Overcoming Barriers to Oral Health Podcast Transcript - [Intro Narrator] Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast. This is where we connect you to public health topics and issues, as well as with colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning in to this episode, which is a collaboration between the Institute for Public Health Practice, Research, and Policy, and the Prevention Research Center for Rural Health at the University of Iowa College of Public Health. Please note that this episode has been reformatted from its original webinar recording. - [Tricia Kitzmann] Welcome everybody to today's webinar, "Overcoming Barriers to Oral Health," organized by the Institute of Public Health Practice, Research, Policy at the University of Iowa College of Public Health in partnership with Midwestern Public Health Training Center and the University of Iowa Prevention Research Center for Rural Health. Today's objectives are to discuss the key issues related to oral health in Iowa and identify communities at higher risk for poorer oral health and lack of access to oral health education, and dental services. Explore potential partnerships and strategies to improve access to oral healthcare. I'm Tricia Kitzmann, I'm faculty here at the University of Iowa College of Public Health. I work for the Institute for Public Health Practice, Research and Policy at the University of Iowa. We highly encourage you to send us messages, send us questions, we wanna make sure we provide or answer any questions that you have while we're here today. And we have three fabulous panelists to share their expertise with us. I'll have our panelists, will you just introduce yourselves for the audience today. And Carole, you're the first on my sheet, so I'll go ahead and start with you. - [Carole Ferch] Sounds good. I'm Carole with the Scott County Health Department. - [Samuel Misleh] Hello, I am Samuel Misleh. I'm with Dental Lifeline Network. - [Jhanvi Desai] Hi, I am Jhanvi Desai. I am with the University of Iowa College of Dentistry. - [Tricia] Wonderful. Well, thank you all for being here today, and I know the people that are joining us are excited to learn about and pick your brains on some of the cool things you're doing out there to address oral health barriers. I'm gonna kick us off with some questions today. Can you share a bit about your background, your current role? What inspired you or what inspired you to pursue a career in oral health? - [Samuel] So, hello everyone again. My name's Sam Misleh, I'm with Dental Lifeline Network. My title there is Manager of Volunteer Engagement and Affiliate Relations, and we operate the Iowa Donated Dental Services Program or DDS. I don't know if some of you all have heard of that, but we operate in all 50 states and we're excited to be here as a panelist. Personally, I got into this line of work. I've always been passionate about healthcare and healthcare equity and access specifically. And so when I landed with Dental Lifeline Network, it was just sort of a perfect fit, especially because as I've grown in these last three years I've been there, I really have realized the importance of oral health and how it is related to overall body health. And so I'll get more into that a little bit later, but I wanted to go ahead and put my contact information out there, so, I'll say it again at the end, I'm sure, but my email is S-M-I-S-L-E-H, so my first initial, last name @dentallifeline.org, and my phone number is, 303-407-1102. So great to be here. Thank you all. - [Jhanvi] All right, I can go next. Is that okay? So, I'm Jhanvi Desai. I'm a faculty dentist here at the College of Dentistry. I've been a dentist for over 14 years now. I did my basic training in India, finished with my master's in prosthodontics and came here to pursue the certificate program in geriatrics and special needs dentistry. That is one area that has always been very close to me. So I came here, did the program, and I have stayed on as a clinical assistant professor in the Preventive and Community Dentistry Department. I am lucky that I get to see students delivering comprehensive dental care to patients in our geriatrics and special needs clinic here at the College of Dentistry. As well as I get to co-direct the extramural program where our students go offsite from the College of Dentistry and provide hands-on dentistry in different community practice settings outside of the College of Dentistry. Very glad to be here. Thank you for having me here. - [Tricia] Wonderful. Thank you. - [Carole] Great. So I started in dentistry as an orthodontic assistant in 1989 and did that while I was taking my pre and co-requisites for dental hygiene and really worked private practice up until just eight years ago when I joined the Scott County Health Department as the I-Smile Silver Coordinator. So, there are three of us in the state of Iowa. Our role began as work with seniors, people 65 and older. However, a couple years into the pilot, we sort of grabbed all adults because we found there was a need for the entire adult population. And even though we help all adults, we still have a strong focus in seniors. I have always been a fanatic about oral health way back when I had braces in middle school and was encouraged by a family member who was a dental assistant at the time to pursue a career in dental hygiene. And I have absolutely loved every minute of it. I can say I am not burnt out on oral health. Not that it doesn't have its frustrations, especially coming into public health. It's a whole different world. But it has been a wonderful, wonderful career and I'm happy to be here amongst the other panelists. I'm very honored. - [Tricia] Wonderful. I always love hearing people who love their jobs, right? Like that's always an inspiration. You know you're doing good work when someone still loves what they do and can talk with excitement about it. So, yay. Thank you all. Why don't you share with us a little bit about your organization and what projects you specifically have been involved in within your organization. - [Samuel] Dental Lifeline Network is a national non-profit, as I mentioned. We are a strategic partner of the American Dental Association and we celebrated our 50th anniversary last year. So we are nationwide. We operate in all 50 states, including Iowa. The DDS, Donated Dental Services Program provides donated comprehensive dental treatment to our country's most vulnerable with a focus on people living with disabilities, elderly and medically fragile. And in addition, we do prioritize veterans in this program. So these are folks who cannot afford necessary treatment, cannot get public aid or just are underserved. And so we operate through a volunteer network of 12,350 dentists right now. And 3,300 dental laboratories also donate across the US and since our program started, the DDS program, we have surpassed $550 million in donated care and we have served over 170,000 people. In Iowa, specifically, Dental Lifeline Network's Coordinator of the DDS program is Iowa or is Diane Wells, some of you may know her, she is great. We're really happy to have her on board and she screens the applicants, she works closely with the patients, also the volunteer dentists and the specialists and labs for overall coordination of the care for each patient. In Iowa, 212 dentists and 35 labs are currently volunteering. And so we would love to grow our program as much as we can in Iowa, since 2005, which is when our Iowa specific program began, we have served 2,000 Iowans, over 2,000 Iowans and they have received $9,200,000 in donated treatment. So we're really proud of that and we just wanna continue to grow and continue to serve more Iowans in need. And then I think the second part of your question, the projects that we're involved in, and so our biggest program as mentioned is the DDS program, Donated Dental Services. We also are one of the main partners of the American Dental Association's Give Vets a Smile program, which was just announced just recently last year, end of last year. And that is, of course, is a veteran initiative and we're focused on veterans largely. So that's exciting to be a part of that. We also work closely with state and local organizations and agencies, who do serve our target populations, the elderly, the disabled, and we try to spread the word with them to prospective patients and vice versa. We also work with health organizations, such as cancer clinics, dialysis centers, and we're looking to partner with more and more of those in the future. And then lastly, we do collaborate with the I-Smile Silver coordinators, so it's great to see Carole here. Diane specifically works with them in Iowa. So, thank you all. - [Jhanvi] So, I can go next. I can talk a little bit about the Preventive and Community Dentistry Department from where I come from. So, we are housed within the College of Dentistry here on Newton Road. And we have different missions within our department starting from first being direct patient care. So I'm involved in patient care once a day every week, where I get to see patients who are medically fragile, older adults, adults with special healthcare needs. But generally you'll end up finding me more often in other student clinics. I teach a comprehensive dental care for this at-risk population to our final year dental students who are pursuing the DDS program. So we provide services to this group of patients in our Delta Dental Geriatric and Special Needs clinic. In addition to that, our department also runs the GMU, that is called as, that is the geriatric mobile unit. And through this we give comprehensive care to older adults who are in long-term care facilities in and around Iowa City. Right now we provide care to up to 10 nursing homes around Iowa City area. In addition to that, education is one of our other missions. So we are with our students right from the very first year and from one of their first non-peer patient experiences right from the D1 year all the way through the D4 year In the DDS program. We also have some advanced standing programs like the Masters in Dental Public Health, as well as the certificate program in geriatrics and special needs dentistry. We are involved in certain service-based outreach programs. So there are I-Smile programs at schools where one of my colleagues, Dr. Steve Levy is involved. There are, we have screening and mobile clinics at libraries, homeless shelters. Also, one of the service activities that our students do when they are on their extramural rotation is do community outreach. So they tie up with the local dentist and different community sources there to provide screening and oral health and hygiene education in community settings. And lastly, research is one of the other missions of our department. So we are involved in policy-based outcome research, kind of seeing how Medicaid is doing, changes and updates with Medicaid. A hot topic right now, fluoridation, we have been in fluoride and bone research studies. Again, Dr. Levy has been doing that over many, many years. So these are the few areas that our department is involved. Certain projects that are close to me. So apart from our clinics and the geriatric mobile unit, there is one project called as Mouth Care Matters. It is a program run by Dr. Howard Cowen. He is my teacher. He, so, what is done here is, they go out into the communities, kind of train the caregivers who are helping older adults and take care of them, kind of give them the tools and the education that they need. My DEO, Dr. Leo Marchini, he, along with others at the College of Public Health, came up with the Dental Aging Tips app, again, kind of directed at importing oral health awareness to not only patients but their caregivers. We have had a teledentistry project with a nursing home facility here in Iowa, kind of a pilot project to see feasibility and outcomes. And currently there is an ongoing project with, for individuals who have special healthcare needs across Iowa, where we are looking to find options to improve access to dental care for those adults. So here are some of those projects. - [Tricia] Wonderful. - [Jhanvi] Thank you. - [Carole] That's a lot. I love it, I love- - [Jhanvi] It's just not me alone, it takes a whole village. - [Carole] Yeah, right, right. - [Jhanvi] Yep. - [Carole] That's for sure. So I think probably a lot of people in the presentation today know a little bit about I-Smile, but for those who are not familiar, our I-Smile program spans across the entire state of Iowa. We have 15 I-Smile coordinators that serve all 99 counties. And then in about late 2014, I believe, I-Smile Silver came to be as a result of the very successful I-Smile program. So the I-Smile program is a program for children and pregnant moms. I-Smile Silver came to be for, as I mentioned earlier, for those seniors who we knew that Medicare does not provide a dental benefit. And so it was thought that, hey, these folks could really use some extra care like our children do as well. So it's so hard to put our, the I-Smile Silver program and I know I-Smile too, but it's so hard to put it in a basket of, well, here it is, nice and wrapped up. We do the exactly the same thing all the time because we don't, it's in the eight years, eight and a half years I've been here, we've done a lot of pivoting and really working hard to try to focus on the needs and the specific needs of the 10 counties that I-Smile Silver serves. So there are three of us coordinators. I myself just have Scott County and then we have a coordinator in Lee County and one in Webster County as well. I often say a lot of our work looks like social work. We really do a lot of care coordination and navigation for the adults and seniors in our communities. I never realized the need of just having a friendly person on the phone to help them call their insurance company with a three-way call or help them understand how the benefits work or to find an in-network provider. We have all said we could probably do care coordination 40 hours a week if we were given that time. But no, we do a lot of other things, which is really awesome. We spend a lot of time trying to integrate ourselves into medical systems. We feel like this is a very beneficial way to, you know, bring the mouth back into the body. So we work with hospitals, we have partnerships and collaborate with some emergency departments. So when they get a patient with an oral health issue, they will have them sign a consent and that consent can be sent to us or will be sent to us so that we can reach out to that patient and help them actually find care for the issue that they're having. We also partner with the hospital in training nurses and patient care techs on how to prevent hospital-acquired pneumonia through oral care. That's been a ongoing project now for several years, been very successful. We also work one day a week in a medical clinic to see patients there where they're at. Along with that comes a lot of fax referrals then from the days that we're not there from those providers referring patients that need a lot of help. We work with Mouth Care Matters as well. That's been a wonderful program to be involved with. I have loved every minute of that. It's an excellent program and whenever we get the opportunity to educate in nursing homes, assisted living, we definitely take that opportunity to do that. Oh gosh, what else? There's so much. I know I'll forget all the little details. Again, there's a lot of focus on, you know, helping to integrate into the medical world. Samuel mentioned our veterans in Iowa here, we have a wonderful program called the Iowa Veterans Trust Fund for low income veterans. That has been amazing. The dental benefit or allotment through that program is been amazing to transform veterans oral health as well as their overall health and mental wellbeing too. We've seen some really great turnaround working with veterans with that. So that puts us in direct contact with the county veteran service officers. Again, just another way to reach populations that certainly need help when it comes to oral health. So I think that's a good share of what we do. - [Tricia] Perfect. Well, none of you are bored, that's for sure, right? Someone shared in the chat, "The I-Smile program is a great program for the state of Iowa, and I concur, I used to assist or oversee an I-Smile program here in the states, so I know the benefits that come with I-Smile. However, once the assessment is done and completed, it's hard to make referrals or there's nowhere to make referrals, especially for those Iowans that are on Medicaid." I think that's a great lead into my next question for all of you. And Carole, I'll probably have you kick it off since we're talking, I-Smile. What are the most pressing challenges and concerns related to accessing dental care or oral health services? And specifically what populations are at highest risk for poor, excuse me, oral health in which populations face the greatest barriers in receiving these services? - [Carole] So I can speak mostly to the adult population there and it is so, so difficult. As much as we want and as much as we receive, you know, phone calls and emails from people who are in need, that lack of Medicaid providers is no secret to all of us here. And that is very, very challenging. I know the rural areas struggle even more my counterparts, you know, it becomes very, very difficult in those areas. Even here in Scott County where we, you know, have a lot of providers in general, it is very difficult to find care for those who have Medicaid as well as, you know, traditional Medicare not having a dental benefit. Medicare Advantage plans also have some dental benefit that are great, but again, we struggle to find enough providers that are in network for those plans. I will say they've gotten a lot better in the eight years I've been doing this on what they cover and how they cover but we still have a few out there that there are no providers within 100 miles for these older folks. And I would say at least I had in my notes that I really feel like one of the pressing challenges, particularly with our adults, 22 to 55, you know, we have a population that will not succumb to a dental home philosophy. They really just want emergency care when they're in pain. And that's been a challenge in my 35 years in dentistry. You know, there's always been those folks that, they're just not going to do their preventive and, you know, go to a dentist regularly, which is what we always want everyone to do. The whole goal of I-Smile is to get people into a dental home. But that can be very, very difficult with probably a good amount of the populations that we serve. It's hard to get them to change the mindset of prevention versus just going when it hurts. So I would say those are my top pressing challenges. - [Tricia] Wonderful. Thank you. - [Jhanvi] It's so interesting. I had kinda the similar things jotted down in my responses. Like the first bit was like the workforce constraints, like you said, like, when we look at statistics, it's like, in Iowa we have one dentist for like 1,700 or 1,800 people and this ratio is much higher than what it is in the other parts of the country. So other parts of the country, they have lesser population, lesser number of people per dentist. So we have definitely a big shortage there. And then you add the entire Medicaid component to it. Like how many of these are going to be dental offices that accept Medicaid? I kind of understand from both the perspective being a public health person, I'm like, let's more people accept Medicaid. It would be so beneficial, people don't have to travel big distances to come and see a dentist and then get a dental home close to home where they will show up for appointments. But then there's this other conversation about the reimbursement and how challenging that is for dental practices to kind of work with. So there is that big workforce constraint that is I think one of the biggest pressing issues, like Carole was saying as well, and I understand it's hard to kind of link when you've done a screening and you need to put a referral, you're like, okay, you'll have to travel these many miles to see the closest dentist who's gonna see you with your insurance and transportation. That's another reason, I think another big barrier or a challenge which kind of makes it so hard for patients to kind of go in and get that routine care or just kind of go for more problem focused care. And like the third bit, which I've mentioned on here, which I've written on here is like the oral health literacy component, like getting into the mindset of prevention versus limited problem focused dentistry. I think that is, that initiator, that motivation needs to be there to kind of go pass through all the other barriers there are to access that dental care. So I think those were my big three, kinda just going by what Carole was expanding on. - [Tricia] Thank you. - [Samuel] Interesting because I have a lot of the same as well. And so I think from our perspective, the Donated Dental Services Program relies fully on volunteer dentists. And even with that, or maybe especially with that, we're seeing those same issues come up with folks in rural areas not being able to have the correct transportation needed or the right transportation necessary. We also see, have seen that even if a patient's able to see a general dentist, there's a lack of specialists for complex cases. And that's of course, a one more added barrier. We know since 2020 especially dentists are experiencing hygienists and staff shortages as well. So we hear a lot of that from our volunteer dentists and that is nationwide of course. And then without, you know, these sufficient staff dentists are busier than ever. So as I said, from our perspective it's harder for them to be able to volunteer to take cases pro bono. And it's interesting to see also a lot of volunteers, a lot of our volunteers are retiring and so we're really trying to focus on bringing in more younger dentists as well just because filling that care gap is gonna be hard if we don't do that. And then we know that a lot of our elderly populations and long-term care or folks and or folks in long-term care facilities don't have access to dental professionals on staff. We used to operate a program that's similar to the program that Carole mentioned called, we called it House Calls, but it was, we went directly to these long-term care facilities, nursing facilities and treated patients there in that way, again through volunteer dentists, pro bono work. But we were unable to continue that after COVID. And so 2021 we were able, we had to terminate that program. I also wanted to mention just that the fact that there is a disparity among Black, indigenous and people of color. We know that these communities often have lower rates of preventive dental visits, but also others as well. And this is just due to a variety of socioeconomic barriers. And so those are probably my big ones as well. But very similar I would say. - [Tricia] Yeah and there seems to be a theme throughout with access to care, multiple concerns with access, but also Medicaid seems to be a huge barrier. And I've witnessed that multiple times through various clients in that as well. What strategies have been effective in reaching some of your hard to reach or most vulnerable populations to increase the awareness of oral health resources and the importance of preventative care? How have these communities been strengthened to increase this awareness to oral health resources and what resources currently exist? And I know I just said a lot to you, so feel free to follow up with the questions, but really comes down to what are some of your strategies that you've really used to reach some of these most vulnerable populations. - [Carole] So I think with the I-Smile programs in general, it's boots on the ground. It's trying to meet these folks where they're at and then get them to a clinic for care. So, I feel like that's very, very effective for both the I-Smile and the I-Smile Silver programs, a little bit more difficult for the adults to find them grouped, right? Where I-Smile goes to schools and preschools and the clinics, things like that, where with the adults it makes it a little more challenging to find them where they are, which the medical clinic has been a wonderful place. We also partner with a really awesome program that one of our health systems has for people with uncontrolled diabetes and a food pantry connected through their foundation that's been wonderful. So they sought out oral health knowing that connection and asked us to be a part of that. So that's been, you know, wonderful to be there where they're at. I would say that just in the, a little over eight years I've been here, even advertising and marketing has been really helpful to reach people. Of course, nowadays the internet more and more within the last probably since COVID really, more and more I'm hearing from older adults on that end of, you know, emailing that they saw in the website and so forth. So, but I would say overall just boots on the ground has been really helpful for us. - [Samuel] Absolutely. We agree from our perspective as well, boots on the ground and as many volunteers as we can and especially in some of the rural and underserved areas is key. I'll just speak from our perspective at the Donated Dental Services Program, as I mentioned, has been able to successfully help over 170,000 individuals receive over 550 million. That's nationwide but and so with that we're seeing a lot of things coming into contact with a lot of things that are effective strategies that we'd like to see more of. Of course, bringing care directly to underserved communities with things like the I-Smile program, fantastic. The school-based dental programs providing screenings, fluoride treatments, sealants for children, things like that. Also, there are community health centers, federally qualified health centers or FQHCs, we refer patients quite often who are, have completed our treatment plan or the treatment plan brought in by our volunteer dentist but needs ongoing care. So more of those and more education about those, their existence is, would be great, but that is a strategy that's of course, helpful, loan repayment, educational loan repayment and incentives like that for dentists. We know that the Fulfilling Iowa's Need for Dentists or the FIND project is a great opportunity for Iowans and we'd like to see more of that as well. And just encourage, you know, again, putting a plugin for our program, encouraging dentists and agencies to refer their patients to our program. The DDS program, Donated Dental Services. We also would love to see more public awareness campaigns on the importance of preventive care and regular checkups. And then again, partnerships with schools and senior centers we'd love to see more of as well. And then I think the next question is also what the gaps are or, and what the current resources are. So, Dental Lifeline Network, dentallifeline.org, I have an online application for individuals seeking treatment, but we also have a button there to donate and volunteer as well, volunteer as a dentist. FQHCs, as I mentioned, university, schools of dentistry often provide sliding fee scales depending on the treatment needed, of course, Medicaid and we'd love to see more of Medicaid as we've mentioned, more dentists accepting Medicaid patients would solve a lot of issues and then the Iowa Department of Public Health, their oral health program, we know they work on expanding access. So gaps that we've definitely seen as limited adult Medicaid coverage as I mentioned and that's state to state, but it depends on the state's plan, of course. The Medicare, fact that there's no dental coverage under Medicare, workforce shortages as mentioned prior and then just the lack of oral health integration into primary care, which I believe all of us have mentioned prior, but many medical professionals don't routinely screen for oral health issues or don't tell their patients to find a dental home, so to speak. So I know that was a lot, but lemme know if there's any questions, thank you. - [Tricia] Oh, thanks, Sam. - [Jhanvi] Yeah, kind of going with what Samuel was talking about. So the College of Dentistry is very much involved with the FIND program, which is Fulfilling Iowa's Need for Dentists. And what this program does is, it tries to bring about connections between communities which have dentist shortage or they have a dentist retiring. And then this dental school where you have graduating dentists who are looking for job opportunities and kind of connecting those two areas. So Iowa trained dentists, if they stay within the state, they can serve a bigger Iowan population. So hoping with that and in return, obviously, our students, they get some help with the debt repayment. So the FIND program has been a great at trying to fill some of those workforce shortages that we have going on. Also, here at the College of Dentistry, we are also one of the biggest Medicaid providers. So we do see large volumes of patients right from our student clinics, our resident clinics, as well as faculty clinics with, for patients who have Medicaid. We also provide, or we try to integrate with the medical school through the Ryan White program so that every patient through Ryan White who has been seen in the internal medicine department automatically gets a referral to us to find a dental home here. So that has been helpful in getting a dental home to some of the most at risk populations, adult populations there. In addition to that, I was looking at the number of older adults living in long-term care facilities and in Iowa with about 400 nursing homes, we have about 20,000 people living in there. One of the things that, as I was talking about the geriatric mobile unit, providing comprehensive dental care onsite, it reduces that transportation barrier for patients to have to come in, kind of finding that other person who can accompany them, finding a right service that would bring them to the College of Dentistry, reducing all of that planning or all of that, all of those pieces that need to fit together to make a dental visit at the College of Dentistry feasible. So I think those things have, those things are working for us here in the department and at the school. We also have a social worker embedded at our dental school, which helps kind of coordinate a few things here. Some of the biggest questions have always been about guardianship and POA-ship, navigating the system through that, navigating the system through that, especially when we have patients who are coming in with questionable capacity to consent and helping them navigate through the system of how to figure this out so that their dental care does not get affected in them figuring out what their social status is or the living arrangement may be. As for other things within the community, the efforts that could help or increase awareness, cannot thank the I-Smile programs enough for doing that and having the providers available at the grassroots level and something that we are trying to do as well as through those mobile clinics, at least get through screenings, place fluoride varnishes and see what are the most pressing needs for those patients. And hopefully they can make it back to the College of Dentistry so we can provide some care to them. I think through the Donated Dental Services, we are a part of that and thank you so much for having that program. I can imagine patients who are already bogged down with the medical complexities of their health, the number of visits that they have going on with their medical providers, battling cancer, battling degenerative health conditions, and then having to worry about their dental health, their dental treatments and the bills and the, and coordination with all of that. I'm very sure all those patients appreciate the availability of this service and thank you. - [Carole] On that community efforts, Jodi and I here in Scott County have a, what we call the Scott County Oral Health Network and we invite people from not just dental people but school nurses, you know, medical people, insurance, you know, MCO, the MCOs form Medicaid medical side as well as the dental side. And anybody that we can grab from our community to come to our network meetings, we feel that that's a great way to help the community take some involvement. And we've had some pretty good success stories I think, especially with our school nurses. They've just been amazing to really help those kids, you know, that we don't get to who need help. And then I'd like to add the Iowa Mission of Mercy as a resource. I know that it's only once a year, but I've worked the exit interview portion of that event for several years now. And it is, again, for some people that's their comfort zone. That's what they seek out every year is the Iowa Mission of Mercy. And I could go on and on about the reasons for that, but it is a good resource and you know, people get good care and it's, yeah, what's is sought out for dental care as opposed to a dental home. Again, not ideal but it is a good resource. I thought I would mention that. - [Tricia] Wonderful. - [Jhanvi] So, IMOM was in Sioux City last year and this year IMOM is coming up in Coralville, September 19th and 20th of 2025. So it's coming a little closer here. Which brings me to the question about, I'm particularly interested in resources available for those in northwest part of Iowa. So I think in the northwest part of Iowa right now, I think one of the biggest FQHCs right there is in Storm Lake and they do offer sliding fee payments and things like that. But I'm not sure if there are mobile services that are available in that region. I know there are a few dental practices there, which are privately owned. I'm not 100% sure if they accept Medicaid. I thought they used to take Medicaid, previously in Pocahontas, Fort Dodge maybe, but I'm not too sure if they still continue to take Medicaid as of now. I know this because one of our extramural programs is based there, one of the sites, Storm Lake, the CHC at Storm Lake is one of our sites for the extramurals where our students kind of go offsite for five weeks to provide dental care and I think it's, they're unable to take new patients and I'm really sorry to hear that, but I know students when they come back and we have like the exit seminar with them, they talk about that they see patients with Medicaid in there. Some of the private practices we have in, I think in Fort Dodge, Pocahontas, I'm not sure, as I said, if they take Medicaid, but students do talk about a diverse group of patients they provide care to in that area. - [Tricia] On the chat, it ask as the only dental school in Iowa, what the University of Iowa Dentistry doing for outreach to counties outside of Johnson County to provide opportunities to those similar that are being provided in Johnson. - [Jhanvi] So, I may not be completely informed about this, but I think the pediatric dentistry department goes out to the Muscatine County for an outreach onsite program to see children in that county. And that is one thing that I know a little bit, but not the whole bit of it, it's kind of housed with the Department of Pediatric Dentistry, in a addition to that, I'm not sure, I know there was some conversation between about having satellite centers with the University of IOWA, College of Dentistry, but I think the discussion is in the higher ups yet, so not anything that I know at this point. - [Tricia] Sam, did you have something you wanted to jump in and I interrupted you? - [Samuel] Oh, of course. No problem. I just wanted to mention, you know, we try to operate in all counties in Iowa and so there might be disparities where we might have a dentist not available in a certain area. But I'd encourage everyone to check out our services, dentallifeline.org and or just reach out to me and we can definitely get, try our best to get care for whatever individual in any part of Iowa. - [Tricia] Wonderful. How can public health agencies or other agencies across the state play a greater role in promoting oral health awareness? Which local or state organizations should public health professionals collaborate with or be reaching out to to see how they can work together? As we all know, public health tends to be the connector. We might not do everything, but we like to be a part of connecting the community and addressing the needs within our communities. So again, kind of who should public health be reaching out to? Who are some of our good partners? If they're struggling to find them, who would you recommend? - [Jhanvi] I think greater amount of medical and dental integration. That would probably be one of the first sites where getting a screening, like, getting the screening or having that question in like, how we have in like the child wellness checks, like, does your child have a dental home? Similarly for adults it would be good to have that come from your primary care or have a screening on site possible. I know a lot of the FQHCs across Iowa are kind of going towards that integration, but that's kind of more of an electronic health record based integration. There are a few FQHCs where we do have some amount of screening opportunities available for the provider at the medical or the annual physical. So I think that would be a great start. One of the biggest things I feel is more awareness about diet because I think nutrition is one thing we talk about from all perspectives except oral health sometimes, kind of bringing that connection between sugar and cavities and how closely they are linked because a lot of the fast food culture has a lot of sugar embedded in them. It's a sneaky, it makes its way, it makes its way into our diet knowingly, unknowingly. So maybe a little more awareness about that. And with the ongoing debate about fluoridation kind of strengthening that connection and talking about like the right concentrations of fluoride is gonna be beneficial and reducing the doubt that is being sewn. I think those would be great efforts to kind of bring the community to better oral health. So, yeah. - [Carole] So, something that our agency does, and I mean in general a lot of our, my coworkers interactions with other agencies with their programs are really great about making connections with oral health. They've had education from Jodi and I on, you know, oral health and its connection to systemic health and they see it when they're out there doing their things. So, we have a maternal health nurse who is planted in a variety of areas and she knows about oral health, she's been trained by Jodi for screenings and they know what kinda questions to ask and are great about, you know, sharing that information out. I think that's been a wonderful way to bring oral health awareness in our area as well as good communication with boards of health, you know, board of supervisors, you know, trying to include something about oral health and in all of those areas, the reports or the presentations and things that we've been invited to do as our director is willing to, you know, help us to share that information with our folks. And then we also have our I-Smile coordinator within our immunization clinic. So kids that come in for their immunizations, I think that's a wonderful connection as well, some of that medical-dental integration but it's something we're doing here in public health, that's easy. You know, they're right here, we're meeting 'em where they're at. - [Samuel] Yeah, I just think basically all of the above. The one thing I wanted to mention, yeah, is definitely what's already been discussed as far as integrating oral health into overall health initiatives and then public health agencies working together to talk about the other resources available beyond their own resources. And then lastly here, I just had strengthening oral health policies and expanding coverage, of course, I think would be great. And of course, it's easier said than done but just with an eye towards that I think we could see a lot of really positive change. - [Tricia] Yeah, I definitely, I kinda heard from all of you, advocacy is gonna be a huge piece, right? Using those advocates, whether it's through the board of health, board of supervisors, a combo of that providing some additional education to get rid of the miss or maybe the dis and misinformation about fluoridation in water. So people are fully educated with the pros of how this has helped and what it looked like prior to fluoridation in waters. Especially in I think some of the rural areas. There's more concerns for folks that just haven't seen or understand maybe what some of those numbers should look like, why we do it, those sorts of things. So I think advocacy obviously is a huge piece for all of that. Not only for the education piece but to drive some of those policy changes, whether it's Medicaid, ensuring that there's more access for those folks who are covered through Medicaid, how to work with physicians if there's policy incentives that they could work with local dentists to improve access to care. And then obviously just the mere numbers, right? Like, just finding those incentives. We have a healthcare shortage and I think a lot of folks think of, you know, primary care doctors, OB-GYNs 'cause that's what's hitting the news a lot. But clearly we have a deficit of dentists as well. So definitely I think advocacy is a huge piece of that. And then connecting those partners and some of those untraditional partners, right? Like transportation, getting folks out to being able to get to where they need to be. And then I know a lot of the public health agencies that have the I-Smile program, definitely love to partner with their immunization clinics, their WIC clinics, their maternal child health clinics. Anytime you can get kinda that one stop shop makes it easier on the clients 'cause you're meeting them where they're at and you're saving them another trip and possible day off of work, et cetera, for a population that probably doesn't have a whole lot of paid time off to go seek preventative care. Thank you. Thanks for sharing all of your expertise. We're wrapping up with our kind of last five minutes. For organizations or individuals that are looking to get involved with oral health activities, what are some of the key steps that you would recommend them doing that they can kinda put in their toolbox or tool belt before they leave today? - [Carole] I think if they're in Iowa, contact their I-Smile coordinator. We'd be happy to partner with anyone interested in oral health. That's definitely something we'd love to do. - [Tricia] And I would say even those that aren't in Iowa, to get ideas on how the program is, even how it's working, you know, how kind of Iowa started it. So even for those of you, those folks who are not maybe in Iowa, feel free to reach out. We can connect you with I-Smile coordinators across the state, so you can hear how they've plugged into communities and what they're doing here in Iowa. - [Carole] And I think with the resources and just obviously with our FQHCs being, you know, really overwhelmed our college, amazing place that it is, but, and they can only handle so much. Resources are difficult. There's no magic pill for this. And it's very time consuming and it does get very frustrating when we're trying to help folks. But then I know, we try to look at those that we have been able to help, not only do we collect the data on those that we couldn't, but we are looking at lots and lots of people, who, I don't know where they would've gotten help if they hadn't connected with Donated Dental or you know, I-Smile, I-Smile Silver in the college. You know, that helps me not to get so bogged down in the fact that the resources are few and it's not just dentistry, it's everywhere. Resources are not as plentiful as we would love them to be. But I think the work that everyone is doing, and I'm sure everyone you know, that attended today, they're all doing really hard work to help people and it's what we have to focus on. Stay sane anyway. - [Samuel] Absolutely. I agree. And I just wanted to say, you know, Dental Lifeline Network, Donated Dental Services Program is a great way to get involved, whether you're a dentist or you know a dentist, ask them if they're involved, ask them if they would like to donate to see someone in need, donate their services to see someone in need. Or you can financially contribute if you are not a dentist, spread the word, of course, if you're not a dentist about our program. And then beyond us, we just, you know, I think school and community groups, educational groups are important. Mobile clinics, public health clinics are also important. And then just looking to, and we are looking to partner with some of these other physical health organizations such as cancer centers, dialysis centers, to spread the word to their region so that we are a resource. So that could go for any other resource in Iowa as well. - [Carole] Volunteer for IMOM. - [Jhanvi] That's what I was gonna say. Volunteer for IMOM. - [Samuel] Absolutely. - [Carole] Except you don't have to be a dentist. - [Jhanvi] Dentist- - [Carole] You know, a licensed professional. You can come and volunteer and there's plenty of need and it is amazing. So that's a great way to be involved in oral health activities, it's wonderful. - [Jhanvi] Yeah. No, and if you're looking to volunteer, there is a free medical clinic with an embedded dental clinic here in Iowa City. They are always looking out for volunteers. There's His Hands in Cedar Rapids. Again, they're looking out for volunteers and like Carole was saying, IMOM, you can provide translation services, triage services. You don't need to be a dentist, dental assistant or a hygienist to volunteer for that. And yeah, I appreciate everybody who has joined in 'cause I think this is a topic which needs to be talked about enough so that we can advocate for those who cannot talk about themselves or sometimes cannot even articulate their dental needs. So we need to be that voice to talk about them, to talk for them in a way that they can receive the care that they need. - [Tricia] Well, that is our time. Thank you guys for participating. Again, thank you to the panelists. Thank you for our audience. Please be on the lookout for any future webinars. Everyone take care. Have a wonderful day, and, again, thank you. - [Carole] Thank you. - [Samuel] Thank you all. - [Outro Narrator] Thank you for joining us today. Special thanks to Tricia Kitzmann, Erblin Shehu, Tasneem Ali, Mary Kosobucki, Dena Fife, Rima Afifi, Laurie Walkner, Cynthia Maharani, Natalie Peters, Melissa Richlen, and the speakers who have shared their expertise with us. Theme music for the Building Health Equity podcast series was composed and produced by Dave Hoing and Roger Hileman. Funding for the Building Health Equity Initiative is provided by the Iowa Department of Health and Human Services. Please see the podcast notes for an evaluation link and transcript. For additional resources and information, or to view the video webinar recordings, be sure to visit the Building Health Equity website at iphprp.org/services/training/building-health-equity/.