Category: News

Although oral diseases are largely preventable, they are among the most non-communicable diseases globally, and they disproportionately burden disadvantaged communities, specially within low- and middle-income nations. There is a shortage of dentist-scientist all around the world, especially in developing countries, such as Thailand.

Thailand is an active member of the Association of South East Asian Nations interested in creating oral health research capacity and training. While governmental efforts towards increasing clinical providers have been successful, there has been a gap in the training and education required to create a cadre of dental researchers beyond clinical expertise, who would advance research that impacts public health.

For over 20 years, the University of Washington, School of Dentistry, has partnered with Thammasat University and Khon Kaen University to train a new generation of oral health researchers who have impacted the dental public health arena in South East Asia. As a result of this partnership, these institutions created the Fogarty International Center Training Program in Clinical, Public Health and Behavioral Oral Health Research for Thailand with assistance by the Fogarty International Center (FIC) and the National Institute of Dental and Craniofacial Research (NIDCR) (Grant Funding: D43 TW007768 and D43 TW009071, PI: DeRouen). By training over 200 trainees from 18 countries, this training site has brought Thailand to the international forefront of oral health research.

The training involved a combination of short, medium, and long-term pathways. Short-term workshops were five days and included general and scientific principles of planning and carrying out clinical research projects, clinical research, study design, statistical concepts, behavioral models, and ethical issues. Medium-term training involved attending the six-week Summer Institute in Clinical Dental Research Methods held at University of Washington in Seattle. The program was designed to provide a short but intensive research training program for dental school faculty and professionals interested in clinical research. Long-term training was designed to augment and strengthen oral health research pathways in existing PhD programs in Oral Science at Thammasat and Khon Kaen Universities. Trainees with English language skills spent one year in Seattle at University of Washington to a) take courses in biostatistics, epidemiology, or health services at UW School of Public Health, b) worked with one or more UW mentors on research projects they were developing to enhance their learning experience, or c) plan and finalize a dissertation research project that they would work on over the period of the next year in Thailand.

With the purpose to provide a perspective on the impact of the FIC and NIDCR support on creating training and research capacity in South East Asia, we conducted a survey of former trainees to inform us on their perception on how the Fogarty International Center Training Program in Clinical, Public Health and Behavioral Oral Health Research for Thailand impacted their professional paths. Most participants (74.3%) were enrolled in short-term training, 17.6% enrolled in medium-term training and 5.4% enrolled in long-term training. The perceived impact on how these training types influenced trainees at personal and at professional levels was assessed through open-ended question. Three major themes emerged, and responses were not exclusive: a) Improved knowledge of research methods (90.2%); b) Better equipped to teach and supervise students’ thesis and research (12.2%); and c) Connections made with other attendees (14.6%).

As a result of this unique training partnership, Thai universities have become the regional resource for oral health research in South East Asia. We believe this to be one of many models to be used to increase research capacity in global oral health for other low- and middle-income countries.

At the end of 2019, the UW Timothy A. DeRouen Center for Global Oral Health interns took part in a breakfast meeting with Dr. Gary Chiodo, Dean of the University of Washington School of Dentistry. The interns shared snapshots of their work in furthering the DeRouen Center’s mission.

Our very first interns, Sydney Russell and Marina Martinez, presented their stories on early growth of various international sites in collaboration with the DeRouen Center, and also shared how their intern experiences have led them to their career path after graduation. After leaving UW, Marina worked as Senior Quality Improvement Specialist at Sea Mar Community Health Centers, and currently is a Business Operations Consultant at The Spur Group. Sydney is a Public Health Analyst with the Health Resources and Services Administration (HRSA) at DHHS.

Susan Lee (at that time, senior dental student) shared her role in administration and advocacy. She excelled at promoting global oral health to the general public through social media, monthly newsletters, and fundraising events. Justin Kahng (current third year dental student) was one of our newer interns who presented his activities on advocacy through social media. Other interns spoke about awards and fellowships in public health. Jennifer Liu was one of the lead applicants in the Morrell Research Fund which was awarded to the Timothy A. DeRouen Center for Global Oral Health in July 2019 for the project “Refugees’ Endeavors for Utilizing Governmental Existing Efforts in the State (REFUGEES); Dental Health Care Utilization Among Newly Resettled Refugees 2015-2018.” Poojashree Rajanbabu was awarded the Northwest Center for Public Health Practice (NWCPHP) Student Collaborative Project Stipend, which is intended to help students defray living expenses during their hands-on public health training experience for public and nonprofit health organizations in Washington, Alaska, Idaho, and Oregon. Pooja was awarded this stipend for her cross-sectional study entitled, “Evaluating Refugee Children’s Oral Health in Washington State.”

After a brief presentation from the interns, Dean Chiodo shared inspiring stories about his journey in public health dentistry and how the field has changed over the years. Especially poignant was the early days of the HIV crisis in the 1980’s where he was one of the first oral health providers to treat HIV/AIDS patients.

This was a great experience for our interns to present their activities and to learn more about the Dean’s journey in dentistry and to understand more of the historical knowledge of dental public health. Opportunities like this enrich student experience and increases networking for future career development.

Since 2015, the University of Washington (UW) DeRouen Center for Global Oral Health has developed a partnership with UW Global Health, University of Nairobi and Kenyatta National Hospital in Kenya to set up the Children’s Healthy Oral Management Project (CHOMP). The CHOMP project investigates the connection between oral health and HIV. By developing research, training, and implementing pediatric oral health and HIV agenda, CHOMP sets an example for working towards improving oral health care for children with HIV. These partnerships not only advance oral health research, they also strengthen institutional collaborations which pave the way for future opportunities.

As a result of this collaboration, CHOMP developed a project focusing on the oral manifestations of HIV infection within current clinical trial pediatric cohort as perceived by parents and caregivers. Oral lesions are often among the earliest clinical signs of HIV infection, highlighting an important opportunity for improved oral care for HIV-infected children.  The routine clinical care schedule for HIV-infected children may provide an opportunity to engage parents in more prompt diagnosis of oral morbidities and improve access to appropriate treatment. Training HIV care providers, or caregivers in the identification and management of oral comorbidities may improve referrals and early treatment.

Currently, we obtained a Sunstar (School of Dentistry) and CFAR (UW Center for AIDS Research) award that allows us to conduct examinations and oral health assessments as well as analyzing the association between salivary AMP and serum vitamin D levels. This pilot study data will inform the design of a randomized clinical trial of vitamin D supplementation in HIV-infected children and adolescents in Kenya.

These collaborations will be enhanced by creating research training opportunities in Kenya. With this is mind, we have applied for a 2020 D71 Planning Grant with the NIH Fogarty Center which will provide the basis for developing a training program with the ultimate goal of creating sustainable institutional capacity in research and training for oral health and HIV/AIDS.

The Fogarty International Center (FIC) is dedicated to advancing the NIH mission by supporting and facilitating global health research conducted by the U.S. and international investigators, building partnerships between health research institutions in the U.S. and abroad, and training the next generation of scientists to address global health needs. By facilitating exchanges among investigators, providing training opportunities and supporting promising research initiatives in developing countries, FIC has served as the bridge between NIH and the greater global health community for more than 50 years. While the initial FIC support has traditionally been allocated to infectious diseases, new opportunities for noncommunicable diseases have been opened and that includes oral health.

The Global Burden of Disease Study 2017 estimated that oral diseases affect close to 3.5 billion people worldwide, with caries of permanent teeth being the most common condition. Globally, it is estimated that 2.3 billion people suffer from caries of permanent teeth and more than 530 million children suffer from caries of primary teeth. Investing in oral health will improve global health.

For the last 2 years, FIC Fogarty Fellowship awarded two fellows in oral health. The 2019-2020 fellow is Ashley Karczewski with her project titled “The association between levels of salivary antimicrobial peptides (LL-37) and the presence of periodontal disease in HIV-infected adolescents,” and the current 2020–2021 fellow is Catherine Mwesigwa with her project titled “Feasibility of integrating oral health in the primary care of HIV-positive pediatric patients in a low-resource setting.”

We hope FIC continues its support to in building up research training and capacity for global oral health.

Course sets an example for integrating Global Health into UW Dental School Curriculum

Dental students have demonstrated an interest in international topics but are largely unaware of global health topics. To improve students’ global health awareness, the University of Washington (UW) Timothy A. DeRouen Center for Global Oral Health at the UW School of Dentistry (UWSOD) created an elective course for dental and public health students. In 2018, UW began a partnership with Harvard School of Dental Medicine (HSDM) aimed to increase global oral health courses at educational institutions. Belle Chen (2020 graduate) received the 2019 Academic Careers in Oral Health Fellowship for her work in facilitating and developing the course integration. The result of this collaboration will be featured in Annals of Global Health, showing the effect on students’ knowledge and attitude towards global health.

The integration of global oral health into the dental curriculum increases an understanding of the current global environment, raises awareness for the global burden of oral disease and health inequities. Undergraduate, pre- and post-doctorate students from the Schools of Dentistry and Public Health not only increased their knowledge of these topics, but they also had the opportunity to meet and work with colleagues from different health professions. Students worked together on a final group project to create a research question for a project of their choice. This interprofessional exchange of ideas and perspectives provided an invaluable experience for students. Overall, creating this collaboration with Harvard sets an example for other institutions to follow in integrating global health courses into the dental school curriculum.

Congratulations to the DeRouen Center interns who graduated in Spring 2020. Jessica Latimer, Susan Lee and Belle Chen recently graduated from UW School of Dentistry. Jessica is currently attending a 4-year residency at Harvard School of Dental Medicine as a Doctor of Medical Sciences candidate and Periodontology resident. Susan has accepted a position as an associate dentist at a private practice in Monroe, WA beginning in August, and Belle is exploring dental opportunities within WA., Pooja Rajanbabu and Jennifer Liu are graduates of UW School of Public Health. Pooja has earned a BS and is currently exploring opportunities in Public Health in the Seattle area, and Jennifer obtained an MPH and is currently in a 1-year internship program with the California Department of Health in Sacramento. We thank them for their hard work and dedication to our mission and wish them much success in their future endeavors.

UW MPH graduate, Jennifer Liu, was recently selected for the California Epidemiologic Investigation Service (Cal-EIS) Fellowship Program for the 2020-2021 year. Cal-EIS is a unique program that provides one year of training in applied epidemiology for epidemiologists who have recently graduated from a Master’s degree program. Fellows have the opportunity to work on a variety of projects under the mentorship of a preceptor, either within the California Department of Public Health or within a local health department in the state. Prior fellows have performed studies on descriptive and/or analytic epidemiology of diseases, investigated disease clusters, and evaluated programs.

Jennifer is planning to work at the California Department of Public Health in Sacramento in the Office of Oral Health for her fellowship year. As a Cal-EIS Fellow, Jennifer’s projects will primarily focus on the oral health of children and seniors and implementing local programs. She is excited for this unique opportunity to engage in applied epidemiology and public health practice at the state level and start her career as an epidemiologist.

Jennifer has interned with the DeRouen Center since January 2019, first as a practicum student working on the Refugees’ Endeavors For Utilizing Governmental Existing Efforts in the State (REFUGEES) Project and later as a data analyst for the global oral health projects ongoing at the Center. Outside of her work at the DeRouen Center, she has also been working as a Research Assistant at Public Health – Seattle & King County on opioid surveillance activities. In addition, she was involved in the Student Epidemic Action Leaders (SEAL) Team, which aims to provide students with experience in applied epidemiology through field assignments. Jennifer will be graduating with an MPH in Epidemiology this upcoming June and will start her fellowship later this summer.

Life as we knew it has changed during the past few months, and it will never again be the same.  The novel coronavirus seemed like a hypothetical risk when it arose in distant countries.  Then the pandemic arrived in our back yard and began spreading here at great risk to public health.  It is an invisible foe, highly contagious and significantly mortal.  In the process of realizing the profound implications that a tiny virus has on our lives and freedom to move about in our communities, we are also confronted with the reality that dental education and dental practice will change forever.  Our ability to gather large numbers of students in an enclosed space, and the wisdom of doing so, will be modified.  The logistics of providing clinical experiences in dental schools and the facilities for that education will evolve.  Patients, whether they access oral health care via private practices or dental schools, will arrive with new expectations and new questions.  The technology that supports both educational methods and patient care must – and will — advance at a rapid pace.   New vaccines and effective treatments will emerge with a high priority; however, these things will be effective against the enemy we know, not the ones that have yet to show up, and our patients and students will understand that limitation.

I have been in this situation before.  In 1983, a Portland, Oregon physician referred a very sick young man to me who had the disease that was called “GRID,” or “Gay-Related Immune Dysfunction.”  That was the start of a rapidly increasing number of HIV-positive patients referred to our public health practice over the next two decades.  The practice of dentistry changed because of HIV.  The implementation of universal body substance precautions happened but not without some level of disagreement and contention.  There were those who worried about the message that gloves, masks, face shields, and gowns sent to patients.  Would patients see this and think that dental practices were potential sources for HIV infection?  Couldn’t there be an accurate way to identify HIV-positive patients and just treat them in other facilities?  With the arrival of COVID-19, those concerns seem quite distant.

Of course, the significant difference between adapting dental practice to HIV versus COVID-19 is that HIV is an infectious agent, whereas the novel coronavirus is highly contagious.  There are further differences.  In the ’80s and ’90s, HIV was almost uniformly fatal.  That changed as new treatments were developed.  COVID-19 has a high mortality rate for a contagious virus, but it is not uniformly fatal.  That will also change as vaccines and treatments are developed.  However, COVID-19 has made it clear that microbiology is unpredictable and can be extraordinarily unforgiving.  Dental practice and dental education will rise to that challenge.  Safer practices will be implemented and, going forward, our focus on how we keep our patients, students, and educators safe will increase and become much more anticipatory rather than reactionary.  Those are all good things for patients, dental practices, dental education, and the public health.

The Northwest Center for Public Health Practice (NWCPHP) Student Collaborative Project Stipends are intended to help students defray living expenses during their hands-on public health training experience for public and nonprofit health organizations in Washington, Alaska, Idaho, and Oregon. These collaborative projects involve a faculty member and a student working in close collaboration to enhance public health services to medically underserved communities. Pooja Rajanbabu, one of our research assistants, has been awarded this stipend for her cross-sectional study entitled, “Evaluating Refugee Children’s Oral Health in Washington State.”

Her project will establish a baseline of oral health data for refugee children in our state and will compare their dental health to their non-refugee peers. Through partnerships with the UW Timothy A. DeRouen Center for Global Oral Health, UW School of Dentistry, WA Department of Health (DOH), WA Department of Social and Health Services (DSHS), and WA Health Care Authority (HCA), this cross-sectional study will utilize Medicaid claims of refugee children who arrived in Washington in 2015. This research will inform interventional studies that can evaluate the effectiveness of educational interventions aimed at improving refugee children’s oral health.

Dr. Seminario has been appointed to the University of Washington’s Population Health Initiative Executive Council for 2019-2020. The Population Health Initiative was found in 2016 by University of Washington President Ana Mari Cauce with the vision of creating “a world where all people can live healthier and more fulfilling lives.” The Population Health Initiative collaborates with diverse fields and practices to address all the factors that influence health, including health sciences, social sciences, public policy, law, business, and more.

Dr. Seminario is one of the seven UW faculty members in the council, which includes senior leaders, faculty, students, and staff from UW colleges, schools, programs, and stakeholder unites. As the director of The DeRouen Center for Global Oral Health and Population Heath Initiative Council member, Dr. Seminario will continue to foster interdisciplinary collaboration and pursue efforts to address national and international population health challenges.  Learn more about Dr. Seminario and her work at the Center.