98 Journal of Public Health Dentistry

Oral Testimony of the Association of State and Territorial Dental Directors

Presented by Lynn Gilbert, DDS, MPH, State Dental Director of Rhode Island

Introduction Good afternoon. My name is Lynn Gilbert. I am a

dentist trained in public health and I am the state dental director of Rhode Island. In that capacity, I serve as the public health dental specialist for the Health Department as well as the chair of the Board of Examiners in Den- tistry. Previously, I was a full-time, tenure-track, assistant professor at Tufts University School of Dental Medicine for nearly five years and I continue to teach there on a part-time basis. I am representing the American Associ- ation of State and Territorial Dental Directors (ASTDD).

ASTDD is an organization composed of all dental di- rectors of the states and territories of the United States. The primary purpose of our organization is to improve the oral health of the American people.

My testimony today will focus on three major chal- lenges for dental education in the next 20 years: the need for a paradigm shift in dental education, the need for dental schools to be relevant to their communities, and the need to increase and subsidize the number of special- ists trained in dental public health.

The Paradigm Shift Last Wednesday, President Clinton addressed Con-

gress and the American people on health care reform. There is no question that there will be many changes in our health care system. Health care is outpricing itself in the market place and managed competition will play a major role in the delivery of health care. These changes also will affect dentistry.

We will need a new paradigm in dental education. Rather than focusing on specific didactic and technical material, we need to focus on the patient and society as the consumer of dental care. The greatest challenge in the next 20 years will be to educate a team of dental providers who will be sensitive to quality, cost, and access as per- ceived by society rather than as perceived by just the profession.

We will need to educate and train teapls of dental providers who can produce a quality unit of dental ser- vice at theleast possiblecost to meet the oral health needs of the American people. We are not doing that now. By dental team, 1 mean dentists, hygienists, assistants, and laboratory technicians each in an expanded, complimen- tary, and possibly new role. To accomplish this goal, the following will need to be done:

1. Prevention on the individual and community level

must be the foundation of their education and this deliv- ery system.

2. Members of the dental team will need to be trained to their maximum competence to provide quality care in the treatment of individual patients as well as groups of

3. Dental schools must have practice and teaching sites where students function as members of a dental team that also is integrated with a health team. This will help them learn to function comfortably with physicians, nurses, and other health and human service providers.

4. Dental teams must be trained to treat a variety of patients. For example, they must be comfortable in treat- ing patients who are frail elderly, medically compro- mised, developmentally disabled, HIV infected, as well as in treating cultural, linguistic, and racial minorities.

5. Dental teams also must be trained to be comfortable treating patients in a variety of different settingsfor example, the homebound in their homes; the institution- alized; individuals in health centers, hospitals, and schools; as well as high-level executives in their own offices with portable equipment.

6. Dental schools will need faculty who are educated and trained to implement this new paradigm of dental teams. They need to be educated in such subjects as policy development, program planning, cost contain- ment, administration, behavioral sciences, epidemiol- ogy, and evaluation. These are some of the subjects that are taught in public health.

Relevance and Responsiveness of Dental Sehoolls to the Community

Dental schools must be responsive to the oral health needs of their neighborhood, city, region, state, and our country. They must also be responsive to the oral health needs of the university of which they are a part. Faculty and students are a resource to the community and should be utilized for prevention, treatment, and policy and program development.

Meaningful working relationships need to be devel- oped with local and state health departments, commu- nity groups and organizations, and other schools in the university.

These recommendations are not new. The IOM "Re- port on the Future of Public Health" made similar recom- mendations for schools of public health. I would strongly recommend that this committee review that report.

people.

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Dental schools will need to develop effective depart- ments of community dentistry to become more relevant to their communities. For example, when the local or state health department develops and implements a school sealant program, the school will need faculty trained in public health to work with the state so that students and faculty will be involved in these community programs. When a community needs assessment isbeing developed and implemented by the school of social work, the med- ical school, or a community-based organization, the be- havioral scientist, and the dental epidemiologist at dental schools should be involved.

Increase and Subsidize the Number of Specialists Trained in Dental Public Health

In the short term, the number of specialists trained in dental public health must be increased, and their training subsidized, to help implement this new paradigm and to meet the unmet oral health needsof society. Public health dentists are trained to improve the oral health of the community. That community may be a city, state, or country. These specialists develop programs and policies that affect the health of hundreds of thousands or mil- lions of people. We need more of these specialists in dental and dental hygiene schools; schools of public health, medicine, and nursing; local, state, and federal agencies; and other community-based programs.

Unfortunately, dental public health is the smallest of all the specialties with only 113 who are board-certified. This is probably the only specialty where, after receiving additional training, your income potential goes down

rather than up. As a clinician, my personal income per unit time is more than twice what it is as state dental director. As a clinician, I can affect the oral health of only about 1,500 people a year. But as a public health dentist, I can affect the oral health of a million people.

When students are graduating with debts as high as $120,000, how can we attract the best and the brightest to go further into debt in a specialty where they have less income potential despite having a much greater impact on society?

Closing Remarks The ASTDD believes there are many major challenges

in educating dentists, hygienists, assistants, and labora- tory technicians in the next 20 years. I have addressed a few of these today. Other issues we have included in the written testimony, but are unable to discuss due to time constraints include: restrictive state practice acts that artificially raise the cost of dental care and education; quality of care, continuing education, and continued competency; recruitment of minorities and the low in- come; changing patterns and trends for oral diseases and population demographics; improved access for the un- derserved; the costs of dental education, loan forgive- ness, and the National Health Service Corps concept; and improved working relationships among dental schools, dental licensing boards, professional organizations, and local and state health departments. Thank you very much for this opportunity to address

the Committee on the Future of Dental Education.