Category: News

Our manuscript publishing class for junior researchers in Kenya is off to a great start as classes began in March 2021. The project was made possible by the University of Washington’s (UW) Global Innovation Fund (GIF), with collaborative efforts between the UW, the University of Nairobi (UoN), and Moi University (MU). Ten students were enrolled in the virtual training program, led by an interdisciplinary team from the University of Washington and the University of Nairobi, including the UW Health Sciences and Suzzallo Libraries (Lynly Beard and Elizabeth Bedford), Global Health and School of Dentistry (Joe Zunt and Ana Lucia Seminario), MU School of Dentistry (Caroline Kilbosia), UoN School of Dentistry (Arthur Kemoli), and our class coordinator from California State University Northridge, Mink Lee.

The cohort has an equal representation of newly graduated junior investigators from the University of Nairobi and Moi University in Kenya, including one trainee from Uganda. These trainees come from diverse areas of the country, and seven out of ten are female. Utilizing virtual ‘breakout’ rooms has fostered active participation despite the challenges of an online environment. Their diverse professional backgrounds in oral healthcare allow them to share different perspectives and receive feedback from their peers.  The students are learning and enjoying camaraderie through sharing ideas, and support has come naturally for many, having graduated from the same universities. We hope that the program will provide the training and resources to increase the students’ manuscript submissions as we work towards expanding global oral health research capacity in Kenya.

The Timothy A. DeRouen Center for Global Oral Health was recently gifted an endowment by our founder and his wife, Tim and Cheryl DeRouen. This generous gift is earmarked to grow and expand the center, and to expand research capacity in oral health in low- and middle-income countries.

Dr. DeRouen is a University of Washington Emeritus Professor in the departments of Biostatistics, Oral Health Sciences, and Global Health. His roles in UW academic dentistry also included Associate Dean for Research and Interim Dean. He served as President of the American Association for Dental Research, and created the Summer Institute in Clinical Dental Research Methods, an intensive six-week interdisciplinary program in research methods designed for dental faculty working clinical areas that has now been offered for more than 25 years and attracted more than 560 faculty from 30 U.S. states and 54 foreign countries. As founder of the Timothy A. DeRouen Center for Global Oral Health, he served as PI on several NIH D43 grants which have expanded oral health research training capacity in Thailand and SE Asia.

We are very excited to receive this open endowment. Initial efforts for the generated funds will be for increasing research capacity through funding junior faculty in our partner sites, leading to expanding lines of research through their respective geographical areas and therefore decreasing inequalities in global oral health.

Make a Gift to the DeRouen Endowment Fund

Refugees often experienced trauma in their home country, and during the migratory process to neighboring countries and refugee camps. Studies have shown that refugees have worse oral health than the vulnerable and underserved populations of their host countries. Furthermore, oral care might consist of just emergent removal of teeth and or abscess treatment with antibiotics. Additionally, many host countries have no pediatric oral care or enough fluoride in water to prevent tooth decay. By the time their migratory process ends in the western world, many face new problems, including learning a new language, finding a job, educating themselves and their children, and generally adapting and acclimating to their new environment. By the time refugee families are in the United States, oral health can seem unimportant compared to the accumulated trauma before their final resettlement.

Washington state ranks third in the United States in the number of refugees it accepts. As a leader in the resettlement of refugees, identifying and addressing severe oral health disease is vital to early treatment and preventing further deterioration. With the generous support of Arcora Foundation, the refugee oral health project seeks to understand the processes of the initial refugee medical healthcare screening. Currently, the dental screening part of this process is just one question with a yes/no answer, asking if they have any dental problems. Given the cultural and linguistic differences and the fact that some refugees have never seen a dentist, it is essential to develop an evidence-based questionnaire to help identify severe oral health disease.

There are seven clinics that are responsible for the initial medical screening of the new refugees that arrive in Washington state. Five of these seven clinics have the capability to be refugees’ primary medical health care home. The potential for establishing oral health care referral, good oral hygiene practices through education, and follow-up referral is an opportunity that cannot be missed. However, establishing a good oral health screening process embedded within a refugee’s first contact with the healthcare system during the initial medical screening can identify problems and direct them towards oral health care immediately. We hope the refugee oral health project that UW’s Timothy A. DeRouen Center for Global Oral Health is conducting with funding from Arcora Foundation is the first step in strengthening the health status of arriving refugees in Washington.

In Peru, according to the Ministry of Health (MINSA), dental caries is one of the most prevalent diseases in the population and oral cavity problems are the main cause of medical visits. In response to this problem the Peruvian State approved the Dental Residency Regulation in 2013, with the purpose of training specialists in dentistry. The model is characterized by the fact that residents carry out their full-time work in public health establishments through a contract with the state, a mechanism that has allowed many dentists to finance their graduate studies, partially closing the human resource gap for benefit of the citizens’ oral health. In this context, in 2015, the Faculty of Stomatology of the Universidad Peruana Cayetano Heredia, implemented the specialization program in Stomatological Public Health under the residency modality, to train professionals who can research, develop and manage oral health interventions at the population level with humanistic and ethical training during the two years of the program.

From the beginning, the Stomatological Public Health residents are part of the health system and their preparation takes place in real environments which are conducive to learning, developing projects, programs, and institutional plans. In addition, residents propose intervention policies at the local, regional, and national level. It is also important to mention that their activities are carried out under the in-service teaching modality in public services at different levels of healthcare, including the Peruvian National Direction of Oral Health. To date, 30 specialists in Stomatological Public Health have been trained, who are currently working for the public sector, including MINSA, Social Security, Ministry of Development and Social Inclusion, Ministry of Economy, and Regional and Local Governments, among others.

However, it was necessary to incorporate a professional profile formed in an in-service teaching model, implemented mainly in private institutions that perform public health and complement it with rotations in public services. Therefore, since 2020, the Faculty of Stomatology includes the regular modality; both modalities have the same learning objectives, curricular subjects and teaching targets, with spaces for discussion that enhance the comprehensive preparation with a public and private approach, beside national and international internships that perfect the experience, providing a more holistic vision of the specialty.

Finally, the specialization program in Stomatological Public Health is recognized nationally by health managers, for having a teaching staff with experience in the area and for being innovative in the teaching modality. However, on its 5th Anniversary, the challenges are as great as the efforts of its graduates to solve them. Currently, with 14 students, the objective of the Faculty of Stomatology is not being only to train scientifically competent professionals in their specialty, but also agents of change committed to improve the oral health and quality of life of Peruvians.

As a health profession, dentistry has been affected by the COVID-19 pandemic, not only in terms of preventing and spreading infections, but also in providing care. Within the areas of dentistry, oral implantology is one of the specialties most affected by its invasiveness since it combines surgical procedures, prosthetic interventions, and aerosol-producing interventions. One of the biggest concerns of dental professionals was to know what the impact of the COVID-19 pandemic would be on implant dentistry and the future perspectives in terms of epidemiological trends, education, biosecurity and professional practice.

Faced with this problem, the Ibero-Panamerican Federation of Periodontology (FIPP) in conjunction with Perio-Implant Research Group UPCH, decided to bring together representatives from 18 Latin American countries to develop the first multinational consensus on oral implantology, using the Delphi method (a qualitative study). The perceived trends in implant dentistry, under the perspective of the post COVID-19 pandemic, was assessed through 64 open-ended questions in a total of 197 experts between July to October 2020.

Considering that there is a high rate of asymptomatic patients, most of the experts agreed that every patient should be evaluated as possible carrier of SARS-COV2, which at the same time could generate a greater concern and fear of the pandemic in dental professionals. Nevertheless, there was high consensus to affirm that SARS-COV2 transmission can be preventable, which reflects a better adaptation and greater confidence with the current biosecurity protocols. Furthermore, one of the aspects that the COVID-19 pandemic has impacted more strongly is education, with a shift to remote live classes. There was a very high consensus in regard to that the curriculum plan of the higher education centers must restructure the hours of clinical activity and the learning methodology.

This study is an important window into oral health care and education during an infectious disease emergency and can help shape the future efforts of oral health safety and clinical and didactic teaching.

Since 2006, there has been a dedicated effort to expand oral research capacity in Thailand. In conjunction with the University of Washington and Dr. Timothy DeRouen, two National Institutes of Health Fogarty International Center (FIC) D43 grants have been awarded, which funds research capacity building. From this initial research infrastructure, many Thai and southeast Asian researchers have been trained in global oral health research techniques. The first grant targeted research capacity building at Khon Kaen and Thammasat universities in Thailand, and the second grant expanded to invite researchers from surrounding SE Asian countries such as Vietnam and Cambodia to study oral health research in Thailand.

To build research capacity, they structured a three-tier training program. The first tier was a five-day workshop in Thailand which has trained over 100 participants, a second tier was attending the Summer Institute held at University of Washington in Seattle and trained over 30 participants, and the third tier was completing a PhD program in Thailand and trained approximately 10 participants. Since the inception of this research expansion program, hundreds of researchers in Thailand and surrounding countries have been trained in research methodologies such as epidemiology and biostatistics.

After the first awarded National Institutes of Health D43 grants which built initial research capacity in Thailand, the original trainees are now capable of taking the leading role as trainers and offering the trainings to other low- and middle-income countries in the region. To expand training capacity further, Dr. Waranuch Pitiphat from Khon Kaen University, applied for and was awarded an NIH D71 grant with the Health Fogarty International Center (FIC). The D71 grant is a 1-year grant which funds the planning of a training program and is a precursor to the 5-year D43 training grant.

This new planning grant was awarded and explored ways to increase training capacity in SE Asia. The grants aims were to assess the need for and structure of the advanced oral health research training programs in the region, to strengthen research training capacity of the host institutions through faculty trainings in mentorship, online course development and evaluation, and short-term training course development and evaluation; and to create a network of collaborating institutions in SE Asia for the future training grant. To fulfill the aims they conducted several activities, including convening a meeting of SE Asian dental school Deans and Associate Deans from 16 cities in 8 countries to establish a network of collaborators and assess the oral health research trainings needs in the region, training mentors, online course development and workshop, short-term research training workshop for trainees, and developing a grant application for a future D43 FIC research training grant.

The D71 planning grant was successful, establishing a cohort of institutions within SE Asia that will are interested in expanding research capacity, and will collaborate on future research endeavors. Based on these findings, a new D43 application to further expand research capacity in SE Asia has been submitted to NIH. Data from increased research training was collected based on this and previous research training grants in Thailand and other developing countries, and published in the Annals of Global Health in November 2020, entitled “Mitigating global oral health inequalities: Research training programs in low- and middle-income countries.”

Several exciting oral health studies have resulted from expanded oral health research capacity in Thailand. Trainees from the initial NIH D43 training grants have now gone on to investigate important topics such as cleft palates, chemo-mechanical dental caries, and the association between breast feeding, bottle feeding, and dental caries in very young children.

Dr.  Araya Pisek studied the impact on cleft palates on oral health status in Thai adolescents in a study entitled, “Oral health status and oral impacts on quality of life in early adolescent cleft patients.” This cross-sectional study was conducted in Khon Kaen, Thailand. Subjects included 68 oral cleft and 118 non-cleft individuals aged 10-14 years. Several oral health issues were studied including decayed, missing, and filled teeth, plaque, and gingivitis. The results showed that children with cleft palates had higher levels of dental caries and gingivitis, poorer oral hygiene, and lower quality of life than the control group.

Dr. Kemporn Kitsahawong has done research on chemomechanical caries removal (CMCR) versus drilling, in a manuscript entitled “Chemomechanical versus drilling methods for caries removal: an in vitro study.” Forty-six carious deciduous molars were randomly divided into two groups: one each for caries removal by (1) CMCR and by (2) drilling. Results were analyzed via visual and tactile criteria and a caries detector device. There was no significant difference in the completeness of caries removal between groups. However, time spent for caries removal by CMCR was significantly longer than that required for drilling. Restorations in the CMCR group had significantly more microleakage than those in the drilling group. Dentin hardness of the cavity floor after CMCR was also significantly lower. Microscopic analyses showed roughened and irregular dentin surfaces in the CMCR group, unlike the smooth surfaces observed in the drilling group. In conclusion, CMCR was as efficacious as drilling in term of completeness of caries removal but required longer excavation times and resulted in lower microhardness of residual dentin as well as more microleakage after restorations with GI.

A project that is still ongoing entitled “Impact of prolonged and on demand breastfeeding on early childhood caries in Khon Kaen” by Dr. Sirima Sritangsirkul, looks at the relationship between extended and on-demand breastfeeding and early childhood dental caries in Khon Kaen, Thailand. On-demand breastfeeding is defined as a mother feeding the child more than 8 times a day and extended is defined as breastfeeding past one year of age. This prospective longitudinal cohort study will invite 450 healthy children aged 1-year-old, attending Thai Primary Health Centers and Mother and Child Health Center Muang District, Khon Kaen to participate in the study.  Enrolled participants and caregivers will submit to questionnaires, oral exams, and salivary samples. They’re aims are 1) to determine the association between both prolonged and/or on-demand breastfeeding and ECC, 2) to determine the association between prolonged and/or on-demand breastfeeding on children’s salivary pH, and 3) to determine the correlation between levels of MS and breastfeeding.

Expanding research capacity in oral health in Thailand has proven to be a success. The resulting research has contributed to oral health in immeasurable ways, and has elevated Thailand’s standing in the research community. Additional research training grants will hopefully prove as fruitful, and further expand oral health research capacity across SE Asia.

The Timothy A. DeRouen Center is among the 2021 recipients of the University of Washington (UW) Global Innovation Fund (GIF). GIF is an award given through the UW Office of Global Affairs. It funds research collaborations that advance interdisciplinarity across the world. This grant is the result of inter-professional collaboration among the School of Dentistry (Pediatric Dentistry and the Office of Regional Initiatives in Dental Education), School of Public Health (Global Health) and the Health Sciences and Suzzallo libraries . The project aims to train junior Kenyan researchers to publish their research work by implementing a curricular program in manuscript writing and provide support for journal submission fees.

By recruiting newly graduated dental professional from University of Nairobi with finalized thesis, this project will foster continued success in the research partnership between the University of Washington and the University of Nairobi. With increased representation in scholarly journals, opportunities for collaborative publication will become more available to Kenyan trainees. Results from this award will increase research capacity and training of the future cadre of Kenyan oral health researchers.

In its November 2020 edition, Annals of Global Health published an opinion piece on creating oral health research capacity on low- and middle-income countries (LMIC). This is a remarkable opportunity for expanding advocacy for decreasing inequalities in global health. Below are relevant highlights.

The COVID-19 pandemic has emphasized the social, economic, and health inequalities in our society, including existing global oral health inequalities. In the past, the NIH has focused on broadening the public health and medical research capacity present in low- and middle- income countries. There is a global shortage of dentist-scientists as well, especially in developing countries, such as Thailand. Investing in research in a recent project with the University of Washington (UW) DeRouen Center for Global Oral Health and the National Institute of Dental and Craniofacial Research (NIDCR) has not only impacted trainees’ career development but enhanced advancement of oral health research of South East Asia. The success of partnership calls for expanding oral health research training in other low-income countries.

The UW, NIH and NIDCR partnered with 2 universities in Thailand to address the shortage of dentist-scientists all over the world who would advance research that impacts public health. At Thammasat University and Khon Kaen University, the Fogarty International Center Training Program in Clinical, Public Health and Behavioral Oral Health Research for Thailand has successfully trained over 200 individuals from 18 countries, bringing Thailand to the international forefront of oral health research.

The program employed curricula in short-, medium-, and long-term instruction to provide research training. From a 5-day seminar, including education on levels of evidence in evidence- based clinical research, to a yearlong research program at the UW, the curricula provide a broad and applicable introduction to careers in clinical research.

While Thailand is the only NIH funded training site for oral health, we hope that the success of this program can be replicated in other LMIC like Peru and Kenya.

Arcora Foundation is Washington state’s largest foundation dedicated exclusively to improving oral health. A nationally recognized catalyst for change, Arcora ensures policymakers, advocates, and the public have the right information to make wise decisions that lead to better health. Their goal is to change the trajectory of oral health so that in the future everyone can enjoy the benefits of good oral health.

The Timothy A. DeRouen Center for Global Oral Health was recently awarded an Arcora Foundation New Opportunities grant that will help us achieve our overarching goal of integrating oral health within comprehensive medical care that refugees received soon after resettlement in Washington state. Currently, there are seven clinics in the state of Washington that are approved by the department of health to conduct such assessments.  For this project, we aim to collaborate with each of these sites.

Via virtual and in-person meetings at each site around the state, we aim to learn about the current clinical procedures, logistical approach, and electronic chart systems to design a custom-made protocol for oral health integration. We will be the first state in the US to implement oral health among the health outcomes that are mandated for refugees’ resettlement. To accomplish our aim, we will use evidence-based mixed-methods techniques informed by the Consolidated Framework for Implementation Research. Integrating oral health within required health screenings in Washington can serve as a model for a national oral health program for refugees.