The five-year project will focus on improving education and training efforts of dental students on how to care for vulnerable groups, including those undergoing substance use disorders.Faculty at the University of Alabama at Birmingham School of Dentistry received a five-year $1.5 million grant from the Health Resources and Services Administration to help improve the oral health of vulnerable adults in underserved areas in Alabama.
The UAB Department of Clinical and Community Sciences has a strong partnership with the Alabama Department of Senior Services and will engage in multidisciplinary education and care of patients of UAB Medicine clinics.
“This project sets the stage to prepare our dental students to meet the needs of diverse patient groups, to collaborate with non-dental health care professionals to bridge the gap between medical and dental care, and to positively impact the future of our dental workforce,” said Raquel Mazer, DMD, principal investigator of the project and associate professor in the UAB Department of Clinical and Community Sciences.
Adults face extensive barriers to oral care, especially those with complex medical issues or living in under-resourced communities. The five-year project will focus on a cross-disciplinary approach to educate dental students and train non-dental professionals on how to care for these vulnerable individuals with medically complex and/or behavioral health care needs, including those with heart problems or diabetes or who are undergoing treatment for substance use disorders.
“The project and funding will provide oral and primary care coordination utilizing a patient-centered care approach with interprofessional education and knowledge exchange among dental students, medical students, residents, nurse practitioners and nursing students to better treat patients,” said Michelle Talley, Ph.D., associate professor and interim associate dean for the Office of Clinical and Global Partnerships at the UAB School of Nursing and one of the project collaborators.
“Oral health is integral to overall health and coordination of care, and it is essential at all ages and for those facing complex medical issues,” said Eric Wallace, M.D., medical director for Telehealth at UAB. “This is especially critical as health care professionals care for adults living with chronic conditions."
Nathan Smith, DMD, an investigator on the project and assistant professor in the Department of Clinical and Community Sciences, says those facing barriers to care often have limited access to health care services, specifically those over the age of 65 who are retaining their natural dentition longer than previous counterparts.
“Several clinical opportunities exist for dental training through established community-based sites,” Smith said. “Collaboration within and beyond the main UAB campus integrates dental, public health and primary care services and prepares the dental workforce to meet the oral health needs of vulnerable, underserved and rural populations.”
This project will also establish a mentoring program for pre-dental students from rural areas of Alabama by connecting faculty and the dental admissions team to prospective dental students from rural areas who may benefit from mentorship.
“Students from rural areas are more likely to serve in a small town upon graduation,” said Carly Timmons McKenzie, Ph.D., assistant dean of Admissions and associate professor in the UAB School of Dentistry. “Frequently, small-town and rural applicants face unique barriers to achieve their goals of professional school. We hope that a development and mentoring program will help them learn more about the profession, prepare for the admissions process, and provide additional academic support to successfully navigate the rigors of dental education. This project will create and sustain partnerships to connect and provide the tools for these candidates to succeed in and graduate from dental school.”
Alabama’s dire need for dentists
Alabama currently ranks 51st in the United States dentist-to-population ratios, with 41 dentists per 100,000 residents, according to the American Dental Association. Additionally, according to the Alabama Department of Public Health, 65 of Alabama’s 67 counties are experiencing a dental professional shortage due to a number of factors.
UAB’s Lister Hill Center states that approximately 80 percent of all Alabama dentists practice in the 13 most urban counties. The remaining 20 percent practice in the 54 non-urban counties of Alabama, many of these smaller counties with only one to three dentists. This translates into about one dentist for every 1,800 people in the urban areas and one dentist for every 4,100 people in the rural areas.
Since 1990, an average of only about four dentists per class of 55 have chosen to practice in Alabama’s most rural 41 counties, while an average of 8.5 dentists per class of 57 have chosen to practice in one of the 54 non-urban counties of Alabama. Lastly, approximately 40 percent of Alabama’s dental graduates are choosing to practice out of state.
In addition to a lack of dental professionals practicing in rural areas, a large portion of the Alabama dental workforce is reaching the age of retirement, resulting in an urgent need to replace dentists in rural areas that is not being met. These collaborative initiatives should help mitigate the significant burden of disease faced by underserved communities and improve access to dental/oral and overall health.
“Oral health is a critical component of both overall health and quality of life,” McKenzie said. “Unfortunately, many residents of these rural areas do not have access to the dental care they need. Through collaborative initiatives such as this one, we can help mitigate some of the burden these underserved communities face to seek appropriate dental care.”