reimbursing
pediatricians through Medicaid to apply fluoride varnish to
strengthen teeth of children under the age of five. When I
started here 16 years ago, that was unheard of, but we are
now training pediatricians to look at teeth and to notice
them. We did a training here in Toledo with some faculty
from the Ohio State Dental College last May that we
encouraged nurse practitioners and pediatricians to attend
and explained what some of the disease processes are in the
mouth of young children so that they could start looking and
making appropriate referrals.
There is now the
recommendation of both the American Academy of Pediatrics
and the American Dental Association that a child should have
the first dental visit by the first birthday or as soon as
the first tooth erupts. Not because the child has a lot of
dental problems, but as a preventive measure. Most infants
go to the pediatrician seven times in the first year of
life, but many pediatricians and even dentists will say,
“Oh, you don’t need to go to the dentist until you’re
between three and five.”
Well for a lot of
children, especially at risk children, that’s way too late,
because once bacteria gets a hold in the mouth at one, two
or three, it’s there for a lifetime. So I think it’s
beginning to turn around, but it’s going to take us a
generation to make that happen.
Perryman:
For oral health education to become incorporated as a
holistic curriculum?
Lindy:
Overall, yes. It’s amazing, you wouldn’t have a gaping open
wound on your arm walking around like that. That’s
essentially what tooth disease is. A cavity is a hole, like
you would have on any other part of your body. Most people
would go and they would get that taken care of. Why? For
fear of infection. But they can’t see in their mouth, and
it doesn’t always hurt.
Perryman:
Well, talk about, oral health and today’s challenges for
African Americans.
Lindy:
Well, challenges definitely exist. I think for a lot of our
patients if they come to the dentist, if they have a job and
it’s a job paying lower wages, they may have to take time
off work without pay. So I think there are definite
disparities in terms of the obstacles involved, including
that of just getting to the dentist.
Perryman:
And in your studies in public health, are you seeing higher
incidences of cavities, of specific oral diseases in African
Americans or lower income people, elderly, blacks and
Hispanics compared to whites and general population?
Lindy:
All of those are at risk populations, and a lot of it, is
you learn what you live. So, we have a large population of
people who their parents didn’t go to the dentist and their
parents’ parents didn’t go to the dentist, and so that’s
just the norm in the family. So prioritizing oral health in
situations of generational poverty is a huge, huge problem.
I also think that people,
all people, but particularly people in a more at risk
environment, if the teeth don’t hurt, they don’t worry about
seeking dental care.
And then, there are issues
related to nutrition, drinking soda versus water, what’s
available on the food stamps programs. You can get soda pop
on the food stamp card, but you can’t get toothpaste or a
toothbrush. So there are lots of different issues, including
lots of different myths and things in there.
Unfortunately, for a
number of years most oral health education was done in the
dental chair when you went to the dentist, so if you didn’t
go to the dentist you didn’t know, so you’d listen to your
grandmother and if she said put a little bourbon on that
child’s gums when they’re teething, you put a little bourbon
on their gums.
So, the Dental Center of
Northwest Ohio is attempting to bridge the gap. Oral
healthcare, preventive care, oral cancer screenings and
cleanings are all so important in reducing the large
disparities.
Contact Rev. Donald Perryman, D.Min, at
drdlperryman@centerofhopebaptist.org
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