On this week’s episode of RTBB Dr. Zeller interviews Dr. Jane Grover. Dr. Grover is currently the Director of Council on Access, Prevention, and Relations at the American Dental Association. Dr. Grover is the expert on the ADA’s program for Community Dental Health Coordinators. This program is a module based curriculum intended to give members of the dental community the skills to help better navigate and coordinate the dental system for patients and dental teams. She compares the training to that acquired by community healthcare workers, crucial members of healthcare teams throughout the world. Dr. Grover believes that this program addresses access to care issues in dentistry.
Topics of discussion include:
Meet our guest
History of Community Dental Health Coordinator program
International use of community health workers
How to improve navigation and coordination of dental care
Stakeholders in CDHC program
Description of training program
Program currently offered to hygienists, dental assistants, and community health workers.
Examples of dental-medical integration
How to integrate CDHC’s in your community
Obstacles for integrating CDHC’s
Jane S. Grover, D.D.S., M.P.H. currently acts as the Director to the Council on Access, Prevention and Interprofessional Relations (CAPIR) in the division of Government/Public Affairs at the American Dental Association (ADA). Dr. Grover provides leadership, vision, management and coordination of the ADA’s activities in the areas of access to dental care, fluoridation and preventive activities, and integrating oral health as an essential part of overall health.
Dr. Grover most recently served as the dental director for the Center for Family Health, a federally qualified health center in Jackson, Mich. In addition, she is an adjunct faculty member of the University of Michigan School of Dentistry and Lutheran Medical Center of New York. She has been active in organized dentistry, first as a trustee of the Michigan Dental Association, and also on the ADA Strategic Planning Committee in the 1990s. She completed five years on the ADA Political Action Committee, serving 2003-2005 as chair. She served as vice-president of the ADA from October 2006 until October 2008.
Dr. Grover received her D.D.S. degree from the University of Michigan School of Dentistry and her M.P.H. degree from the University of Michigan School of Public Health.
On this week’s episode of Removing the Bite Block Dr. Zeller interviews Jason Faler. As the first and only non-dental guest from Season 1, Jason has no skin in the dental therapy game, making his assessments less emotional and more objective. His experience in healthcare systems across the nation have provided him with many lenses in which to view this issue.
We discuss the following topics:
Meet our guest
Ultimate motivation behind dental therapy and importance of remembering this goal during entire discussion
Scope of practice vs standard of care
Legislation of scope of practice
Four elements of medical malpractice – GETTING SUED!
Historical case in which standard of care was redefined by the courts
Are mid-level providers held to the same standard as general dentists? Are general dentists held to the same standard as specialists?
Is the cost worth the difference in quality of care?
Utility in providing value of oral health to overall health and it’s economic impact
Working at top of license
The VALUE of access to care
Are we overtraining general dentists?
Jason Faler gets unblocked
Jason has worked with several healthcare delivery systems on both the east and west coasts of the United States to include Atlantic Health, Salem Health and most recently, Providence Health & Services in Portland, Oregon, most recently as the Director of Business Development in the Strategic Management Services Division.
Jason Faler has been an Adjunct Assistant Professor at Portland State University since 2007. His teaching responsibilities include courses in Healthcare Law as well as Strategic Management.Jason holds a Bachelor of Arts in Political Science from the College of Liberal Arts at Oregon State University. He is also a graduate of Seton Hall University in South Orange, New Jersey, where he earned a Master of Healthcare Administration degree, and the Seton Hall University School of Law in Newark, New Jersey, where he earned a Master of Science in Jurisprudence with a health law concentration. Jason is also a Fellow of the American College of Healthcare Executives.
Jason is a field grade commissioned officer in the Reserve Component of the US Army where he has served since 1999, including service in support of combat operations in Southwest Asia and the Horn of Africa. Among his awards and decorations are the Combat Action Badge and the Bronze Star Medal.
In addition to healthcare, Professor Faler maintains an interest in Middle Eastern and International Affairs and Policy. He speaks Arabic and studied at the American University in Cairo (Egypt) in 1999 and 2003.
In 2008, Jason founded The Checkpoint One Foundation, a not-for-profit, charitable organization benefiting Iraqi and Afghan nationals who face threats in their homeland as a result of their assistance to US and coalition entities since 2001. In 2009, he was nominated by Senator Ron Wyden (D-OR), and was named a finalist for the Above and Beyond Citizen Honors Award, administered by the National Medal of Honor Society. Jason and the Foundation have been featured by numerous national and international media outlets, and have been commended on the floor of the United States Senate.
Master of Science in Jurisprudence (MSJ), Health Law, The Seton Hall University School of Law, Newark, NJ
Master of Healthcare Administration (MHA), Seton Hall University, South Orange, NJ
Bachelor of Arts (BA), Political Science, Oregon State University, Corvallis, OR
On this week’s episode of Removing the Bite Block Dr. Caroline Zeller discusses future dental trends with her long time friend and colleague, Dr. Amardeep Bains. This episode fits nicely in the Dental Therapy Series, by discussing how the future supply of dentists might affect dental workforce models like Dental Therapy. Dr. Bains and Zeller also discuss trends in self-employed versus employed dentists and whether this trend exists in the rest of healthcare. Topics discussed in this episode include:
Meeting Dr. Bains
Statistics on self-employed versus employed dentists
Future trends towards corporate dentistry
How an employed dental workforce affects access to care
Responsibility of dental corporations to increase access
Future supply of dentists
How changes in gender composition of dentists will affect amount of dentistry provided
Changes in dental demand
How changes in age of retirement changes supply of dentist
How supply of dentists does not equate to adequacy of dental workforce
What future supply of dentists means for dental therapy
Why female dentists provide more care to the underserved than male dentists
Statistics on males versus females in specialties
Dr. Amardeep Bains is a dentist based in Sacramento, California. Dr. Bains graduated as a dentist from King’s College London, University of London in 2009 following which he worked in private practice in England as well as an Oral Surgery Senior House Officer with University College Hospitals, Eastman Dental Hospital and Great Ormond Street Hospital in London, United Kingdom. He attained the Membership of the Joint Dental Faculties at the Royal College of Surgeons of England in 2011. Dr. Bains worked as a dental healthcare consultant in the United Kingdom before relocating to Australia where he worked as a dentist serving both private and community patients in a variety of different clinical settings. Dr. Bains completed his D.M.D. at Tufts University School of Dental Medicine in Boston, MA after which he pursued a General Practice Residency at Oregon Health and Science University in Portland, Oregon. Following his GPR residency, Dr. Bains has worked with community dentistry, in the public health sector and privately in Beverly Hills, CA. Dr. Bains has lectured at the UCLA GPR Program as well as for the State of California. Dr. Bains has lectured at the UCLA GPR Program as well as for the State of California and continues to play an active role within organized dentistry.
The title ALMOST says it all. But to be sure there are no questions left unanswered, two men stole a bunch of stuff from a man in Buffalo, New York. At gunpoint. A list of these items include:
The thieves were caught. Most of the stolen property was returned. I know what you’re wondering. The answer is I don’t know. The police reports were not clear about whether said gold tooth was returned to the man. But it did get me thinking.
We have all had patients that wanted to take home “gifts from the dentist”. Sometimes that means a baby tooth. Sometimes that means a decayed first molar. Sometimes that means a gold crown. Every time I ask what exactly it is they plan to do with their new swag. I have heard the following:
make a necklace out of it
include it in a piece of art
melt it down, to create jewelry
send the gold in for money
“I keep all my children’s teeth.”
So the question is, how often do these teeth or leftover teeth accessories, get stolen, before the above plans occur? And more importantly, will insurance cover this? How does the patient send proof? Lab slips? Should I be advising patients to keep their swag in their safes at home? Do people still have safes at home?
They never taught me about this kind of stuff in school.
I met Dr. Vujicic two years ago at a dental conference. I knew about him six months before that. An audio interview of him was sent to me with the caption, “you’re gonna like this.” I did. Marko is articulate and his competence is evident. But that’s not what piqued my interest. The thing that drew me in was how nonchalantly he discussed topics that felt taboo in my world. They were controversial topics, that he spoke to directly. Yet, he worked for the ADA. Which is only to say that when you work for such a large organization, you must be careful of your words, because you represent a lot of people. At the time, I remember wondering if he was like a child that was asking what a bad word meant. His comfort must rest in his ignorance. Yes, that must be it. The thought of that made me giddy with delight. See, I wanted to talk about these things. But without a space, the opportunity rarely presented itself. Then I saw him speak in person. This was when I was confronted with a second surprise. I discovered that it wasn’t that he didn’t understand the weight of his words, it was that he didn’t care. Which I thought was even more fantastic. I’m not saying he doesn’t care about the work or its consequences. I believe he cares deeply about that. But he made his role clear from the beginning. “My job is to give you the data, and interpret it from my point of you. It is your job to do with it as you please.” Wait, what? How did he just manage to toss himself into a bucket of safety one sentence into his presentation? At that point it didn’t matter. He had swept the room away and not a single Oregonian was looking back. Later, I would have a conversation with a well-known public health figure in the dental community that compared Dr. Vujicic to Madonna, stating “everyone knows him simply by his first name, Marko”.
I think that over the past ten years some of the dental community has felt thirsty. They have grown dissatisfied with a system that they felt was destined to doom, by staying exactly the same. Then walks in this data-loving, Canadian economist with a Diet Pepsi in one hand and a Wayne Gretsky analogy in the other. And over the past seven years Marko’s team has dived deeply into the American dental system to better understand what, how, and why we do what we do.
Then, in March of 2018, after feeling confident about what he had discovered during his time at the health policy institute, he wrote a guest editorial in JADA. The editorial is called “Our Dental System is Stuck.
And here is what to do about it.” In it he says that if we as a dental community want to expand access to dental care and improve the way we care for the American public in a meaningful and long-lasting way, major reforms are necessary. He then suggests four major areas of reform.
Late February, Portland, Oregon.
Under my heated blanket, and with a large glass of cab in hand, I read Marko’s thought piece. A few times, I forgot to breathe. I know that sounds dramatic, but it’s true. Also, I’m allowed to be dramatic sometimes. But this time, I wasn’t. A private practice dentist of 30 years would later describe this piece as “the most important piece of dental literature in the past 30 years”. And he was right.
It is important for the following three reasons:
In the dental community (as also seen in other healthcare sectors) ideas that change or disrupt the way things have always been done, whether it is with the goal of improving or not, are rarely discussed publicly. This blocking is active, not passive.
Discussions of minor changes in the dental world have been discussed before, but the kinds of reforms Dr. Vujicic suggests are major. Some would say massive.
Marko and his team at the Health Policy Institute are highly respected. The research they have done is significant. And this work is at least partially if not fully tied in some way to the American Dental Association – the face and voice of the American dental workforce.
If you would like to read the editorial, here is thelink. If you’d prefer it narrated for you with some periodic and relevant background and commentary, click here. This is a link to my podcast episode. To skip the intro, fast forward to 4:18.
eight. And I imagine narrowing them down to eight, was not an easy task. From what I can tell, the responses in these letters covered a wide spectrum of reactions to Dr. Vujicic’s thought piece. Some were in support, while many others were quite the opposite. The authors have differing backgrounds, representing public health, private practice, academic dentistry, medicine, oral health advocacy, and younger dentists. And while none of us can simply be defined as one of the above, it was fascinating to see how individuals that chose the same profession and experienced identical training, could not have more differing reactions.
I have deconstructed each response, offering key points, key quotes, and a short description of the author. These deconstructions can be found at the end of this post. It includes a deconstruction of my own letter, which was also published in the June 2018 JADA.
I also created a table to summarize chief complaints of those that responded and as well as suggestions, that were provided in the letters. It can also be found below.
Then, I interviewed him. Here is a link to this episode, where Dr. Vujicic talks about these reforms and many other controversial topics. Again, if you’d like to skip the intro, start at 9:45.
Now what? Well you can see from the letters of response that people are fired up, in excited, motivated, and disgruntled ways. So people are talking about it. Dr. Vujicic suggests that getting the word out about how some of these reforms are already underway will be helpful for the dental community to conceptualize how this systems change approach is truly a feasible one. The first season of Removing the Bite Block will be devoted to this endeavor, along with some other hot topics in dentistry.
The point however, is that we continue to talk. The only way for positive change to occur is if we are all taking part in the dialogue, so that those making changes in our professional understand our experiences, as well as what it is that we want our profession to become.
So keep talking about it. Send his editorial to a friend. Or if your friend quit reading after dental school, send him the podcast. If the goal is to increase access to dental care, then we must start by increasing access to our own dental community by communicating in the best ways we know how. Even if some of those ways make us feel uncomfortable. Unblock your minds to all voices and ideas. And remove your own bite blocks, so your voices can be heard.
In March of 2018 Dr. Marko Vujicic wrote a guest editorial in JADA. It was titled Our Dental System is Stuck. Below is my response to this thought piece.
In the March issue of JADA Dr. Marko Vujicic described the current dental system as “stuck”. He believes that major reforms are needed to improve the dental care system in a meaningful way. He recognizes the disruptive implications of these reforms, but insists that they are absolutely necessary to improve the oral health of the American public. Dr. Vujicic ends his editorial asking: who will lead the change? Well Dr. Vujicic, I’m raising my hand.
I believe there are others in the dental community also stepping forward and speaking out. I believe that we must find a way to connect, collaborate, and create. The reforms you suggest will take many years, and they start with the decisions being made today. The organizations that affect dentistry are changing the future of the dental profession. Yet the individuals making these decisions will likely not be affected. The future that is being changed, is mine.
I personally am dissatisfied with the millions of Americans being left behind in our current dental system. But I am just one voice with only a handful of experiences. Do we know what the voices of the future want it to look like? New dentists are graduating with hundreds of thousands of dollars in student debt and entering a dental community that doesn’t look anything like what they imagined. We are struggling to adapt, struggling to achieve the quality of life we worked so hard to attain.
I believe the only way to produce sustainable and meaningful improvements in our dental system, is to seek the help of my generation.
I challenge students and new dentists to get informed and speak up. Don’t feel like you don’t have a voice. You do and you must. Connect with others on social media. Get involved in organized dentistry. Apply for positions on committees. Every voice is important.
I challenge dental educators to support these discussions. Create a space where students feel comfortable asking ‘Why’ and ‘How can we make this better?’ If the goal is to prepare students for the real-world, we must teach them how to thrive in an ever-changing environment.
Finally, I challenge the entire dental community to actively create space for new perspectives. I believe that our profession is made of large hearts and brilliant minds from all ages and with unique experiences. We must consider them all if we want to improve our profession and the impact it has on the American public.
So stand up. Speak out. We want to hear what you have to say.
Last week Arizona was officially the seventh state to pass a bill allowing the practice of dental therapists. Dental therapists are midlevel dental providers aimed at addressing the problem of access for many Americans. They have been operating in Alaska since 2004 and in Minnesota since 2011. Approximately 12 other states are considering laws that would allow dental therapists. There is much controversy surrounding midlevel providers in dentistry, creating questions of scope of practice, patient safety, and licensing requirements.