nn Feature Story Community Dentistry’s Impact is Strong and Wide Since 1971, the <strong>of</strong>ten unnoticed Eastman Institute’s Division <strong>of</strong> Community Dentistry and Oral Disease Prevention has been quietly making strides in better understanding oral disease, and working to reduce disparities among children and adults. Below are four projects that demonstrate the positive impact this division is having on the community at large. Dr. Sangeeta Gajendra chats with HIV patient and Aids Care <strong>Center</strong> employee Alexander Foldvari after his exam. 10 eioh | university <strong>of</strong> rochester medical center
Compared to the other disciplines within dentistry, dental public health is the smallest segment, with only 162 active diplomats with the American Board <strong>of</strong> Dental Public Health. Eastman Dental’s Sangeeta Gajendra, DDS, MPH, assistant pr<strong>of</strong>essor, is one <strong>of</strong> them. Raised in India by her father, a dentist, and her mother, a doctor <strong>of</strong> homeopathy, she developed a passion for dentistry and helping the underserved. After earning her master’s in Public Health from the <strong>University</strong> <strong>of</strong> Illinois and completing her dental public health residency in Albany, she came to Eastman Dental for the Advanced Education in General Dentistry program. She graduated in 2004, and has since worked in the Division <strong>of</strong> Community Dentistry and Oral Disease Prevention as associate director providing dental care particularly at Eastman Dental Downtown, Eastman Dental School 17 and the SMILEmobiles. Gajendra has also started the process for an Eastman Institute for Oral Health residency program in Dental Public Health. “The vision I have for a unique residency program in Dental Public Health is to include a clinical component, which I believe is absolutely critical to be effective and successful in the field,” said Gajendra. In addition, she is leading two projects affecting vulnerable populations, children in foster care and those afflicted with HIV. 1 HIV Patients and Oral Health Low scores in the dental component <strong>of</strong> a NYS DOH assessment prompted the AIDS Care <strong>Center</strong> to seek help a year and half ago from Eastman Dental to provide oral screenings and referrals. This project’s goal was two-fold: to assess the oral health status in HIV/AIDS patients at the Aids Care <strong>Center</strong>, including the prevalence <strong>of</strong> dental caries, periodontal disease and presence <strong>of</strong> oral s<strong>of</strong>t tissue and mucosal lesions; and to determine oral health related impact on quality <strong>of</strong> life in this population. New York ranks second for HIV prevalence in adolescents and adults among 33 states with confidential name-based HIV infection reporting. About 3,380 cases are in Monroe County. To date, Gajendra has examined nearly 200 <strong>of</strong> the <strong>Center</strong>’s 640 patients, <strong>of</strong> which 99% had either treated or untreated caries experience. “More than half <strong>of</strong> the patients had not been to a dentist in the recent past,” Gajendra stated. “The prevalence <strong>of</strong> s<strong>of</strong>t tissue lesions commonly found in HIV patients has reduced drastically.” This possibly could be due to HAART (Highly Active Antiretroviral Therapy), which aims to stop any weakening <strong>of</strong> the immune system and allowing the body to recover from any damage that HIV already caused. However, dental caries experience is high, especially those with untreated caries (88%). Only 2.4 % had healthy periodontal conditions, 42% reported going to the dentist only for emergency visits, and 51% reported they were anxious about seeing a dentist. Roberto Baun Corales, DO, AAHIVS, medical director <strong>of</strong> Aids Care <strong>Center</strong>, attributes a few things to poor oral health among HIV patients. “A combination <strong>of</strong> poor diet, missed follow up visits with their dentist and decreased access to a dentist is the most likely reason,” said Corales, who said the project is a mutual collaboration to bring the dentist to the patient. “We are trying to meet patient needs when they need it, and Eastman Dental Downtown <strong>of</strong>fers a closer venue for some <strong>of</strong> my patients.” “Our preliminary findings clearly showed that a higher number <strong>of</strong> HIV patients reported greater oral health related impact on quality <strong>of</strong> life in terms <strong>of</strong> physical pain, socially and psychologically,” Gajendra explained. Despite being encouraged by the staff and providers <strong>of</strong> the AIDS Care <strong>Center</strong> to be screened by Gajendra, less than half <strong>of</strong> the scheduled patients showed up for their appointments. This rate improved slightly when an incentive was provided as a result <strong>of</strong> a supplemental grant from the <strong>Center</strong> for Community Health. Yet because half <strong>of</strong> the patients are still not showing up, Gajendra and her team believe there are other barriers accessing dental care that need exploration. Gajendra intends to apply for an NIH grant to explore these barriers. “There is most definitely a high level <strong>of</strong> unmet oral health needs in this vulnerable population,” Gajendra said. “Accessing dental care may not necessarily be an issue, but there may be barriers to utilizing it appropriately. This project is an opportunity to educate patients about the importance <strong>of</strong> oral health, especially with a compromised health condition, and provide them with the treatment they need.” 2 Foster Care For several years, Eastman Dental has been partnering with the Monroe County Department <strong>of</strong> Public Health for the ongoing oral health surveillance <strong>of</strong> school children, including a teledentistry project that’s been underway for three years.. Monroe County Health Director Andrew S. Doniger, MD, MPH, decided to look at local children in foster care, to see if the local situation matches the national trend <strong>of</strong> about 35% with significant dental momentum | fall <strong>2010</strong> 11
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