Category: Blog

I am proud to work with the Arcora Foundation, the foundation of Delta Dental of Washington. Our vision is that all people can enjoy good oral and overall health, with no one left behind. Through advocacy, programmatic work, and grantmaking, Arcora Foundation focuses on prevention and access in underserved communities where disparities are significant—specifically Black, Indigenous, and People of Color (BIPOC). We are a passionate, creative and committed team that cares deeply about the work we do and the communities we serve.

While our work is interesting (really, it is!), it doesn’t always lend itself to good cocktail party conversation. Typically, when I begin to talk about what I do, people’s eyes glaze over, they start asking about dental insurance, or they tell me they need to refresh their drink. Though others may not find oral health particularly glamorous, Arcora Foundation’s work improves, and sometimes saves, people’s lives.

My personal journey into dental public health began at the University of North Carolina, where I got my master’s in public health, focusing on health behavior and health education. In one of my first epidemiology lectures, the professor talked about one of the most effective public health interventions ever: community water fluoridation. I became motivated by the sad reality that not all people experience access to equitable health care and treatment. I believe that: 1) healthcare is a right – not a privilege; 2) our systems are flawed and need much help and attention; 3) behavior change is VERY difficult; and I could go on – but a major area of hope is in prevention!

Prevention saves money and improves people’s health. So preventive health has been my career (and personal) focus and passion. Following graduate school, I moved to Seattle where I began working in the Group Health Cooperatives’ Center for Health Promotion. I felt fortunate to land with this group who was doing amazing preventive-based work which included a robust smoking cessation program, cancer screening programs, patient education resource development and most notably planning for a future in healthcare with an electronic health record rather than paper charts. One project I worked on with the Center’s well-child committee, updating the well-child visit templates to prompt healthcare providers to address key prevention areas with their young patients. I have a confession here: Kaiser California shared their well-child templates with me, and Kaiser’s templates included questions about children’s oral health. Sadly, our pediatric committee decided that we shouldn’t include oral health questions on our template. The committee didn’t recognize the importance of oral and overall health since dental was not part of the Group Health system of care.

(But there is good news! Today, I am pleased to report that I work with this same medical system to help them with oral health integration, including training their residents.)

After my time at Group Health, I moved to the UW Child Health Institute, where I worked with medical teams across Washington to help them integrate best practices into the care they provided through quality improvement. From there, it was an easy transition to Arcora Foundation (Washington Dental Service Foundation at the time) to continue to support medical teams across WA but this time focusing on the integration of preventive based oral health services into well-child visits. This seemed like it might be a short-term project, but as we have come to learn, good oral health is key to good overall health, and many children (and adults) who have trouble accessing dental care in dental clinics can do so in a medical office.  Turns out, this short-term project has been my passion for the last decade plus. At this point, I consider it my life’s work.

My work is challenging as medical teams have so much to address with patients, and oral health needs might not be as urgent as others during medical appointments. But I am happy to be part of national and local efforts to make oral health part of medical providers’ standards of care. I now consult with partners across the country who have similar programs. In 2014, the US Preventive Services Task Force made fluoride varnish a grade B recommendation, showing the evidence and importance of this work.  I am training and coaching more medical education training programs – including residencies, ARNP and DO programs – every year. My future ambitions are to get further upstream by reaching students in all medical fields. In the meantime, I continue to support large and small medical teams across Washington to address the leading preventable chronic condition of childhood: oral disease. I feel so fortunate to get to work with amazing medical teams across the state who are doing such great work in caring for children and families. They all have so much work on their plates. I am always impressed and awed by their dedication and big hearts for the important work that they do.

In closing, I’d like to share Lisa Lee, MD, FAAP’s perspectives on delivering oral health services in medical settings. Dr. Lee is a partner of mine and an oral health champion.

Pediatricians take the time to listen to our patients and their caregivers, to meet our families’ needs and to engage them in preventative care. They trust us as we strive to create a safe environment of open communication and education. As pediatricians, we are instrumental in teaching our families how nutrition can affect both dental and health well-being and how proper brushing and using fluoride can keep our teeth healthy from an early onset. This education helps to reinforce the Dental Profession’s Optimal Oral Health message as we collaborate with them. Let’s continue to be champions for both the health and dental well-being of our patients! 

Lisa Lee, MD, FAAP South Sound Pediatrics

 

Hello from Boston! My name is Elizabeth Alpert, and I am pursuing a path in dental public health. Beginning dental school, I envisioned a career in clinical pediatric dentistry, but I soon realized how quickly goals change with experience and exposure to new perspectives.

As a dental student at the University of Buffalo School of Dental Medicine, I had the opportunity to participate in numerous outreach events throughout the city. Although I grew up in the area, I was unaware of the reality of barriers to oral health care among different communities. This was my first exposure to the concept of social determinants of health – “the conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes” (CDC). The importance of public health resonated more and more deeply, and I began to seek experiences beyond Buffalo.

Across the country, in vastly different settings, I repeatedly saw the same theme. Unintended consequences of systems-level policies catalyze inequities and inefficiencies in the US health care system, translating to dental disparities. Ultimately, I realized that the part of dentistry I was passionate about was addressing disparities in access to quality oral health care, which is critical to overall health and well-being.

Through outreach, I also realized how much I loved geriatric dentistry – which further changed my plans for pediatric dentistry. Instead, I decided to complete a GPR in Hospital Dentistry, at an institution with a strong MPH program. During my PGY-1 at the University of Washington, my rotations at different Seattle-based hospitals and medical centers undermined the connection between oral and systemic health. I also began realizing my clinical interest in treating adults with developmental and intellectual disabilities, and I completed a PGY-2 year in Special Care Dentistry. At this point, family obligations brought me to Boston, and I completed my MPH at the Harvard T.H. Chan School of Public Health.

Currently, I am dividing my time between teaching, research, and clinical practice as I figure out the next step in my career. I am grateful to truly enjoy teaching dental students at the Harvard School of Dental Medicine (HSDM) and dental hygiene students at the Forsyth School of Dental Hygiene; collaborating on oral health policy research with the HSDM Oral Health Policy and Epidemiology team; and practicing general dentistry in a private practice setting to strengthen my clinical skills.

For other early-career dental providers who face a similar dilemma – realizing that their true passion in dentistry is for dental public health and addressing population-level issues, rather than clinical dentistry treating individual patients, I’d like to share two main themes from my story. The first is to take your path one step at a time and know that even if is non-linear and impacted by factors beyond your control, following your passion will start taking you closer to the place where you best fit in dentistry. Secondly, develop relationships with mentors who share your core interests and truly care about you as a person beyond your dental skills, and trust their guidance. I am so grateful for my mentors, including Debbie Licata, Ana Lucia Seminario, Kim Espinoza, Ashland Doomes, and Jane Barrow – thank you all!

Warm greetings from Thailand. My name is Sawita, a lecturer in the Department of Oral Biomedical Science, Khon Kaen University (KKU), Khon Kaen, Thailand. I had an opportunity to attend the summer course in 2015 and continued in a long-term training program combined with KKU PhD in Oral Science curriculum, funded by the National Institutes of Health (NIH) and KKU. I have had inspiration academic purpose from mentors and friends from many countries since then. We have learned and shared our knowledge and experience in improving oral health/dental school curriculum, culture, etc. In 2015, dental public health was out of my interest (I have backgrounds in dentistry and neurophysiology of cardiovascular response to dental pain in a rat model). I was impressed with clinical and behavioral research methodology, epidemiology, and biostatistics. Integrating all these into my work creates more fun and, of course, benefits my career so that I can distribute them to my patients and students.

I started a project which was new to me both in science and methodology. My project was about the innate immunity function of taste receptors relating to dental caries and periodontal disease in Thai dental patients. Learning new things and developing new skills were challenging. I’ve had struggled along the way. All the mentors in the program were very understanding and provided me with all their support to achieve my goal. I’ve learned academic and life skills from all the mentors. I feel that they work so hard in collaborating between countries/universities. Besides the curriculum, I feel thankful to have them devoting their time guiding me through the journey. I am ready to pay it forward and learn more to help improve dental public health.

My name is Immaculate Achieng’ Opondo, from Kisumu County, which is in the Western part of Kenya. I am a Pediatric Dentist working with Maseno University School of Medicine. I love working with children and I am passionate about Pediatric Dentistry. This passion began early in my career when I developed a desire to help children with dental problems, after I realised some reluctance by colleagues to treat them due to their behavioral issues. During this period of interest, I noticed that the children had high levels of dental caries, and I immediately started outreach activities in nursery schools. With time, I got motivated to enhance my skills which pushed me to the next level of master’s training in Pediatric Dentistry.

The decision to further my education opened a new window of opportunities for me. It is during this period that I appreciated the importance of research and the impact of HIV/AIDS on oral health. By taking care of HIV infected children, I began to understand the health, social and economic struggles associated with HIV infection. It is also during this time that I met Dr. Arthur Kemoli (University of Nairobi).  Through him and Dr. Ana Lucia Seminario (University of Washington), I   received funding from International Association for Dental Research (IADR) that enabled me to attend the Summer Institute in Clinical Dental Research in the University of Washington.  This was a wonderful opportunity which not only whet my appetite for research, but also exposed me to a new mentor, Dr. Ana Lucia Seminario.  Immediately after I got home from the Summer Institute, I was able to write a research proposal, get ethical review and start data collection on oral health status of under five-year-old children in Kisumu County primary schools. Unfortunately, this activity was disrupted by the COVID-19 pandemic. I look forward to continuing with data collection once the disease is controlled.

Ana Lucia Seminario and Arthur Kemoli have continuously encouraged me to pursue my research goals. Now, I am working alongside them as they guide me through grant writing and research work. I am hopeful that with this kind of exposure, I will continue growing my research skills to the point of being a mentor to other upcoming oral health researchers.

I am Yan Wang. I was born in China with a great passion for numbers. My undergraduate major is Mathematics, with a double major in Computer Science. I received my PhD in Biostatistics of School of Public Health at UCLA in 2019. My research passion is the joint research of HIV and oral health.

My passion in HIV/AIDS research started from a multi-site adherence collaboration in HIV across sixteen studies from fourteen universities and institutions. With the opportunity to collaborated with all world well-known scientists, I was responsible for coordinating the data transfer, data management, statistical analysis as well as modeling and publications. We used Medication Event Monitoring System (MEMS®) to record the date and time medication events. In the later project, we used Wisepill® box (designed by a South African company), and then Ingestible Sensor (Proteus) to measure HIV adherence in real-time, together with customized text messages. It was very challenging to have optimal adherence lifetime, as it is hard to maintain the optimal adherence.

Meanwhile, long-term ART and HIV-infection have great impact on oral health. We found that the measures on overall oral health status and treatment needs was very limited. We used the approach of PROMIS (patient reported outcome measurement information system) to design a psychometric validated survey to measure children’s oral health status and treatment needs with a smaller number of questions using Item Response Theory and Machine learning algorithms. To further understanding the oral health of children, we conducted the oral health screening in Los Angeles County. The screening included screening for the prevalence of untreated decay, caries, and the treatment needs of kindergarteners and third graders in seventy-three public elementary schools. We luckily finished all screening activities before the pandemic. During the field work, we learned there are oral health disparities in children, even before they start school.

I received my T37 GATHER (Global Alliance for Training in Health Equity Research) fellowship in 2019. This fellowship supported my research in African Population Health Research Center (APHRC) in Nairobi, Kenya. I made a lot of friends with the researchers in Kenya. During that time, I learned of the work of both Drs. Ana Lucia Seminario and Arthur Kemoli. I joint their research team on the CHOMP (Children’s Healthy Oral Management Project) among HIV-infected children, the oral health of refugee children Washington State, and the infant oral mutilation traditional practice in East Africa. Since then, we have started an ongoing collaboration. After my GATHER training, I received my T32 UCLA postdoctoral fellowship in 2020, focused on Global AIDS prevention. I joint Dr. Grace Aldrovandi’s research team in 2020. I was very fortunate to participate in the COVID study of high-risk health services workers at UCLA and first responders in the Los Angeles County Fire Department. We compared the humoral responses to mRNA vaccine by prior infection and by vaccine type.

Now more than ever, with the burden of two pandemics, both HIV and SARS-CoV-2, it is critical to study global health, especially in low- and middle-income countries. Through my journey, I found my passion in the joint area of research of HIV/AIDS and oral health in the global setting. This motivated me to further investigate bacteria and virus in the oral environment, especially among HIV-infected individuals, whose immune systems are extremely vulnerable.

My name is Roberto A. León-Manco, I am a graduate of the School of Stomatology, Master of Public Health, and specialist in Dental Public Health at the Universidad Peruana Cayetano Heredia (UPCH). Once I finished my undergraduate studies, I was invited by Dr. Cesar Del Castillo to be part of the Academic Department of Social Dentistry (UPCH) to which I still belong and I was able to learn from all his mentors, especially Dr. Juan Bernal Morales, founding professor of the faculty and first specialist in dental public health in Peru. In my early years, I began teaching at the undergraduate level and later at the master’s level. Currently, I am the Coordinator of the specialty in Dental Public Health, and head of the Academic Section of Public Health and Dental Services Management.

Within my professional training, I was able to be part of the 10th Annual Summer School of Social Determinants of Health (SDH) at the University College London (UK). In this program, in addition to meeting many other public health professionals from around the world, having shared with Sir Michael Marmot and his perspective of the SDH was crucial to really understand the health problems of Peru and the need for a new approach, especially in the case of oral health. Other important internships were at the Research Center of Social Inequality and Governance at the Universidad de La Laguna (Spain) with Dr. Sara Darías-Curvo, and the research management internship at the Faculty of Dentistry of the Universidad de La Frontera (Chile) with Dr. Ramón Fuentes.

This last internship has been the most relevant in my current teaching activity. Dr. Jorge Beltran, Vice Dean of the Faculty of Stomatology at UPCH appointed me Coordinator of the Research, Science and Technology Unit, a position that aims to improve all research processes in undergraduate and graduate students and teachers. Recently, we approved the Strategic Plan 2021-2025 of the unit, with the collaboration of the faculty and collaboration of Dr. Ana Lucia Seminario of the University of Washington (UW). With this, a long-term objective has been established that will allow the faculty to place at a high level of research in oral health.

Currently, I oversee the Integrated Unit of Research, Science and Technology of the Faculties of Medicine, Stomatology and Nursing, which represents a different opportunity at the management level, being responsible for most of the research conducted at the university and promoting the main policies for the benefit of students and teachers. In addition to this position, I continue to engage in public health activities, continuing to train professionals and participating in research. Recently, together with the UW and the Direction of Oral Health of the Ministry of Health of Peru, we are organizing a program to improve the skills of oral health coordinators throughout the country, which will improve the health of all Peruvians.

Sawadee Ka, I am from Khon Kaen University (KKU) in the Northeastern region, “I-San”, of Thailand.  In 2008, I was back from the University College London, UK, after pursuing my PhD in Developmental Biology focusing on the cleft formation. At KKU, I am a senior lecturer of the Division of Pediatric Dentistry, Faculty of Dentistry, where I am responsible for teaching dental students and providing care for children in our Dental Hospital.  One of the burdens I was facing at that time, was giving emergency dental treatment for children with cleft lip and palate. Prevalence of children born with orofacial clefts in I-San is the highest among other regions in Thailand. The KKU Center of Cleft Lip Cleft Palate and Craniofacial Deformity was established in the year 2000, to systematically tackle this health issue by an interdisciplinary team. These children were mostly from underprivileged family backgrounds. The limited access to appropriate oral health care has reflected in severe and untreated dental caries since they were in the preschool age. Their complicated congenital craniofacial deformities that greatly affected feeding and appearance had taken all the attention from the family, therefore brushing the child’s teeth was usually the last thing in their mind. We soon realized that increasing the family awareness on maintaining good oral health and providing access to dental care should be incorporated as part of the cleft treatment protocol.

After joining the KKU Cleft Center in 2010, I led a social service project entitled “Big Smile, Bright Teeth” to improve the oral health status in children with clefts.  A holistic approach was implemented by creating a fast track for regular dental examination and treatment, at the time when patients attending the Center for other healthcare, such as speech training. The significance of good oral health and instruction for oral care at home was given to the parents, via empowerment group activities, at early stage and regularly in the cleft protocol. Dental students both undergraduate and postgraduate had volunteered to help providing dental treatment for these children, in which they also learn to work with the special needs, their families and with the interdisciplinary professionals. It had been a pleasant experience for these future dentists and the young specialists. I hope that they would carry on working with children with special needs in the future.  Ten years on in the project, we have clearly seen the reduction of untreated caries in our preschool children.

As my background was mainly involved molecular biology, I had gained some valuable experience in research in dental public health via a workshop in 2010, supported by NIH Fogarty Funding, entitled “International Workshop on Clinical Research Methods in Oral Health”.  This is a part of the jointed training program organized by KKU Faculty of Dentistry, Thammasat University Faculty of Dentistry, and University of Washington School of Dentistry.  Following the workshop, I had been recruited in a few clinical research teams funded by NIH. All of these give me the courage to take on clinical research in children with cleft lip and palate, alongside with improving the sustainability for oral health care for them.  We are now setting up a network with local primary care centers around the I-San as well as become part of a Global Task Force “Cleft without Caries”.  This is my small journey and I enjoy it very much!

Hello, my name is Brenda Okumu from Kenya. I graduated with a Bachelors in Dental Surgery from the University of Nairobi and later pursued a Masters in Dental Primary and Public Health at the University of Western Australia. My passion is in oral health promotion and research. Recently I have been a beneficiary of a thesis publishing program, a partnership between the University of Washington and University of Nairobi. Sitting at the experienced feet of Prof Ana Lucia Seminario and Prof Arthur Kemoli has been a great eye opener into world-class research and publishing. For the last 10 years I have been teaching at the School of Dentistry, Moi University. Currently I am at the department of Community, Preventive Dentistry and Periodontology, and have been the outreach coordinator since 2016.

Doing outreach is not only our co-operate social responsibility as an institution but also a key strategy in eliminating and preventing the impact of oral disease particularly among high risk, resource limited populations. We mainly target health schools in slum areas and childrens’ homes within Eldoret town and its environs for oral health education, free dental check-up, and basic treatment such as extraction. For comprehensive management we refer the patients to our facility at the school for subsidised or free treatment. Although the main participants are our faculty and students, over the years we have often partnered with visiting Indiana University dental faculty and students. It is through this partnership that to a large extent we have been able to sustain most of the activities, including offering free or subsidised treatment at the school. We also partner with Moi Teaching and Referral Hospital and Colgate Palmolive Limited, who have often provided manpower, materials and donations of free toothpaste and toothbrushes respectively.

Unfortunately, for the last one and half years we have not had any outreach events due to the Covid -19 situation. The risk for infection, coupled with the increased costs to carter for the extra personal protective equipment required are some of the challenges that compelled us to put the activities on hold. There is need to restrategise on how we can carry on despite the pandemic which, it seems, may be here with us for much longer than we anticipated. Oral health is a key component of general health, and efforts towards primary health care in communities with limited or no access to dental services must not be delayed any longer if we are to sustain the gains that we have already made. Perhaps it is time to engage all the stakeholders in these discussions to allow for new policies on outreach activities and to seek out new partnerships that will support this course.

Greetings! I’m Sarah Borgida, Director of Children’s Programs and Tribal Partnerships at Arcora Foundation, which is funded by Delta Dental of Washington. Our mission is to bend the arc of oral health toward equity, and we do this in a variety of ways. We address public policy, work to achieve systems change, and award grants, mostly to safety net clinics in Washington state.  At Arcora, we partner with communities that experience oral health disparities and carry the burden of oral disease to eliminate disparities and eliminate oral disease (such as community clinics, refugees and immigrants, Native American tribes, and other community groups).  I’ve spent the last decade working in partnership with communities, patients, providers, organizations, and stakeholder groups to improve oral and overall health for people in Washington and the Northwest. My work is incredibly interesting, challenging, and rewarding (To be honest, it’s sometimes difficult to convince people I meet at cocktail parties that it’s interesting, but I do my best!).

I’m a former teacher, administrator, and have worked in education reform and to improve early learning systems and programs. So how did I get involved in oral health and spend ten years and counting doing this work? The story is long, but the reason is simple: I’m passionate about doing mission driven work, specifically social justice work, and oral health is a social justice and equity issue. Through my travels abroad, and my professional and personal experiences right here in Washington, I’ve seen how some people – particularly those with resources – have fantastic oral health and think very little about it, while others – often those with few resources – struggle to access even basic dental care and think about oral health constantly because they suffer with oral disease with no respite.

So, what is Arcora Foundation and I doing to end oral health disparities? As I mentioned above, all of the work we do at Arcora Foundation is in partnership with others – communities, providers, and organizations. We don’t do anything alone. One public-private partnership that I’m particularly proud of is Access to Baby and Child Dentistry (ABCD). This partnership includes Arcora Foundation, the University of Washington School of Dentistry, Washington’s Department of Health, and Health Care Authority (Medicaid Program), the Washington State Dental Association, and the Washington State Dental Hygiene Association. Together, this partnership supports the ABCD statewide system of care that connects Medicaid-insured children under 6 with dentists in their local communities who are ABCD trained and certified, and who receive enhanced fees for certain procedures. ABCD patients/families in need of extra help making and keeping dental appointments receive help from local ABCD coordinators. ABCD is nationally recognized and replicated and has been incredibly successful – over 54% of Washington’s Medicaid insured children under 6 accessed dental care in 2019, making ABCD a national leader in access for young Medicaid insured children.

Another partnership I’m honored to be a part of is one with Northwest Tribes, and the Northwest Tribal Dental Support Center. Together, we work to improve the oral health of Native people in the Northwest. We do this in a variety of ways, including through quality improvement collaboratives focused on young children 0 – 5 and with Native elders, and by providing grants and continuing education to tribal dental teams. The work we do together has also been nationally recognized and has been successful. For example, for Tribes that participated in the collaborative focused on young children, access to care increased 87% on average after the first year of program participation and 105% by the end of the program.

I am involved with a variety of other oral health improvement efforts at Arcora Foundation. One wise dentist said that in collaborative work, “everyone teaches, and everyone learns”. I truly believe that is what I’m doing at Arcora Foundation and with our partners, and while I hope I’m teaching something (I am a former teacher, after all!) I know have learned, and continue to learn, so much. I’m grateful to work with others every day to improve oral health, and overall health, and to end oral health disparities.

My name is Ailín Cabrera-Matta, I am a pediatric dentist with a PhD in Public Health. I currently work as an Associate Professor in the Department of Dentistry for Children and Adolescents at the Dental School, and as a researcher in the Epidemiology, STD and HIV Unit at the School of Public Health and Administration, both at Universidad Peruana Cayetano Heredia (UPCH) in Lima, Peru.

I received my undergraduate and postgraduate degrees from UPCH, where I also completed my pediatric dentistry residency. Although my training has been mainly in my home country, I have had the opportunity to visit and learn from American universities during different stages of my career. One of the most memorable of these international academic experiences was attending the 2014 Summer Institute on Clinical Dental Research Methods at University of Washington (UW) in Seattle. Not only did it help me to articulate my oral health knowledge and my recent—at that time— epidemiology training, but also allowed me to make a long-lasting friendship with a Thai colleague. At the end of that year, I was convinced of two things: I wanted to pursue a career in research, and I had to visit Thailand. I did both.

The following year, I was accepted to the Fogarty Fellowship Kuskaya: Interdisciplinary Training Program for Innovation in Global Health—developed and implemented by UPCH and the University of Washington (UW)—and also received the Pilot Award in Oral Health-HIV Research from the Ictus program at UW. These initiatives allowed me to have the resources I needed for my doctoral thesis project. As a Kuskaya fellow, I learned the importance of interdisciplinary collaboration to address global and public health issues and effectively implement change. It was also during this time, in 2015, that I met Dr. Patricia García and Dr. César Cárcamo, who from that moment became my mentors and have been a positive influence in my personal and professional life.

Another impactful experience is my time as an aide to the Peruvian Minister of Health between 2016 and 2017. As a result, I had the unprecedented and unique opportunity to work on the inclusion of oral health in the national regulation for check-ups in children younger than 5 years of age. I was very enthusiastic about having the chance to discuss this with non-dental health professionals in key positions within the public sector and learn about oral health policy and advocacy in the field.

Recently, the National Institute of Dental and Craniofacial Research (NIDCR) decided to fund my 2021-2022 GloCal Health Fellowship at the University of California Global Health Institute (UCGHI). My research will focus on identifying the potential barriers and strengths to developing a training program on infant oral health for nurses working with children during the first two years of life using mixed methods. I would like to contribute towards the development of public health strategies to address early childhood caries and promote infant oral health in resource-limited settings.