Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join us in this episode as we discuss the critical shortage of health care workers, especially in the dental field, with our guest Theekshana Fernando, a research scientist. We explore the connection between oral health and overall health, the challenges of accessing dental care, and the potential of dental therapists to bridge the gap. Discover the impact of dental therapists in improving access and addressing diversity in the dental workforce. Don’t miss this enlightening conversation with Theekshana Fernando, a dedicated advocate for better oral health care.

Theekshana Fernando is a research scientist.

He discusses his KevinMD article, “Revolutionizing oral health care: the affordable solution that’s breaking barriers and boosting health equity.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

Ambient intelligence augments human capabilities to make our lives easier. The applications are many, especially in health care. Ambient clinical intelligence is offsetting the most pressing challenges in health care today, such as burnout, physician shortages, physician and patient dissatisfaction, and underperforming financial outcomes, by applying the technology to clinical documentation. 

The Nuance Dragon Ambient eXperience, or DAX for short, utilizes artificial intelligence and natural language processing to automatically document care. It securely listens to and captures the natural, clinician-patient encounter conversation unobtrusively, and turns that conversation into a clinical note for the clinician’s review and signature directly in the electronic health record. You just talk naturally, and DAX does the rest. 

DAX is being used by thousands of physicians across 30 different specialties nationwide. It has already won the Silver Stevie award in the health care technology category and was ranked #1 for improving clinician experience in KLAS’s top 20 emerging solutions.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/ebHWnK

Powered by CMEfy.

Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Theekshana Fernando. He is a research scientist. His KevinMD article is titled “Revolutionizing oral health care: the affordable solution that’s breaking barriers and boosting health equity.” Theekshana, welcome to the show.

Theekshana Fernando: Thank you so much, Kevin. I’m very happy to be here.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Theekshana Fernando: OK, so I am a physician by training. I studied in Kathmandu, Nepal. I completed my medical education there as well as my medical internship. The medical school that I studied at was quite unique in that it really instilled the concepts of public health and community medicine in its students, which I thought was fantastic. Some of the experiences I had during my medical education, together with my experiences in India, Bangladesh, and Sri Lanka, showed me how, if properly leveraged, public health systems can actually make such impactful and long-lasting improvements in health.

So I wanted to learn about the upstream drivers of change. I wanted to learn about population-level changes and advances to health equity. With that in mind, I moved away from clinical medicine to public health, and I came to the University at Albany School of Public Health to get my master’s in public health. I’m now pursuing my doctorate in public health at UAlbany itself.

In early 2020, I started working at the Center for Health Workforce Studies, located at the School of Public Health at the University at Albany. Within the center, I focus on oral health. So I work at the Oral Health Workforce Research Center, which incidentally is the only federally funded oral health workforce research center in the country, and our goal is to research the oral health workforce and assist in future workforce planning.

Kevin Pho: Wonderful. So this isn’t a topic that we have a lot of on the podcast, so I’m certainly interested in hearing more about the oral health issues that are facing the workforce today. Your KevinMD article is titled “Revolutionizing oral health care: the affordable solution that’s breaking barriers and boosting health equity.” So tell me, how did your article come about?

Theekshana Fernando: So when it comes to access to care, we know that health insurance does not mean access. It’s an important step, but it is not the only step. So let’s put it another way, and I want to emphasize this: Health insurance or dental insurance does not mean patients have access to care. But let’s stop there.

In the U.S., there are over 75 million Americans with no dental insurance. Now, this is in spite of decades and decades of research, which has shown us that oral health is an integral part of overall health. In the U.S., there are about 331 million people, and 75 million of them have no dental insurance. Let that number sink in: 75. And even if they did, 70 million Americans live in dental health professional shortage areas. These are provider deserts, where you will either not have or have limited access to oral health care.

At the Oral Health Workforce Research Center, we have researched the dental therapy model before, and I really wanted to share some of our findings, as well as the research from the broader scholarship, about how effective dental therapists have been in advancing health equity.

Kevin Pho: So before we get into that, you did say that oral health is integral to overall health. Give us some individual examples. I think that intuitively, obviously, that makes a lot of sense, but give us some specific examples that could really illustrate that point.

Theekshana Fernando: Oral health has been linked to heart disease, to diabetes, pregnancy complications, pneumonia, and so much more. In the U.S., we often forget that the mouth is actually a part of the body, given the way insurance and providers are organized, but it is an essential part of our body, which we need to pay attention to.

Kevin Pho: And you mentioned these dental health worker deserts. What are some of the reasons that precipitate that?

Theekshana Fernando: So something that we know is that the dentistry workforce is predominantly white and affluent, and health equity has been a significant issue in this population. So there are communities where oral health providers simply don’t go and practice, because it could be related to reimbursement issues or related to the infrastructure. There are quite a few reasons.

Kevin Pho: So in terms of next steps, what are some possible solutions, or what are some options that we have facing this issue?

Theekshana Fernando: So one thing is, even though I said dental insurance does not mean access, it has to be addressed from several different directions, the first of which is making sure people have access to care. Now, we know that Medicaid dental benefits don’t exist for everyone in all the states, and on occasion, whenever states are strapped for cash, oftentimes Medicaid dental benefits are the first to go. So it’s essential to make sure that people have the insurance.

And a lot of the people go and receive their services from the safety net, from federally qualified health centers, which have been pushed to the limit during the pandemic. They are understaffed, they are underfunded. So we need to make sure that FQHCs and other safety net organizations are also supported in the work that they do.

And then there are also things like addressing burnout and resilience in the oral health workforce. Again, it’s something that’s been there for ages, but it really came to the forefront during the pandemic, which is in fact one of the reasons, I think, it’s a priority area for the U.S. surgeon general, to make sure the workforce is protected from burnout and stress.

Kevin Pho: So we hear about burnout and stress certainly within the medical profession, but go more into the dental profession specifically, in terms of how that’s decimating the workforce.

Theekshana Fernando: Interestingly, at the Oral Health Workforce Research Center, we did a project just last year where we did a number of key informant qualitative interviews. The report is actually available on our website. We really wanted to talk to oral health providers. We talked to dental directors and FQHC directors to learn about their experiences.

One of the things we’ve noticed is that a lot of people, especially during the early parts of the pandemic, a lot of the workforce, the oral health workforce, left. I mean, that was very early on in the pandemic. There were a few percentage points of the entire dental hygiene workforce which left, and that is causing so many problems across the board, because when the workforce leaves, there are longer delays. That means that you might have to wait for months, and in some cases, we’ve heard of instances where patients have to wait for over a year to get an appointment. And when they come back, a problem which could have been addressed fairly easily has, over a year, progressed to something far more serious. So what could have been a fairly simple restorative procedure now is a very complex procedure, which keeps adding to the workload of the workforce.

Kevin Pho: So as a solution, you mentioned dental therapists. Talk more about that.

Theekshana Fernando: So dental therapists have been around for a long time. The dental therapy model started in New Zealand over a century ago. We at the Oral Health Workforce Research Center have been researching the dental therapy workforce for a while, and we have partnered with a number of really incredible organizations that have dental therapists on their team. What we have found is that dental therapists have significantly improved access to care, especially in vulnerable populations.

Now, like I said earlier, the dentistry workforce is predominantly white and affluent. Dental therapists, however, represent the communities that they serve, and they have had tremendous impact, especially in rural communities like in Alaska, on improving access for tens of thousands of people. The dental therapy model in the U.S. started in the early 2000s in Alaska, but it has since expanded to over a dozen states now.

Kevin Pho: So contrast what dental therapists can and can’t do in relation to dentists. What’s their scope of practice in comparison to dentists?

Theekshana Fernando: So when it comes to oral health providers, like dental assistants, dental hygienists, dental therapists, and dentists, the scope of practice is different. And definitely there are some procedures which dental therapists can perform, similar to dental hygienists. But again, the scope of practice of dental therapists is a little narrower than the entire scope allowed for dentists.

Kevin Pho: And can they practice independently, or do they have to practice under the purview of a dentist?

Theekshana Fernando: So the authorization requirements vary across the states. For that particular question, I would have to pull up our very own infographic to find the answers, but often they work under the purview of a dentist.

Kevin Pho: And in terms of the training model, how many years does it take to become a dental therapist?

Theekshana Fernando: The training model varies depending on the state, but it could be anywhere from three to several more years.

Kevin Pho: So tell us your ideal world. If you were in charge of public oral health care, what would you like the ideal world to be?

Theekshana Fernando: I would authorize dental therapists in all states. Dental therapists come from the communities that they serve. They provide care to underserved and vulnerable populations where you might not find a dentist. So an ideal world is where dental therapists, similar to dentists and dental hygienists and dental assistants, can practice and be a part of the dental team in meeting the needs of the population.

Now, interestingly, what research shows is that after a dental therapist was actually added to the team, patients reported having shorter waiting times. It allowed patients to have more of their health needs met in a single visit. It gave the patients a sense of having a regular provider. These are all tremendously important, especially in some very rural and underserved areas.

Kevin Pho: And where are we now in terms of policy to implement your vision?

Theekshana Fernando: So states have to enact the legislation to authorize dental therapists, and right now, over a dozen states allow dental therapists to practice in those states. And this is keeping in mind that the dental therapy model itself began in the U.S. in the early 2000s. So in less than two decades, we’ve had more than a dozen states which have authorized dental therapists to practice in these states, which I think is tremendous.

So to enact this wonderful vision, I’d say a lot of state coalitions and oral health providers in the states that they practice in have to come together and recognize the tremendous potential that dental therapists can have. That requires collaborations, partnerships, more research, and giving this workforce model an opportunity to really matter and provide services to the populations that are very much in need of them.

Kevin Pho: So talk about some of the obstacles that prevent this from being implemented. Are you encountering any pushback from any groups to this dental therapy?

Theekshana Fernando: That’s an interesting question. When the model was first introduced in the early 2000s, there was a fair bit of resistance from organized dentistry. But what we have found, and research supports this, is that after dentists have actually had an opportunity to have a dental therapist on their team and see what they’re capable of doing, when a dental therapist comes and joins a team, the dentists end up doing fewer basic preventive and restorative services, which actually allows dentists to take on more complex roles and work to the full potential of their scope. So that initial resistance has somewhat lessened, which I think is a wonderful, wonderful thing for the progression and expansion of this model.

Kevin Pho: In a typical dental practice, what do you envision as the role of the dental therapist?

Theekshana Fernando: A dental therapist would take on basic preventive and restorative services. They will see the patients, and they will collaborate with dental hygienists and dentists. They are essentially a tremendous part of the dental team. And some of the research that I mentioned earlier is regarding an organization that actually works with dental therapists, and what they found was that even when a dental therapist joins their team, they’re very welcomed by the other provider models within the dental team, which I think is fantastic.

Kevin Pho: You know, when you say restorative services, can they do procedures?

Theekshana Fernando: Yep, they can do procedures.

Kevin Pho: All right. We’re talking to Theekshana Fernando. He’s a research scientist. His KevinMD article is titled “Revolutionizing oral health care: the affordable solution that’s breaking barriers and boosting health equity.” Final question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Theekshana Fernando: The complexity of the health care system in the U.S. and the complexity of the oral health care system in the U.S. mean that it’s very unlikely for there to be one single grand solution that’s going to solve all the problems. But that being said, here are dental therapists, which have proven to be effective at increasing access to vulnerable and priority populations.

The take-home message that I would have for your audience is to think about how they can integrate processes and protocols to truly offer integrated health care, and to use their positions of power and privilege to identify, advocate for, and research health workforce models such as dental therapists, who are proving to be so very instrumental in offering services to priority populations that actually need those services.

Kevin Pho: Well, thank you so much for sharing your time and insight. Thanks for coming on the show.

Theekshana Fernando: Thank you so much for the opportunity, Kevin.