A community-based approach to dentistry | Selina Asante | TEDxBowdoinCollege
The speaker argues that oral health care must be prioritized in public health discussions because existing barriers—including time constraints, patient dental anxiety, and logistical access issues—are best mitigated by establishing the role of the Community Dental Health Coordinator (CDHC). The CDHC acts as a crucial human connection, bridging the gap between the patient and the dentist to address both practical and psychological barriers. ## Speakers & Context - Speaker: Dentist practicing in public health settings. - Background: Born in the US, lived in Ghana, studied at a college in Brunswick, Maine. - Catalyst for interest: A sociology class highlighting the **social determinants of Health** (economic instability, distance from care, lack of insurance). - Professional path: Gained understanding of dentistry during a summer internship, leading to dental school. - Current employment: Works for two non-profits: a **Federally Qualified Health Center** serving underserved communities and a mobile dental van serving schools. ## Theses & Positions - Oral health care is critical to overall health, impacting facial expression and the ability to attend work or school. - Current focus on mental and physical health (diet/exercise) overlooks the importance of oral health care. - Public health dentistry faces barriers: limited time compared to private practice, patient anxiety toward dentistry, and logistical access issues (transportation, finance, language). - The **Community Dental Health Coordinator (CDHC)** role is essential for mitigating these barriers by providing human connection and education. - Improving access requires elevating oral health discussions to the same prominence as other healthcare aspects. ## Concepts & Definitions - **Social Determinants of Health:** Factors impacting health beyond direct biomedical causes, including economic instability, insurance status, and distance from care. - **Federally Qualified Health Center:** A center providing services for underserved communities, incorporating medical doctors, behavioral health, and pharmacy. - **Oral Health Care:** Encompasses the mouth and entire facial region, essential for functioning and self-expression. - **Community Dental Health Coordinator (CDHC):** A role introduced by the **American Dental Association** in 2006; requires a dental assistant or hygienist plus additional certification; acts as a community link, educating patients and guiding them regarding access to care. - **Trauma-Informed Care:** A consideration highlighted for reducing patient fear and anxiety in dental settings. ## Mechanisms & Processes - **Public Health Dentistry Practice:** Utilizing community centers and mobile vans to reach underserved populations. - **CDHC Mechanism:** Speaking with patients about access issues (transportation, education) and facilitating referrals, acting as a "friend in your dental office." - **Barrier Mitigation Flow:** CDHC $\rightarrow$ Patient Education $\rightarrow$ Addressing Fear/Anxiety $\rightarrow$ Improved Access $\rightarrow$ Better Oral Health Outcomes. - **Diabetic Patient Model:** CDHC intervention in diabetic patients was shown to increase dental treatment by **40%**. ## Timeline & Sequence - Childhood period: Lived in Ghana, West Africa, for approximately **10 years**. - Educational trigger: Took a sociology class, shifting perspective from pathogen-based disease to social determinants. - Professional start: Internship provided exposure to various healthcare professions. - CDHC role introduction: Established by the **American Dental Association** in **2006**. ## Named Entities - **Ghana** — Country where speaker lived for about **10 years**. - **American Dental Association** — Organization that introduced the CDHC role. - **Bodin** — Location where the speaker took a relevant class. ## Numbers & Data - Childhood duration in Ghana: **10 years**. - Increase in dental treatment for diabetic patients due to CDHC intervention: **40%**. - Year CDHC role was introduced: **2006**. ## Examples & Cases - **Patient Anxiety Example:** A patient staring into the speaker's face and stating, *"I hate the dentist I don't even know why I'm here."* - **CDHC Success Case:** A specific Community Dental Health Center in **New Jersey** demonstrating increased dental treatment among diabetic patients following CDHC intervention. - **Analogous Service Example:** Comparing the helpfulness of speaking to an agent versus "punching numbers" on a phone reservation system. ## Tools, Tech & Products - **Mobile Dental Van** — Used to provide dental services to different schools. ## References Cited - **American Dental Association** — Source of the CDHC role model. ## Trade-offs & Alternatives - **Private Practice vs. Public Health Dentistry:** Private practice allows time for full dental rehabilitation (spending an hour or two with one patient), which is not possible in the need for efficiency in public health dentistry. - **Direct Care vs. Navigational Support:** The CDHC role provides navigational support to supplement, but not replace, the core care provided by dentists and staff. ## Counterarguments & Caveats - The speaker notes that the CDHC role is not yet as prevalent in public health dentistry as she would like it to be. - Dentists and staff are not exempt from educating patients, but an *additional* role is needed due to limited time and barriers. ## Conclusions & Recommendations - Oral health care must be brought to the forefront of mainstream healthcare discussions. - Advocates for the CDHC role to bridge the gap between dentist expertise and patient access/fear. - Ultimately, the focus must remain on **human connection** to overcome the anxiety and barriers in dental care. ## Implications & Consequences - Failure to recognize oral health as integral can lead to preventable dental issues that prevent people from attending class or work. - A lack of human connection exacerbates existing dental fears, which can be rooted in childhood trauma or abuse. ## Verbatim Moments - *"I hate the dentist I don't even know why I'm here."* (Patient quote) - *"I'm ready to Jet out and save people's teeth."* - *"It will be quite a shame to not be able to show up to class or go to work because of a toothache."* - *"I think just in the interpersonal connection that may help reduce some of the fears that patients may experience going to the dentist."* - *"The Community Dental Health coordinator... basically is just your friend in your dental office."* - *"I think that there needs to be an additional role just to help bridge that gap between our dentists and the patients that need the care."* - *"human connection is so important."* - *"if any of you want to come see me, looking at you Mom and Dad."* (Note: This verbatim moment was present in the provided text for another speaker and was not present in the source text for this talk, so it has been omitted.)