A BROADER VIEWOF HEALTH: - UCLA School of Public Health

the mouth. Untreated, tooth decay (cavities) – the
most common chronic disease in children – can
cause everything from pain and difficulty eating to
lost school and work time. Serious oral disorders can
undermine self-esteem, inhibiting children and adults
from smiling. Gum disease has recently been linked
in studies to increased risk for diabetes, heart disease
and stroke.
And while much attention has been paid to
the problem of lack of health insurance, the fact
that even more are without dental coverage is often
overlooked. Although public insurance programs
such as Medicaid have increased coverage for children,
dental benefits tend to be vulnerable to cuts in
tough economic times. By the same token, for many
low-income families struggling financially and, in
some cases, lacking education about the importance
of regular dental visits, dental care may be viewed
as optional.
“Oral health issues fit so closely with public
health’s mission,” observes Andersen, “and through
efforts aimed at prevention, education and addressing
access issues, we have the potential to get more in
return from our investment than from many other
investments.”
Dental public health issues haven’t been ignored
at UCLA, where faculty in the School of Public
Health and School of Dentistry have worked – often
together – to address some of the major concerns.
One of the key efforts began in 2001 when The
Robert Wood Johnson Foundation provided funding
for a national demonstration program aiming to
reduce dental-care access disparities. Fifteen dental
schools were selected to participate in the Dental
Pipeline Program, which would receive additional
funding from The California Endowment. The
program’s national evaluation team was based in the
UCLA School of Public Health, with Andersen as
the principal investigator and Dr. Pamela Davidson,
associate professor of health services at the school,
as co-principal investigator. (The original project
ended in 2007, but a follow-up study to measure its
sustainability is ongoing.)
The pipeline program was established in an
effort to increase access to dental care in low-income
and minority communities by recruiting more students
from underrepresented minority groups to
dental schools, improving dental school curricula to
better prepare students to provide culturally competent
care, and providing more clinical practice experiences
for students in underserved communities.
“If you look at the ethnicity of dentists compared to
the distribution of the population, there are greater
differences than in medicine,” Andersen notes. That
has contributed in part to the shortage of oral health
providers in minority communities, he says.
Dental schools have faced significant challenges
in their efforts to recruit minority students into
dental careers, Andersen notes. For one, the shortage
of providers in minority communities means there
are few family members or friends serving as role
models and mentors. Nonetheless, through steppedup
efforts, including the establishment of pre-dental
programs to assist students in meeting prerequisites,
the pipeline program schools increased applications
from underrepresented minority students by 77
percent from 2003 to 2007, while enrollment of
underrepresented minority students increased by
27 percent.
Beyond the effort to increase the number of
minority dental providers, the pipeline program
sought to revamp education and training experiences
that would make all students more likely to consider
careers in public health and service to underserved
communities. While curricula were revised and the
number of days senior dental students practiced
in underserved communities increased, it’s unclear
whether there was a corresponding increase in graduates
going on to practice in these communities.
Unfortunately, Andersen notes, dental students tend
to enter practice with huge debts; thus, many who
want to go into public service positions are deterred
by the lower salaries and instead feel compelled to
opt for private practice.
The problem of disparities in utilization of dental
services – particularly among children – is underscored
by a recent study conducted by Dr. Nadereh
Pourat, professor of health services and director of
research for the Center for Health Policy Research,
which is based in the school. Using data from the
2005 California Health Interview Survey, Pourat
found that nearly 25 percent of California children
ages 11 and under had never seen a dentist, and
that among those who had, there were significant
differences by race, ethnicity and type of insurance
in the amount of time between dental care visits
(see page 24).
Having any kind of insurance significantly
increased the odds that a child would see a dentist
on a regular basis, but the type of coverage mattered:
54 percent of privately insured children had seen
a dentist within the previous six months, vs. 27
percent of publicly insured children (Medicaid or
the Children’s Health Insurance Program) and 12
“Public programs
are designed to
improve access
to care for
underserved
populations,
and our study
shows that they
are successful
in doing so.
However,
they don’t close
the gap.”
—Dr. Nadereh Pourat
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