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Closing The Gap

Closing the Gap lead photo

Closing The Gap

New learning institute builds on past success to diversify the dental profession

By Janet Edwards

At the age of 13, Esther Lopez, DDS, knew intimately her mother’s battle with cancer because she served as the primary translator between the patient, a native of Ecuador, and her doctors. Even at such a young age, Lopez vowed the excruciating experience would influence her life’s work. She didn’t know the term “public health” then, but that’s where she would later find fulfillment, through dentistry. In part, Lopez credits the now defunct, but still influential, Dental Pipeline program for helping her achieve that dream. A new project, the Dental Pipeline National Learning Institute, builds on the program that brought Lopez into dentistry.

Esther Lopez is a dentist in Oak Park, Ill. Through both private practice and volunteer public health efforts, she works with low-income and minority populations, groups that typically find Esther Lopez, DDSEsther Lopez, DDSdental services inaccessible, complex, and unwelcoming. In large part, Lopez credits a now-defunct minority recruitment program, the Dental Pipeline, for the opportunity to do such work, a longtime ambition that often seemed out of reach.

Lopez is one of a small number of minority dentists in the country—only 9 percent of practicing dentists are African American, Hispanic, or American Indian. While these underrepresented groups comprise nearly 30 percent of the general population, they account for just 13 percent of first-year dental students. Dental schools and their community partners seek to close that gap through a new program that adopts lessons learned from the Dental Pipeline.

Dental Pipeline National Learning Institute
The original Dental Pipeline launched with funding from The Robert Wood Johnson Foundation (RWJF) and The California Endowment. In all, 23 (out of 62) U.S. dental schools were involved in the decade-long program, which ended in 2011. Widely credited with transforming dental education, the Dental Pipeline resulted in better access to care for underserved populations, along with more student exposure to community-based services and higher enrollment among minority students.

A new program launched in fall 2012, the Dental Pipeline National Learning Institute (NLI), is intended to build on that success. Project partners are the American Dental Education Association and the University of the Pacific Arthur A. Dugoni School of Dentistry, in San Francisco, Calif. Support comes from an initial 18-month, $650,000 grant funded by RWJF.

Eleven schools were tapped as NLI participants. Each institution receives $12,000 to cover the cost of building a recruitment project or community-based education component. The program includes a three-day training course covering best practices, advocacy and leadership, and various mentoring opportunities.  

Paul Glassman, DDS, professor and director of Community Oral Health at University of the Pacific, is project director. The primary goal is to expose other dental schools to Paul Glassman, DDS Project Director, National Leadership InstitutePaul Glassman, DDS Project Director, National Leadership Institutemethodologies developed as part of the Dental Pipeline “so they wouldn’t be reinventing the wheel,” he says.   

Evidence of the Dental Pipeline’s success is found in the numbers, Glassman says. “Schools involved in the Pipeline managed to dramatically increase—double, triple, even quadruple—the number of underrepresented minority students entering their schools. [Enrollments of] other dental schools not involved in the program stayed static,” he says. 

The NLI is a one-year program. Participants are dental school faculty members who collaborate with a partner from a local organization, such as a minority-focused college or community health center. “We want some significant community partner involved because we’re really trying to emphasize the fact that in this very complex world that we live in, dental schools really can’t break through these barriers by themselves. The way to make progress in our current world is through partnerships and establishing networks,” Glassman says.  

Like its predecessor, the NLI is also designed to develop future leaders in the push to provide more diverse dental care in community-based health settings, Glassman says. Barriers to health care for low-income and minority individuals, which result in less dental care and more dental disease, are well documented, he adds.  

“Minority populations tend to have more dental disease than more affluent populations and majority populations. They tend to have more barriers to access to care, so they get care less regularly,” he says. Paying for dental care is a serious obstacle, along with language and cultural challenges. “They feel uncomfortable going into a dental office because they feel someone isn’t going to understand them,” he says.  

“We’re expecting people who go through this program to become future leaders in this area, so within their own school and their community, and maybe even regionally, they’re going to be someone steeped in this whole idea of the dental profession doing a better job of improving the health of underserved populations and keep the momentum going,” he says.

The Minority Enrollment Challenge   Kim D’Abreu,  Senior Vice President, ADEAKim D’Abreu, Senior Vice President, ADEA

While the Dental Pipeline made positive inroads toward recruiting minority dental students, the NLI is designed to keep the momentum going, says Kim D’Abreu, senior vice president for access, diversity, and inclusion for the ADEA.   

The effort continues to face several high priority challenges. A large pool of minority students who could succeed in dental school remains untapped, D’Abreu says, including 12,500 students of color who graduate with majors in the biological sciences each year. “A 2003 focus group study published in the Journal of Dental Education found that early and frequent exposure to dentistry and dentists in practice is essential for minority students to consider the profession. Dental schools need additional tools and strategies to attract a talented group of underrepresented minority students,” she says. 

The process by which dental schools evaluate student candidates is undergoing review, Glassman says.        

“Traditionally, admission is based on grade point average, extracurricular activities, and other sorts of measures that aren’t necessarily the measures that students from minorities have excelled in … because they were working while they were in school and facing other social challenges in their lives,” he says. While it makes it harder for them to get through the admission process, it doesn’t necessarily mean they are less qualified or passionate about a career in dentistry, he says. Schools are now adopting a whole file review approach, one less focused on the numbers, Glassman says.  

The whole file review, which takes into consideration a host of cognitive and non-cognitive variables, has already proven to be effective and is just one of other successful admissions strategies shared with NLI institutional participants, D’Abreu says.

Engaging Students in Community Health
Along with recruitment of minority students, another goal of the Dental Pipeline was to get students to spend more of their clinical time in community health settings, a mission that continues under the NLI program.  

“(In the Dental Pipeline) we increased the number of days from three to four to up to 50 days for senior dental students as part of the education program,” Glassman says. “The hope is that in doing so, these students become more comfortable with community sites, they understand more about that kind of delivery mechanism, become more comfortable with diverse populations, and are better able to serve those populations in the future.”  

Esther Lopez knows too well the importance of that exposure. Her father, a Cuban-born immigrant, abandoned the family of three children, including a brother and sister, following the death of her mother. But in the midst of her undergraduate work in biology at DePaul University—coursework Lopez had hoped would lead to medical school—her father returned, homeless and afflicted with health issues that eventually led to two strokes. He had no job and no insurance. Between studies, Lopez pleaded with pharmaceutical companies for free medicine, and again served as a translator with various health agencies and doctors. 

“We were able to get some assistance,” Lopez says. “Things were going as well as they could have, considering the fact that we didn’t have health insurance. I really wanted to stay in school so I tried as best I could to find resources to help us along the way.”  

By the time her father died in 2000, Lopez, exhausted, had given up on medical school, but she was more determined than ever to help resolve the challenges facing low-income and minority individuals seeking medical care. She completed her bachelor’s degree, and then enrolled in the master’s program in public health at the University of Illinois at Chicago (UIC). With her coursework finished, Lopez continues to work on her thesis.  

While attending UIC, she joined a research project involving people with periodontal disease and diabetes.   

“We were trying to determine what needs existed for people that had diabetes, and if they even knew there was a corollary between that and periodontal disease, specifically in the Latino community. I got engaged, really excited, and decided dentistry intrigued me,” Lopez says. 

With the help of the Dental Pipeline, she enrolled in UIC’s College of Dentistry. “Dental school is really,
really expensive. The fact that we have programs like the Dental Pipeline for people like me is just amazing,” she says. Lopez received some tuition reimbursement from the program and worked as a research assistant in exchange for remaining tuition waivers.  

While in dental school, she joined a group of fellow students in establishing the first student-run dental clinic in the United States.   

Located on the north side of Chicago, the clinic still operates in Goldie’s Place, which serves as a place for homeless adults to get back on their feet. In 1997, a single dentist began providing services. In 2008, Lopez and others created the student component.  

“Goldie’s Place helps dental students become part of the change, which is what I really wanted to do,” says Lopez, who served for a time as clinic director after graduating
from dental school.  

As a student, she often spoke with colleagues about the challenges of health care in low-income communities. “A lot of times someone who comes from privilege has blinders to different barriers that exist. I think it’s more impactful when you’re hearing from a colleague about things that make it hard for you to succeed,” she says.   

No matter a person’s race, ethnicity, or income level, dental needs will always be the same: a cavity is always a cavity, an extraction is an extraction, Lopez says. “But the way they perceive disease is always different,” she says, a concept that young dental students initially struggle with at Goldie’s Place. “It’s hard for them to understand, but it’s true. When you come from an underprivileged background, it’s not that you’re neglecting yourself; it’s just that it’s more important to feed your child. Or pay your rent.”  

Communicating correct information in a way that is easy for clients to understand is imperative, Lopez says. “It’s important to service them understanding their cultural needs.”  

Today, many of her classmates continue to work with grassroots organizations. One student has written a manual on how to establish a student-run dental clinic based on the Goldie’s Place model. “They’re addressing dental health issues not one person at a time, but communities at a time,” Lopez says. Other community-based health organizations in Chicago are beginning to incorporate the model for student clinicians, she says.  

“I’m proud of the fact that … I was able to do something like participate in the Goldie’s Place dental clinic. There are so many great things going on there. Every time I hear of some success on their part it makes me happy. If it weren’t for the Dental Pipeline I wouldn’t have been able to do that. It’s meant a lot, not just for me, but for community members that really needed it.”  

Lopez continues to volunteer at Goldie’s Place, and as part of a Chicago Community Oral Health Forum project to assess the dental health needs of adults and children. The Dental Pipeline gave Lopez the opportunity to both share her hard-won knowledge in the realm of public health and to establish a meaningful career addressing the issues, she says.  

“I’m really excited that programs like this exist because they give students like me a chance to fulfill their dreams,” Lopez says. “It really does make me feel a sense of responsibility, because there was an organization that backed me, to really give back to the community in a significant way.”●

Janet Edwards is the editor of INSIGHT Into Diversity magazine. Published in our June 2013 issue.

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