ACD Ethics Summit 2024

ACD Ethics Summit

Breaking Down the Silos: Dentistry’s Ethical Responsibility as a Partner in Healthcare

September 12-13, 2024

Rockville, Maryland

With appreciation for the ACD Foundation and the Santa Fe Group for their support.

On September 12-13, 2024, over 45 participants gathered in Rockville, Maryland, for the “Breaking Down the Silos” summit, sponsored by the ACD Foundation and the Santa Fe Group. The planning committee included Drs. Scott Tomar, Toni Roucka, Lisa Simon, Jane Barrow, Theresa Dolan, Dick Jones, Robert Lamb, Mr. John Kerns (SPEA), Ms. Suzan Pitman, and Mr. Mike Graham. The event aimed to advance strategies for integrating dental care with mainstream healthcare through interdisciplinary collaboration driven by dentistry’s ethical responsibility to improve overall health outcomes through integration.

Building on the work of the Santa Fe Group’s Advance Health Equity summit, the ACD summit opened with a keynote address by Dr. Lisa Simon, MD, DMD, a renowned leader and researcher in medical-dental integration, who emphasized the ethical imperative of bridging the gaps between the fields. Her talk set the tone for the event, inspiring participants to tackle barriers preventing closer collaboration between healthcare disciplines. A series of presentations from pillar leaders followed, addressing key areas such as education and training (Dr. Nader Nadershahi, Dean, University of the Pacific), interprofessional practice models (Dr. Dan Pihlstrom, Chief Dental Officer, Permanente Dental Associates), research (Dr. Jennifer Webster-Cyriaque, Deputy Director of National Institute of Dental and Craniofacial Research at the National Institutes of

Health), and reimbursement models (Dr. Ron Inge, Chief Strategy Officer for 32Health). The morning sessions highlighted existing challenges and showcased evidence-based practices that promote integration.

The second day featured a compelling keynote from Dr. Natalia Chalmers, Chief Dental Officer at the Centers for Medicare and Medicaid Services (CMS), who discussed the vital work that CMS is doing to move this effort forward and the work that still needs to be done. Breakout sessions, headed by pillar leaders, focused on crafting specific, achievable strategies for integrating dental care into broader healthcare systems. These collaborative efforts resulted in each pillar group drafting a set of strategic goals to foster interprofessional cooperation and address systemic barriers.

In conclusion, the summit was a success, with participants developing key strategies to promote medical-dental integration.By the end, cohesive statements and strategies were crafted for each pillar, outlining concrete steps to advance medical-dental integration within the next three years. The event reaffirmed ACD’s commitment to ethics, professionalism, leadership, and excellence through collaboration, providing a roadmap for continued progress in the College’s strategic plan and advancing healthcare integration into the future. The summit proceedings will be published in the spring issue of the JACD.

Breaking Down the Silos: Dentistry’s Ethical Responsibility as a Partner in Healthcare

September 12 - 13, 2024 Rockville, MD

Purpose:

Despite repeated calls for health integration, dentistry remains isolated from mainstream healthcare. The ACD acknowledges the Santa Fe Group continuum, Advance Health Equity - an alignment and action summit, and seeks to build on the ACD’s white paper, Healthcare Integration Through an Ethical Lens. The purpose of this summit is to assemble a diverse and interdisciplinary cohort of oral healthcare professionals, policymakers, researchers, and industry leaders to develop strategies that break down silos and promote interdisciplinary collaboration. This summit aims to facilitate collaborative discussions and knowledge exchange, providing a platform to address the critical challenges at the intersection of dentistry and broader healthcare. With targeted sessions, keynote presentations, and interactive forums, the summit seeks to explore innovative ideas, share cutting-edge research, and foster partnerships that uphold dentistry's ethical responsibility as an integral partner in the larger healthcare ecosystem. This summit endeavors to inspire action, advance evidence-based practices, and ultimately contribute to improving healthcare delivery, alleviating health disparities, better patient outcomes, and greater healthcare system efficiency.

Learning Objectives:

1. Understand dentistry’s ethical responsibility to be a partner in overall healthcare.

2. Review progress and acknowledge the 2021 Santa Fe Group Continuum, Advance Health Equityan alignment and action summit.

3. Examine the challenges faced by the dental profession in breaking down silos between healthcare professions.

4. Formulate and prioritize strategies to overcome barriers.

5. Develop an agenda for ongoing collaboration among dental leaders.

Schedule

All events are in the Buchanan Room of the Vis Arts Building at 155 Gibbs Street in Rockville Town Square, except where noted.

Day 1 - Thursday, September 12, 2024

7:00 – 8:30 AM Breakfast

8:30 – 10 a.m.

Keynote Presentation

Lisa Simon MD, DMD, is a physician, dentist, and researcher involved in many medical dental integration projects nationally. She is a faculty member in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, Harvard Medical School, and the Harvard School of Dental Medicine.

10:00 a.m.

10:15 a.m.

Break

Pillar Leader Presentations

Education and Training – Dr. Nader Nadershahi serves as the ninth Dean of University of the Pacific’s Arthur A. Dugoni School of Dentistry and Vice Provost of the San Francisco campus, bringing to the role nearly 30 years of leadership experience in dental education, organized dentistry, and clinical practice.

Interprofessional Practice Models of Care – Dr. Dan Pihlstrom serves as chief dental officer of Permanente Dental Associates (PDA). In this role, Dr. Pihlstrom oversees the quality agenda of the Kaiser Permanente Dental program, helping to ensure the organization’s 290,000 members receive patient-centered, integrated, value-based care.

Research – Dr. Jennifer Webster-Cyriaque is the deputy director of National Institute of Dental and Craniofacial Research, National Institutes of Health. An accomplished clinician, researcher, and leader, Dr. Webster-Cyriaque had previously served as a faculty member at the University of North Carolina (UNC) schools of dentistry and medicine for more than two decades.

Third-Party Payors / Reimbursement Models – Dr. Ron Inge is currently the Chief Strategy Officer for 32Health. 32Health is an AI-powered Healthcare Administration Platform focused on increasing efficiency and decreasing the cost of administering dental benefits. In this role, he brings to bare his years of experience in the dental benefits industry to assist in the development of artificial intelligence models to perform routine administrative tasks.

Day 1, continued

12:30 p.m.

1:30 p.m.

Lunch

Special Presentation

Mary Otto - Author, Teeth. Ms. Otto is a Washington-based journalist who began writing about oral health at the Washington Post

2:00 p.m.

3:00 p.m.

3:15 p.m.

5:30 p.m

Day 2 - Friday, September 13, 2024

7:00 – 8:30 AM

8:30 a.m.

Pillar Groups

Break

Reconvene Whole Group

Reception at the ACD Office Dinner on your own.

Breakfast

Keynote Presentation

Natalia Chalmers DDS, MHSc, PhD, is a board-certified pediatric dentist, oral health policy expert, and public health advocate. She is currently the Chief Dental Officer in the Office of the Administrator for CMS.

10:00 a.m.

10:15 a.m.

10:45 a.m.

12:30 p.m.

1:30 p.m.

2:45 p.m.

3:00 p.m.

4:30 p.m.

4:45 p.m.

Break

Review objectives for the day.

Pillar Groups

Lunch

Resume Pillar Groups

Break

Reconvene Whole Group

Wrap-up and next steps.

Adjourn.

Jane Barrow

Organization Representing:

Jane Barrow, MS serves as Executive Director of HSDM’s Initiative to Integrate Oral Health and Medicine working closely with partners in academia and leaders in health care to develop innovative ideas and conduct research around the integration of oral health and primary care. As Director for the Office of Global and Community Health, Jane directs school-wide efforts in education, research, and clinical services that further the School’s strategic goals for oral public health and the integration of oral health and medicine.

Working with an inter-professional team of faculty and staff, her Office strives to identify the burden of oral disease, educate an interprofessional workforce, reduce oral and other non- communicable diseases with shared risk factors, and thereby strengthen health systems and improve the health of communities locally and around the world. She is currently involved in several projects that advance this mission.

Deesha Bhaumik

Organization Representing: American Dental Association, Health Policy Institute

Deesha Bhaumik PhD, MS is the Senior Health Policy Analyst at the Health Policy Institute (HPI) of the American Dental Association. Prior to joining HPI, she obtained her Ph.D. from the University of Michigan in Epidemiology and her MS in Biostatistics. Her research focuses on dental public health and oral health policy, particularly in areas related to Medicaid, Medicare, and the Affordable Care Act.

Sheila Brear

Organization Representing:

Dr. Brear is the Chief Learning Officer at the American Dental Education Association (ADEA) and leads a team of 6 staff who are dedicated to supporting ADEA in its mission: To lead and support the health professions community in preparing future-ready oral health professionals. ADEA is the voice of dental education.

Dr. Brear graduated from dental school in London, England, in 1986. Between 1987 and 2020, she worked in both private practice in Hong Kong, and then in San Francisco and concurrently held academic positions, first at the Prince Philip Dental School, Hong Kong, and then at the University of California San Francisco School of Dentistry (UCSF). In 2000 she completed a Prosthodontic Residency at UCSF.

Leadership roles have been as course director of multiple courses in all areas of predoctoral and specialty programs, UCSF Division Chair of General Dentistry (2004-2025), and Academic Dean at both UCSF (2015-2020) and then at California Northstate College of Dental Medicine (2020-2022) where she developed the curriculum, budget and hiring plan for the new predoctoral dental program. She joined ADEA in June 2022.

Dr. Brear has a strong motivation to serve the public and the profession. This has been an important role for her: she seeks ways to streamline education, reduce costs to students and improve the health of communities.

Natalia Chalmers

Keynote Presenter

Organization Representing: Centers for Medicare & Medicaid Services

Dr. Natalia Chalmers is a board- certified pediatric dentist, oral health policy expert, and public health advocate who brings more than 20 years of clinical, research, industry, and regulatory experience to CMS in her role as Chief Dental Officer in the Office of the Administrator. Previously, Dr. Chalmers served as a Dental Officer at the US Food and Drug Administration. Her research has translated into action, improving oral care and advocating for the role health policy can play across the lifespan particularly when it embraces dental well-being as a facet of care for the whole person.

Ashland Doomes

Organization Representing: University of Washington School of Dentistry

I am a master's student in the Bioethics Department at the UW School Of Medicine and an assistant teaching professor at the UW School Of Dentistry. As a clinician, I focus on teaching care to diverse patient populations, and I provide dental care in a clinic that exclusively treats adults with developmental disabilities. I intend to focus my master's capstone on Bioethics integration within the UW dental education organization. I am currently the chairperson for the UW SOD Faculty Professionalism and Development Committee. As a faculty member who teaches both didactically and clinically, I am very interested in the subject matter of the ACD Ethics SumitDentistry's Ethical Responsibility as a Partner in Healthcare.

Jeffery Ford

Organization Representing: Defense Health Agency

Colonel (Dr.) Jeffrey A. Ford currently serves as the Deputy Chief of the Dental Operations / Optimization Division in the Defense Health Agency (DHA). He provides strategic guidance and input as a Senior Advisor in the Defense Health Agency (DHA) under Health Care Operations. He also facilitates communications for Chief Executive Dentists across the Enterprise, supporting key functions in the Military Health System to advance the mission of healthcare and readiness.

Dr. Ford began his military career as a dental assistant and completed his last three years of National Guard duty as a Medical Service Corps officer while attending Dental School full time. He transitioned to active duty in the United States Air Force upon completion of the University of Mississippi’s School of Dentistry and attended Commissioned Officer’s Training at Maxwell Air Force Base (AFB), AL. He then started his Dentist/Officer career at Keesler AFB, MS, and completed a one-year advanced education in general dentistry (AEGD) residency. Col Ford continued there as a general dentist with many extra duties and then transferred to Travis AFB, CA. After being accepted for additional education, he then moved to Lackland AFB, TX, for training in the Orthodontics specialty and arrived full circle back at Keesler AFB as a Uniformed Services University Assistant Professor teaching AEGD residents. Dr. Ford was then stationed at Joint Base ElmendorfRichardson, Alaska, as the Support Flight Commander and Chief of Orthodontics. In 2017, Col Ford entered Health Sciences Informatics post graduate training at the Johns Hopkins School of Medicine in Baltimore, MD, and has worked in three key leadership positions in the DHA since graduation.

Irene Hilton

Organization Representing: NNOHA

Irene Hilton DDS, MPH, FACD is a dentist at the San Francisco Department of Public Health, and is the dental consultant at the National Network for Oral Health Access (NNOHA), HRSA’s oral health National Training & Technical Assistance Partner. For almost 20 years she has been involved in the development of NNOHA’s integration quality improvement collaboratives, publications and other resources that support health centers to implement sustainable models that incorporate oral health into whole person care. Dr. Hilton has dual faculty appointments in the School of Medicine and in the School of Dentistry, at the University of California San Francisco, and is a member of the ASTDD best practices committee.

Ronald Inge

Pillar Leader

Organization Representing: Dental Benefits Industry

Dr. Ron Inge is the Chief Strategy Officer for 32Health, which is an AI-powered Healthcare Administration Platform where he brings his years of experience in the dental benefits industry to assist in the development of artificial intelligence models to perform routine administrative tasks.

Dr. Inge started his dental care in private dental practice for 15 years. He has served in executive roles at various organizations including: Aetna, Delta Dental of Washington, Delta Dental of California, the American Dental Association, DentiCare of California and AVP Vision Plans. In 2016, Dr. Inge moved to Missouri where he served as the chief dental officer, chief operating officer and vice president of professional services at Delta Dental of Missouri. In these roles, Dr. Inge was responsible for all aspects of the dental networks and directing the organization’s operations, including the claims and customer service teams.

Dr. Inge serves his community as a volunteer on numerous boards and is the recipient of numerous awards for his professional contributions. He received his Bachelor of Arts degree in human biology from Stanford University and his Doctor of Dental Surgery degree from the University of California, Los Angeles.

While I have shared some of Dr. Inge’s professional successes, he also has had a very successful athletic career as a running back for Stanford University’s football team where he holds the record for the most kickoff returns for the Stanford Football Team. More importantly, he was the hero of the 1976 Big Game (between Stanford and Cal (Berkeley)) when he scored the winning touchdown against Cal in the last minute of the game.

Richard (Dick) Jones

Organization Representing: ACD

Richard E. Jones, DDS, MSD completed his prosthodontic training at Indiana University in 1978. He was in the full-time practice of prosthodontics and maxillofacial prosthetics in Munster, Indiana for 30 years. The practice emphasis was on complex reconstruction utilizing advanced evidenced based treatment planning concepts.

Dr. Jones directed the Private Practice of Prosthodontics Seminar at Indiana University for 20 years. He lectures to small study clubs and national organizations. He has held membership in many dental organizations, including the American College of Prosthodontists, the American Academy of Fixed Prosthodontics, the American Academy of Maxillofacial Prosthetics, the Academy of Osseointegration and the Academy of Dental Sleep Medicine. He has served the American College of Prosthodontists as an officer, Director, Judicial Division, the Director of the Center for Prosthodontic Education and the Parameters of Care Committee. He served the American Dental Association on the ADA CERP Committee and the Prosthodontics Test Construction Committee, Joint Commission on National Dental Examinations.

Dr. Jones has a strong interest in ethics and evidenced based dentistry and a mission to collect and share knowledge that makes quality dental care easier and more predictable. He presents a value-based lecture The Self-Centered Practice: Keys to Success. He chaired the Indiana Dental Association Council on Peer Review, 1989 to 2018. He chaired the IDA Task force on Ethics and Professionalism. He chaired an ACD Indiana Section committee that developed a mentoring program. He received the Indiana State Ethics Award, 2005 and the Indiana University School of Dentistry Distinguished Alumnus Award, 2009.

Krista Jones

Organization Representing: ACD

Dr Jones graduated from the OU College of Dentistry in 1981 after doing her undergrad at OU, Norman campus. She had a private restorative dental general practice for 39 years before retiring in 2020. She has been active in organized dentistry and has been president of the OK Dental Association, OK County Dental Society, OK Association of Women Dentists, an ADA Delegate and was a founding member of the J Dean Robertson Society and on their Board of Directors.

She was named Dentist of the year by the ODA and received the Jim Saddoris Lifetime of Leadership Award from the ODA. She was chair of the mediation Review Committee for the ODA for 10 years. Dr Jones is currently the District 5 member and Secretary/Treasurer of the OK Board of Dentistry and is an Examiner for licensure with the CDCA, WREB, CITA. She is a Fellow with the American College of Dentists, where she is also an At Large Regent, International College of Dentists, the Pierre Fauchard Academy, and the Academy of Dentistry International. She is also on the Board of the Gillette Hayden Memorial Foundation that provides grants to young female DDS. Ethics has been one of her passions and as such is a member of the American Society of Dental Ethics (ASDE) and studied and presented Ethics courses for 18 years. Dr Jones believes it is important to give back to your community because when your community thrives, your practice thrives. She was the Edmond Citizen of the year in 2012, has been named to the Edmond Hall of Fame and was the founding chair of the Edmond Visual Arts Committee which now has added over 220 pieces of public art in Edmond, she was selected the 2024 Leadership Edmond Alumni of the year. She is a member of the Del City High School Hall of Fame and was the Rotarian of the year for the Edmond Central Rotary Club.

John Kerns

Planning Committee

Organization Representing: SPEA

John Kerns is a D4 at Marquette University (MUSoD) and Immediate Past President of his school’s newly revived Student Professionalism and Ethics Association (SPEA) chapter. After graduating from the University of Wisconsin-Madison for undergraduate studies, John became involved in statewide initiatives for progressing oral healthcare including as the dental student member of the Wisconsin Oral Health Coalition and as the State Education Lead for Wisconsin’s Mission of Mercy, amongst other committee, leadership, and research positions. John will be leading a Student Work Group of national SPEA members to assist with summarizing summit discussions and to evaluate the summit’s effectiveness in the short and long terms.

Dushanka Kleinman

Organization Representing: ACD

Dushanka V. Kleinman D.D.S., M.Sc.D., (RADM, USPHS (ret.)), a Diplomate of the American Board of Dental Public Health, is Professor Emerita, School of Public Health (SPH), University of Maryland (UMD), College Park, MD and a Special Volunteer, National Institute of Dental and Craniofacial R esearch (NIDCR), National Institutes of Health (NIH). She has a D.D.S. from the University of Illinois at Chicago College of Dentistry, a hospital rotating internship certificate from the University of Chicago Hospitals and Clinics and received a M.Sc.D. in dental public health from the Henry M. Goldman School of Dental Medicine at Boston University. She has served as president of the American Board of Dental Public Health, American Association of Women Dentists, and the American Association of Public Health Dentistry, and currently is the Vice President of the Santa Fe Group.

Jandra Korb

Organization Representing: Society of American Indian Dentists

Dr. Jandra Korb is a Cherokee Nation citizen representing the Society of American Indian Dentists (SAID). Dr. Korb graduated from the University of Oklahoma College of Dentistry in 2000 and was in private practice with her father for 21 years in Vinita, OK. Since that time, she has served as the Oklahoma Dental Director for DentaQuest. She is a past Oklahoma Dental Association President and has served as President of the Northern District of the ODA for 21 years. Dr. Korb is a Fellow of the American College of Dentists, International College of Dentists, and the Pierre Fauchard Academy. She is currently serving as the President-Elect of the Oklahoma Chapter of ICD. Dr. Korb is the chair of SAID’s Policy and Legislative Committee and is a Core Team Memb er of the Native Oral Health Network. Recent awards include the 2022 Sun Life CEO Award of Excellence and The Journal Record’s Woman of the Year:

50 Women Making a Difference award in 2023.

Robert Lamb

Organization Representing: ACD Foundation

Robert Lamb, DDS, is the President of the American College of Dentists Foundation. Active in organized dentistry for over 30 years, he has served on the ACD Board of Regents in every office. He is also Clinical Assistant Professor at the University of Oklahoma College of Dentistry and has a special interest in management of student debt and its effect on practice choices and patient treatment. He is a retired Oral and Maxillofacial Surgeon and a retired Colonel, USAF Reserves. He and his wife, Donna, are from Edmond, Oklahoma.

Tim Leeth

Organization Representing: American Dental Education Association

Tim became the ADEA Chief Advocacy Officer in October 2017, after having served as the Senior Director for Federal Relations since 2014. Tim started his career on the personal staff the late Representative J. Edward Roush (IN) as the legislative assistant responsible for Mr. Roush’s work on the House Committee on Appropriations. After Mr. Roush left Congress Tim joined the professional staff of the Senate Committee on Appropriations and became a subcommittee Staff Director shortly thereafter. In his nearly 20 years on the Senate Committee he served eight different Senators on three subcommittees under five full committee chairmen. For a time, he served as the full committee staff director while the incumbent was on medical leave. During his entire service Tim served in the majority, even though the party leadership changed three times the only subcommittee Staff Director to do so.

Upon leaving Capitol Hill Tim has served 5 years as an Assistant Director of the Division of Congressional Affairs of the American Medical Association, were he was the lead Senate Republican Leadership lobbyist during the debate and enactment of the Medicare Modernization Act and was the AMA representative on the executive committee of the PARTNERS Coalition of the Campaign for Tobacco Free Kids.

He left AMA to be Vice President of the Jefferson Consulting Group, a Washington, D.C. based Federal business development and lobby firm; and as the Principal of his own firm, Lincoln Capitol Consulting. Tim has represented many health care related clients including medical specialty associations, community health clinics, and a devise manufacturer, as well as the American Dental Education Association.

Xiang Li

Organization Representing: Defense Health Agency

Commander Li graduated from State University of New YorkBinghamton University with a Bachelor of Science degree in Biology. She obtained her Doctor of Dental Surgery from University of California, Los Angeles School of Dentistry in 2008. Upon graduation from Dental School, she was selected for General Practice Residency training at the U.S. Naval Hospital Camp Pendleton.

In June 2018, CDR Li graduated Pediatric Dentistry Residency training and earned her postdoctoral certificate from Texas A & M Baylor College of Dentistry. In 2019, she successfully challenged her boards and became a diplomate of American Board of Pediatric Dentistry.

Hand selected as the Chairman of Pediatric Dentistry, she reported to Naval Postgraduate Dental School (NPDS), Bethesda, MD in 2022. CDR Li is concurrently serving as the interim Chairman for the Orthodontics department and Pediatric Dentistry from 2022 to 2024.

Summer of 2024, CDR Li transferred to Defense Health Agency serving as the Active Duty Dental Program’s Dental Service Point of Contact.

Jennifer McGuire Haveman

Organization Representing: Defense Health Agency

CAPT Jennifer McGuire Haveman is a native of Agawam, Massachusetts. She completed her undergraduate education at Hamilton College in Clinton, NY and her dental school education at the University of Pennsylvania School of Dental Medicine. Following dental school, she completed an Advanced Education in General Dentistry Residency Program at Naval Dental Center Norfolk followed by an operational tour as the Division Officer aboard USS Harry S. Truman (CVN-75). After a successful sea tour, she reported to the Naval Postgraduate Dental School, where she earned a certificate in Periodontics and a Masters in Oral Biology from Uniformed Services University of the Health Sciences. Following residency, CAPT McGuire Haveman reported to 2d Dental Battalion, Camp Lejeune, where she had the unique opportunity to complete three tours of duty serving as a Staff Periodontist and Division Officer with 12th Dental Company Cherry Point, Clinic Director as the Osborne Branch Dental Clinic, and as the 2d Dental Battalion/Naval Dental Center Camp Lejeune Director for Dental Services managing 11 geographically diverse clinics. CAPT McGuire Haveman is currently serving as the Acting Chief Dental Officer for the Defense Health Agency in Falls Church, Virginia.

Nader Nadershahi

Pillar Leader

Organization Representing: University of the Pacific Arthur A. Dugoni School of Dentistry

Dr. Nader A. Nadershahi serves as the ninth Dean of University of the Pacific’s Arthur A. Dugoni School of Dentistry and Vice Provost of the San Francisco campus, bringing to the role nearly 30 years of leadership experience in dental education, organized dentistry, and clinical practice.

He earned his DDS, completed GPR training, and has also earned MBA and EdD degrees. He is a fellow of the American College of Dentists, Academy of Dentistry International, International College of Dentists, and Pierre Fauchard Academy. He also completed fellowship in the ADEA Leadership Institute and served as advisor.

Dr. Nadershahi has led milestone projects such as strategic planning and implementation, the design and implementation of the school’s integrated curriculum and competencies and raising $69.3M in the comprehensive fundraising campaign. He helped develop the university’s San Francisco campus facilities and the new collaborative teaching clinical and education facilities in Sacramento. He supported the launch of new health science programs such as the MPAS and eventual creation of the School of Health Sciences. He serves as a Board member for the Bay Area Council and San Francisco Chamber of Commerce and was appointed by the Governor and serves as Vice Chair of the California Health Workforce Education and Training Council. He has more than 140 presentations, 30 publications, five book chapters, and numerous abstracts and other publications.

Dr. Nadershahi has been actively involved in organized dentistry and dental education. He served as Chair of the Board of Directors for the American Dental Education Association, serves as delegate to the ADEA and American Dental Association houses, and is currently Vice Chair of the ADA Foundation. He also serves as a member of the California Dental Association Board of Directors. Dr. Nadershahi is a member of the Santa Fe Group and has been actively involved in leadership development, accreditation, national licensure, and the evolution of oral health education and collaborative care.

An Nguyen

Organization Representing: NNOHA and Clinica Family Health

An Nguyen, DDS, MPH is a public health dentist, wife, mom, maker of things, and an avid systems thinker in all aspects of her life. She is an advocate for personcentered, transformative solutions that improve the lives of marginalized people and their communities, and her approach to this work comes from a place of deep, personal connection and professional commitment. She currently serves as Chief Dental Officer at Clinica Family Health, a large federally qualified health center and a nationally recognized leader in health quality and health equity. She was honored by the Colorado Dental Association with the Exceptional Service Award in 2017 and by Oral Health Coalition of Colorado as 2018’s Outstanding Dentist of the Year. Dr. Nguyen is current President for the National Network for Oral Health Access, serves on the Dental Quality Alliance Executive Committee, holds an appointment as adjunct faculty for the University of Colorado, School of Dental Medicine, serves on multiple state and national health and policy-related boards, and is a frequent advisor for dental quality, integration, and chronic disease management initiatives. She is a proud graduate of Rhodes College, the School of Public Health at Saint Louis University, the College of Dentistry at the University of Tennessee, and the Healthcare Executive Program at UCLA’s Anderson School of Management.

Marry Otto Guest Speaker

Mary Otto is the oral health topic leader for the Association of Health Care Journalists. She began writing about oral health at the Washington Post, where she worked for eight years covering social issues including health care and poverty. The author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America (The New Press), she lives in Washington, DC.

Kayhan Parsi

Organization Representing: Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine

Kayhan Parsi, JD, PhD, HEC-C, is a Professor and Graduate Program Director at the Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine. He is an active educator in the Stritch School of Medicine and also serves on the Loyola University Health System (LUHS) ethics committee and is an ethics consultant for LUHS. He became certified in 2019 by the HCEC Certification Commission and holds the Healthcare Ethics Consultant-Certified (HEC-C) credential. He is the moderator for Loyola Bioethics Live, a monthly webinar program. In 2018, he was named Graduate Faculty Member of the Year at Loyola University Chicago. He has been quoted in various media outlets, such as Forbes, Insider, and BMJ.

He has published in a variety of areas and has interests in clinical ethics, medical ethics education, professionalism and professional ethics, global health and justice, media and bioethics, the history of medicine and bioethics, and autism and neurodiversity. He is currently an associate editor for the American Journal of Bioethics (AJOB). He has also done extensive service for the American Society for Bioethics and Humanities (ASBH), having served on the board and as a treasurer. He served as president of ASBH (2021-2023) and is currently serving as immediate past president of ASBH (20232025). He has moderated a number of webinars for ASBH and AJOB.

He co - edited with Nanette Elster Transitioning to Adulthood with Autism: Ethical, Legal and Social Issues whi ch was published by Springer in 2022.

Donald (Don) Patthoff

Organization Representing: WVU

Dr. Don Patthoff practices general dentistry in Martinsburg, West Virginia. He was a clinical dentist and a principle research investigator at the Martinsburg Veterans Administration, and is a past president of the West Virginia Dental Association and the American Society for Dental Ethics (ASDE). He co -authored the Academy of General Dentistry’s dental ethics column in Impact and is an ethics consultant to the American Dental Association’s Council on Ethics Bylaws and Judicial Affairs. He co -authored Dental Ethics at Chairside, and was coeditor of the Journal of Dental Education’s special issue on Professional Promises: Hopes and Gaps in Access to Oral Health Care. Dr. Patthoff is editorin- chief of the Journal of Laser Dentistry. He chaired the dental sessions of the three Engineering Conferences International (ECI) conferences on light-activated tissue regeneration and two Photobiomodulation (PBM) incubators for the Optical Society of America (OSA), and initiated the Lasers in Dentistry Special Interest Group in the American Dental Education Association. He co - chairs the George Washington Institute of Living Ethics and the Foundation for Photobiomodulation Research and was liaison to the International Dental Ethics and Law Society from ASDE. Dr. Patthoff is a Master of the Academy of Laser Dentistry (ALD) and the Academy of General Dentistry (AGD). He is a Fellow of the American College of Dentists and the Pierre Fauchard Society. He is a Certified Dental Editor (CDE) of the American Association of Dental Editors and Journalists (AADEJ). He chairs the WVU-BMC ethics committee and is a certified ASBH Health Ethics Consultant (HEC-C).

Gary Pickard

Organization Representing: PDS Health (previously Pacific Dental Services)

Daniel Pihlstrom Pillar Leader

Organization Representing: Permanente Dental Associates

Daniel Pihlstrom, DDS, is chief dental officer of Permanente Dental Associates (PDA). In this role, Dr. Pihlstrom oversees the quality agenda of the Kaiser Permanente Dental program, helping to ensure the organization’s 290,000 members receive patient- centered, integrated, value-based care.

Dr. Pihlstrom has practiced general dentistry for over 20 years and has served in various leadership roles for PDA. During his career at PDA, Dr. Pihlstrom developed the Kaiser Permanente Medical-Dental Integration (MDI) programincorporating licensed practical nurses, dentist-administered flu vaccinations, and medical care coordination into daily clinical practice. Dr. Pihlstrom is Affiliate Investigator at the Kaiser Permanente Center for Health Research and has contributed to numerous scientific publications on evidence-based dentistry and medical- dental integration, including the 2021 Surgeon Generals' Report on Oral Health in America.

Dr. Pihlstrom graduated from the University of Minnesota with a Bachelor of Sciences in Biochemistry and received his dental degree from the University of Minnesota School of Dentistry in 2000. He completed a General Practice Residency at the Oregon Health & Sciences University and joined PDA in 2001. In 2019 he completed the Harvard Business School Executive Leadership Program.

Dr. Pihlstrom lives with his wife, three children, and the beloved golden doodle in Lake Oswego, Oregon.

Toni Roucka Summit Co -Chair

Organization Representing: ACD

Dr. Toni Roucka is a Professor of Developmental Sciences and Director of Graduate Studies at Marquette University School of Dentistry. She received her undergraduate degree in nursing from the College of DuPage. She received her DDS from the University of Illinois Chicago and an MA in Bioethics from the Medical College of Wisconsin.

Dr. Roucka is a nationally recognized speaker on dental ethics and has numerous publications in peer-reviewed journals on ethics topics such as social media and dentistry, sustainability in health care, and narrative ethics. She also authors a regular ethics column for the Academy of General Dentistry Journal, General Dentistry. Dr. Roucka is a past president of the American Society for Dental Ethics, a Fellow of the American College of Dentists and the Pierre Fauchard Academy, and Regent at Large on the Board of the American College of Dentists serving a four-year term.

Michele Schultz-Robins

Organization Representing: American Academy of Orofacial Pain

Dr. Michele Schultz-Robins is a dedicated dentist who has been practicing general dentistry and Orofacial Pain for the past three decades. After completion of her DMD from the University of Medicine and Dentistry of NJ (now Rutgers School of Dental Medicine) and GPR from Monmouth Medical Center in NJ, she enrolled in the two -year program at UMDNJ entitled “Diagnosis and Management of Orofacial Pain and Temporomandibular Disorders”. Dr. Schultz-Robins is Diplomate of the American Board of Orofacial Pain and is a Fellow of the American Academy of Orofacial Pain.

In addition to her private practice, Dr. Schultz-Robins holds a dual appointment as a Clinical Assistant Professor in the Orofacial Pain Department and Restorative Department at the Rutgers School of Dental Medicine and is an attending at Monmouth Medical Center.

Dr. Schultz-Robins is committed to giving back to her specialty and community. She has been active in AAOP and is currently serves as its President-Elect. She also is president of American Friends of Dental Volunteers for Israel which is a free clinic in Jerusalem serving the community at large.

Lisa Simon

Planning Committee and Keynote Presenter

Dr. Lisa Simon is a physician, dentist, and health services researcher. She has been involved in the implementation of medical- dental integration projects in both the primary care, dental, and inpatient setting and has published more than 70 peer-reviewed articles on oral health policy and the separation of medicine and dentistry. She is a faculty member in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, Harvard Medical School, and the Harvard School of Dental Medicine.

Carlos Smith

Organization Representing: American Society for Dental Ethics

Dr. Carlos Smith is the inaugural Associate Dean of Inclusive Excellence, Ethics, and Community Engagement and an Associate Professor in the Department of Dental Public Health and Policy at Virginia Commonwealth University School of Dentistry. He is the President of the American Society for Dental Ethics and a member of the board of directors of the Academy for Professionalism in Health Care. An active member of the American Dental Education Association, Smith was most recently appointed to serve as Chair-Elect of the ADEA Annual Session Program Committee (ADEA ASPC) for 2024-25 and will assume the position of Chair for 2025-26. He is currently the secretary for the Section on Minority Affairs and Inclusion and past chair of the Section for Professional, Ethical & Legal Issues.

Also an ordained clergy, Smith completed Clinical Pastoral Education at Duke Medical Center, with emphasis on providing care and crisis management to families of cardiac pediatric patients. Dr. Smith has a certificate in Diversity and Inclusion Leadership from Virginia Commonwealth University and a certificate in Diversity and Inclusion from Cornell University. He graduated from Hampton University, the University of Michigan School of Dentistry, and Duke Divinity School. His scholarly activity currently focuses on conceptualizing a reimagined professionalism, the history of racism in healthcare, inclusive excellence in dental education, and provider wellbeing and burnout.

Within the Virginia Commonwealth University community, he was recently appointed Vice Chair of the VCU Institutional Equity Council and serves as the Program Director of a recently awarded Health Resources Services Administration (HRSA) grant for the in-house development of a VCU School of Dentistry Dental Faculty Loan Repayment Program with direct costs just under $1 million, which after 5 years will eliminate the student debt of 5 faculty members.

Kristi Soileau

Organization Representing: American Academy of Periodontology

Dr. Soileau graduated from the LSU School of Dentistry in 1985, received a Certificate in Advanced Education in General Dentistry in 1986 and a Certificate in Periodontics in 1988, also from LSU. She obtained a Master’s in Education from the University of New Orleans in 1987 and a Master’s of Science in Health Care Ethics from Creighton University in 2017. She is a Board- certified periodontist and has maintained a private practice in New Orleans, Louisiana, for 34 years. Dr. Soileau has been Editor for the New Orleans Dental Association since 1988, is a Past-President of the New Orleans Dental Association, the Louisiana Dental Association, and the Alumni Association Board of Directors of LSUHSD, and was voted Alumna of the Year in 2016 for the Dental School, where she is a Clinical Associate Professor for the Periodontal Postdoctoral Program. She is Secretary of the LSU Health Foundation Board, served on the Greater New Orleans Advisory Board and is the volunteer dentist for Notre Dame Hospice, and has worked in nursing home dentistry for 33 years.

She was President of the Southwest Society of Periodontists and has served on the SRACC of the American Academy of Periodontology. She now serves as Secretary/Treasurer on the AAP Board of Trustees. She served on the Council on Ethics, Bylaws and Judicial Affairs and the Council on Dental Education and Licensure for the American Dental Association from 2016-2020 and on the ADA House of Delegates for the past ten years. She is the Louisiana Deputy Regent of the International College of Dentists, is a member of the Pierre Fauchard Academy, and is Area 6 Regent for the American College of Dentists. She is also a member of The Louisiana Museum Foundation.

She is married to Dr. David DeGenova, an orthodontist, and they have three sons.

Dawne Stefanik

Organization Representing: The Ohio State University

Dawne Stefanik earned her Doctor of Dental Surgery degree in 2000 from The Ohio State University College of Dentistry, after which she enjoyed working in dental private practice before transitioning to academia in 2009. She is an Associate Professor-Clinical in the Division of Restorative and Prosthetic Dentistry at The Ohio State University. In 2020, Dr. Stefanik completed a Master’s Program in Bioethics from the Center for Bioethics, The Ohio State University College of Medicine.

Dr. Stefanik formerly directed her college’s Screening and Limited Care Clinics and is currently the course director for the Introduction to Clinical Dentistry series of courses for first-year dental students and also directs the Ethics and Communications course for second-year dental students. In 2021, Dr. Stefanik established an Ethics and Professionalism Committee for her college and serves as its Chair. Around the same time, she also helped establish the first Ohio-based Student Professionalism and Ethics in Dentistry student organization at The Ohio State University and serves as the group’s advisor.

She is an active member of the American Dental Association, the Ohio Dental Association, and the Columbus Dental Society and in 2018, was inducted as a fellow into the American College of Dentists.

Her research interests include investigations into educational pedagogy, emotional intelligence and conflict management, and ethics and professionalism in dental education.

Gina Thornton-Evans

Organization Representing: Centers for Disease Control and Prevention

Dr. Thornton-Evans is the Director of the Division of Oral Health (DOH) in CDC’s National Center for Chronic Disease Prevention and Health Promotion, where she directs programmatic and scientific efforts, as well as policy, partnerships, and communication strategies, to promote oral health equity and fulfill the division’s mission.

Previously, Dr. Thornton-Evans led DOH’s Surveillance, Investigations, and Research Team and is the director of CDC’s Dental Public Health Residency Program. She leads several key activities to monitor the oral health of the US population and directs a training program for dental public health professionals. She also serves as the division’s lead on Healthy People 2030 activities and the CDC lead for the oral health topic area, and oversees all efforts related to highlighting the Leading Health Indicator for Oral Health.

Dr. Thornton-Evans has represented DOH on various committees and workgroups related to health disparities, health equity, social determinants of health, periodontitis, diabetes, and maternal and child health. In 2019, she received the US Public Health Service Herschel S. Horowitz Oral Health Research and Policy Award for her leadership in advancing the surveillance of periodontal disease and monitoring the progress toward national oral health objectives over several decades. In 2021, she was appointed as a Santa Fe Group Senior Scholar for her work in advancing oral health research.

Dr. Thornton-Evans received her DDS from the University of Michigan School of Dentistry and MPH from the University of Michigan School of Public Health. She is a diplomate of the American Board of Dental Public Health. Dental public health is one of the 12 specialties recognized by the American Dental Association.

Scott Tomar

Summit Co - Chair

Dr. Scott Tomar is Professor and Associate Dean for Prevention and Public Health Sciences at the University of Illinois Chicago College of Dentistry and is the Immediate Past President of the American Board of Dental Public Health. Dr. Tomar has published about 180 journal articles and book chapters and contributed to seven reports of the US Surgeon General. He is a former editor of Journal of Public Health Dentistry and Journal of Evidence-Based Dental Practice and has received numerous awards, including IADR’s H. Trendley Dean Distinguished Scientist Award.

Jennifer Webster- Cyriaque

Pillar Leader

Organization Representing: NIDCR/NIH

Dr. Jennifer Webster-Cyriaque is the deputy director of National Institute of Dental and Craniofacial Research, National Institutes of Health. An accomplished clinician, researcher, and leader, Dr. Webster-Cyriaque had previously served as a faculty member at the University of North Carolina (UNC) schools of dentistry and medicine for more than two decades.

As a tenured full professor at UNC, Dr. Webster-Cyriaque also served as the attending on clinical service at the UNC Hospital’s dental clinic. While there, she led research into a potential etiologic agent for salivary gland disease in patients living with HIV, assessed the oral microbiome and its implications for cancer- causing viruses, and studied the impact of the oral microbiome and oral health on HIV outcomes.

In addition to her research, Dr. Webster-Cyriaque has held leadership roles as the chair/vice chair of the Oral HIV/AIDS Research Alliance, as research director at the National Dental Association Foundation, as director of postdoctoral CTSA training, along with multiple roles within the American Association for Dental, Oral, and Craniofacial Research and the International Association for Dental Research. Since 2004, she has led the UNC Malawi project and provided assistance in founding Malawi’s first dental school in 2019.

Dr. Webster-Cyriaque earned her PhD in microbiology/immunology from the University of North Carolina-Chapel Hill in 1998, her DDS from SUNY Buffalo in 1992, and her BA in biology and interdisciplinary social science from SUNY Buffalo in 1988.

Pamela Zarkowski

Organization Representing: American Society for Dental Ethics

Professor Pamela Zarkowski, JD, MPH, is Provost and Vice President for Academic Affairs at the University of Detroit Mercy. An educator for more than 45 years, she has served in several administrative roles at the University of Detroit Mercy and continues to teach predoctoral, graduate, and dental hygiene students. She has held various leadership roles in national organizations, provided professional development workshops and seminars, and published articles and book chapters on dental public health, professional, legal, and ethical issues for dental and health professionals. She is a past president of the American Dental Education Association, Society for Executive Leadership in Academic Medicine, the American Society for Dental Ethics, and former Chairperson of the ADEAGies Foundation. Zarkowski is a Sigma Phi Alpha Dental Hygiene Honor Society member, an honorary member of Omicron Kappa Upsilon, and an honorary fellow of the American College of Legal Medicine. She serves on the Board of Regents for the American College of Dentists. In 2011, she received the Distinguished Service Award from the American Dental Education Association. She was honored in 2017 by the ADEAGies Foundation as the recipient of the Gies Award for Achievement – Dental Educator. In 2019, she was named one of Crain’s Notable Women in Education Leadership.

Not Pictured:

Jennifer Bassiur

Organization Representing: AAOP

Bruce Donoff

Organization Representing: Harvard School of Dental Medicine

Thomas Elliott

Organization Representing: American Dental Association Council on Ethics, Bylaws and Judicial Affairs

Carole Hanes

Organization Representing: ACD

Robert Iovino

Organization Representing: Stony Brook School of Dental Medicine

Sharon Jackson

Organization Representing: NIH

Lance Rucker

Organization Representing: American College of Dentists Audit Task Force

Jane Steffensen

Organization Representing: Population Oral Health

Thank you to our Planning Committee and SPEA Volunteers:

Toni Roucka, Co-Chair

Scott Tomar, Co-Chair

Jane Barrow, Planning Committee

John Kerns, Planning Committee/SPEA Representative

Lisa Simon, Planning Committee

Jackson Bickford, Marquette SPEA Chapter

Ben Hung, University of Maryland SPEA Chapter

Jessica Martin, University of Maryland SPEA Chapter

Emily Nguyen, University of Maryland SPEA Chapter

Dispatches from “both sides of the aisle”

2024 Ethics Summit September 12, 2024

Lisa Simon MD DMD

A bit about me

• 2010 - 2014: Dental school at HSDM

• 2014 - 2015: Dental residency at FQHC

• 2015 – 2020: Dentist at the Suffolk County Jail

• 2016 – 2020: Medical school at HMS

• 2020 – 2023: Internal Medicine residency at Brigham and Women’s Hospital, longitudinal clinic at FQHC

• Now: PCP at BWH, oral health researcher

Why is dentistry separate from the rest of healthcare?

“Keep invented and manufactured many dental tools and is credited with being one of the first to manufacture porcelain teeth. Also a practicing physician, Keep was the first to use anesthesia for childbirth, administering ether to Fanny Longfellow, Henry Wadsworth Longfellow's wife, on the occasion of her daughter's birth on April 7, 1847.”

(12) where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services;

A brief history of health insurance

Medical insurance originates as plans to prevent catastrophic expenses from unforeseen illness or injury; many employersponsored 1900s

1954

Dental insurance offered as a fringe benefit through unions; largely a discount plan for anticipated expenses (the opposite of medical insurance!)

Multiple proposals to develop nationalized health care, many include dental benefits 1930s - 1945

2010

Affordable Care Act requires pediatric plans sold on the exchange to offer dental insurance and slightly increases dental coverage for some groups

AMA and ADA unite to oppose Medicare and Medicaid; the ADA “wins” and the AMA “loses”

1965

The separation of medicine and dentistry is a lucrative historical accident … that harms many Americans

It doesn’t have to be this way

• Many Eastern European countries: Dentistry is a specialty of medicine and dentists attend medical school before specializing in “stomatology.”

• Many Western European countries: Dental insurance is integrated into nationalized health insurance schemes

• Including in Canada starting in 2024!

How we talk about the work we do

• “Oral health is a critical part of overall health”

• “Annual health care savings of more than $1,000 per capita have been realized when preventive dental treatment is provided to high-risk groups, such as people with diabetes, cardiovascular disease, or a history of stroke”

• “Studies have previously demonstrated the relationship between periodontal disease and inflammatory markers associated with diabetes severity. Among patients with diabetes, periodontal intervention has been associated with improved oral health status and substantial reduction in total health care costs and rates of hospitalization”

Kidney Disease

Ruospo M, Palmer SC, Wong G, et al. Periodontitis and early mortality among adults treated with hemodialysis: a multinational propensity-matched cohort study. BMC Nephrology. 2017;18:166. doi:10.1186/s12882-017-

Diabetes

From: The Effect of Nonsurgical Periodontal Therapy on Hemoglobin A1c Levels in Persons With Type 2 Diabetes and Chronic Periodontitis: A Randomized Clinical Trial. JAMA. 2013;310(23):2523-2532.

doi:10.1001/jama.2013.282431

The

“Oral

-Systemic Health Link”

“Cardiac-Systemic Health”

“Liver-Systemic Health”

How we talk about the value of oral health

“Oral health is associated with many systemic health conditions” “Oral health is only important because it’s connected to health conditions that actually matter”

“Dental care may lead to overall health care cost savings”

“If dental care isn’t cost-effective, it’s not worth providing it”

“Dental disease has a bi-directional link with inflammatory chronic diseases, like diabetes and heart disease.”

“Dental

treatment

should only be

covered for people with certain conditions”

We are not alone!

N Engl J Med. 2020 Jan 9;382(2):152-162. doi: 10.1056/NEJMsa1906848. Health Care Hotspotting - A Randomized, Controlled

Value-based payment

Song Z, Ji Y, Safran DG, Chernew ME. Health Care Spending, Utilization, and Quality 8 Years into Global Payment. New England Journal of Medicine 2019;381(3):252–63.

Applying an ethics lens

Inequities

• 43.88% of people with an income below the Federal Poverty Level have untreated dental disease

Only 17.97% of people making more than 200% the Federal Poverty Level do

• People who are unable to work are 2.59 times more likely to be missing their teeth

• People who live in rural areas are 1.63 times more likely to be missing their teeth

• Low-income people are 15.91 times as likely to be missing their teeth

Saman DM, Lemieux A, Arevalo O, Lutfiyya MN. A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders? BMC Public Health. 2014;14:65. doi:10.1186/1471-2458-14-65.

Racism in oral health

• 28% of Black children ages 2-5 have untreated caries, compared to 18% of white children

• Early childhood caries rates are 5 times higher in American Indian and Alaska Native children than white children

• Black and Latinx older adults have twice the rates of untreated caries as white older adults

• The 5-year-survival rate for oral cancer is 62% in white men and 41% in Black men

• 72% of minority-identifying dentists reported experiencing discrimination while in practice

https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm

ADA HPI, Racial and Ethnic Mix of the Dentist Workforce in the U.S., 2021

American Academy of Pediatrics, Early Childhood Caries in Indigenous Communities

We are “integrating” something that patients are already seeking within the medical system

• Dental problems cause ~1.5% of all ED visits, costing $900,000,000 per year.

• Patients unable to access treatment in the ED

• 50% of patients with an ED visit do not see a dentist in the 6 months after ED discharge

• Of these patients, 32 die in the ED each year.

• 1.27% of all hospital admissions are for a dental problem, costing $1.2 billion per year.

• Of these patients, 20 die in the hospital each year.

• Up to 4.5% of primary care visits in underserved areas are for a dental problem.

Allareddy V, Kim MK, Kim S, Allareddy V, Gajendrareddy P, Karimbux NY, Nalliah RP. Hospitalizations primarily attributed to dental conditions in the United States in 2008. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Sep;114(3):333-7.

Allareddy V, Rampa S, Lee MK, Allareddy V, Nalliah RP. Hospital-based emergency department visits involving dental conditions: profile and predictors of poor outcomes and resource utilization. J Am Dent Assoc. 2014 Apr;145(4):331-7.

Lockhart PB, Mason DK, Konen JC, Kent ML, Gibson J. Prevalence and nature of orofacial and dental problems in family medicine. Archives of Family Medicine.

• 90% of Medicare beneficiaries diagnosed with metastatic oral cancer saw a physician in the year prior to diagnosis …

• … and 50% saw more than 11.

Reid BC, Warren JL, Rozier G. Comorbidity and early diagnosis of head and neck cancer in a Medicare population. Am J Prev Med. 2004 Dec;27(5):373-8.

What do we mean by integration?

An example: Hypertension

ADA Guidelines

ACEP Guidelines

Our findings

What are our medical colleagues excited about?

Source: https://www.reddit.com/r/educationalgifs/comments/35s7od/root_canal_surgery_xpost_rgifs/

What are our medical colleagues not excited about?

Translation to Policy

For almost every other measure of health, reaching Medicare eligibility improves health and health equity!

Source: Wallace J, Jiang K, Goldsmith-Pinkham P, Song Z. Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at

2021;181(9):1207–1215. doi:10.1001/jamainternmed.2021.3922

“Medicare currently pays for dental services in a limited number of circumstances, such as when that service is an integral part of specific treatment of a beneficiary's primary medical condition. We are proposing to clarify and codify certain aspects of our current Medicare FFS payment policies for dental services. We are also proposing and seeking comment on payment for other dental services, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures that may be inextricably linked to, and substantially related and integral to, the clinical success of an otherwise covered medical service.”

An example from Medicaid

Lessons from elsewhere

Learning from the healthcare team

Roblin DW, Liu H, Cromwell LF, Robbins M, Robinson BE, Auerbach D, Mehrotra A. Provider type and management of common visits in primary care. Am J Manag Care. 2017 Apr;23(4):225-231. PMID: 28554207.

Who makes up a team?

Learning from behavioral health integration

• About half of all mental health care for common psychiatric illness occurs in the primary care setting.

• Although primary care providers can diagnose and prescribe medication to treat these illnesses, patients may require other services: therapy or counseling or more sophisticated medication regimens. Not possible within a 15 minute primary care encounter!

• Sound familiar?

SAMHSA-HRSA Center for Integrated Health Solutions

How should we talk about our work?

Dental care is …

• Cost-saving?

• Able to prevent other chronic disease?

• An important part of overall health?

Dental care is healthcare, and healthcare is a human right

No one should suffer pain, stigma, and shame from a preventable disease

Conclusions

• Oral health matters … no matter what

• Oral health integration is a health equity imperative

• We have a lot to learn from our colleagues!

• It’s time for us to think big, not small …

• And that’s really exciting!!!

Nader A. Nadershahi, DDS, MBA, EdD

• Where we have been

• Where we are

• Where we are going

“Framework

“The Interprofessional learning continuum (IPLC) model.” Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: National Academies Press; 2015.

Version 3 IPEC core competencies endorsed by 22 member organizations

• Values and Ethics (previously Values/Ethics for Interprofessional Practice)

• Work with team members to maintain a climate of shared values, ethical conduct, and mutual respect

• Roles and Responsibilities (previously Roles/Responsibilities)

• Use the knowledge of one’s own role and team members’ expertise to address individual and population health outcomes.

• Communication (previously Interprofessional Communication)

• Communicate in a responsive, responsible, respectful, and compassionate manner with team members.

• Teams and Teamwork (unchanged)

• Apply values and principles of the science of teamwork to adapt one’s own role in a variety of team settings.

IPE and Collaborative Care

Didactic

Introduction to Interprofessional education and Collaborative Practice Seminars

IPE events with Lectures

Global IPE campus events with all healthcare professional students

Public Health Advocacy Projects

IPE and Collaborative Care Simulation

Social Justice simulation projects

Multidisciplinary team conferences public health focus

Medical Emergency management

Standardized patient activities

IPE and Collaborative Care Service

Community based events

Senior Smiles and Wellness Health Fair

Project Homeless Connect

Give Kids a Smile

Give Special Kids a Smile

IDD events

IPE and Collaborative Care

Clinical

Outpatient Clinics with multidisciplinary teams rotating in.

Extramural rotations with multidisciplinary diagnostic and treatment approaches

IPE and Collaborative Care

Future Clinical Collaboration

Pacific Health Care

Collaborative

New collaborative clinical and academic facility in Sacramento, CA

Combines dental, medical, behavioral health services for the public in a teaching and learning environment

Goals

Improve patient experience

Improve the health of populations

Improve provider experience

Reduce the cost of care

Equity and access

Interprofessional Practice Models:

Breaking Down the Silos: Dentistry’s Ethical

Responsibly as a Partner in Healthcare

Dr. Dan Pilhlstom

Advancing excellence, ethics, professionalism, and leadership in dentistry.

American College of Dentists

Integrated, Integrative, Whole-person health, Whole-health, team-based care…

What is it and is medicine integrated?!

CONCLUSIONS

The concept of integrated care is ambiguous since it is often an umbrella term that differs in underlying scope and value.

Integration should be pursued at different levels within a system to facilitate continuous, comprehensive, and coordinated service delivery to individuals and populations.

What is Medical-Dental Integration (MDI)?

- Working together to provide integrated oral, medical, and behavioral health care1

- An approach to care that integrates and coordinates dental medicine into primary care and behavior health to support individual and population health2

- A patient-centered continuum of care where the healthcare team multidirectionally communicate, collaborate, and share patient health information in order to improve overall health outcomes3

1) Oral Health in America: Advances and Challenges; 2021 2) https://www.carequest.org/topics/medical-dental-integration

3) National Action Framework to Accelerate Whole-Person Integrated Care, National Oral Health Conference, 2023

What do Interprofessional Practice Models have in common?

• FQHCs

• VA system

• Academic health systems

• Military health system

• Pacific Dental Service

• Health Partners

• Kaiser Permanente

• Share and communicate through a common EHR

• May have a common HRN for the patient

• Have medical and dental staff that are in the same office, location or nearby

• Patients may have a common payer for medical and dental

• May or may not have formal programs that integrate medical and dental care

How do Interprofessional Practice Models integrate care?

Patient level:

• Dental clearances for cancer patients, orthopedics, cardiac surgery, organ transplants, etc.

• H&N cancer tumor boards

• Medical clearances for dental patients going to the ASC

• Medical clearances for oral surgery

• Some oral pathology cases

• Sleep apnea and TMD clinics

• Abnormal vital signs or other findings in the dental setting

Population-level:

• Fluoride varnish or oral health services in the medical setting

• Closing medical care gaps in dental (vaccinations, labs etc.)

• Closing dental care gaps in medical (guidance and appointing)

• Depression screening in dental

• SDOH screening in dental

What are the barriers and opportunities?

Barriers:

• Lack of a shared EHR

• Limited communication channels

• Separate business lines and payers

• Lake of familiarity with scope of practice, workflows, practice

• No formal financial incentive to collaborate

• Medical providers don’t see the value

• Dental providers lack the knowledge, motivation, and drive to do more?

Opportunities:

• Pediatric departments and pediatricians have embraced oral health

• Dental teams see a high volume of relatively healthy patients who have primary care needs… a touch point in the health system

• States are broadening the dental team’s scope of practice in primary care

• Dental teams are highly trained and capable

• Patients increasingly see dental staff as an important part of the healthcare team

KP Membership / Permanente Physician Groups / Permanente Dental Group

12,500,000 medical members

635,000 Medical members in the NW region

290,000 Dental members in NW (Oregon & SW Washington)

85% Dental members also have KP Medical coverage

8 autonomous KP regions (Colorado, Hawaii, Georgia, Mid-Atlantic, N. California, S. California, Oregon and Washington)

8 autonomous Permanente physician groups

1 autonomous Permanente dental group (Pacific NW)

Relationship with Kaiser Permanente

Kaiser Foundation Health Plan NW Permanente Dental Associates

• Dental Service Agreement (DSA)

• Memorandum of Understanding (MOU) - Annual Contract

• Global + Value-based payment

A Journey of Integration

Late 1990’s

• Blood Pressure Advice Slip Early 2000’s

• Referrals to Health Coaches

• Smoking Cessation

• Patient support tool & care gap reminders

• Integrated EHR (Epic)

• Oral Health Care Gaps in Primary Care

• Embedded LPNs

• Dentist Administered Vaccinations

• Flu and COVID-19 shot in the dental office

1,450 tobacco counseling (110 accepted referrals)

78,163 care gaps closed attributed to dental offices

8,000 diabetes members had care gaps closed

• Care Gap Reminders

• Cancer Screenings

• Vaccinations

• Chronic Care Management

OUR DENTAL VISITS COME WITH SOMETHING EXTRA LPN staffed offices

8,700

Dental Nurse Visits

9,400 Care Gaps Closed

1,100 Medical Appointments Booked

MDI Offices Performance YE 2023

Glisan, Beaverton, Cedar Hills, Tanasbourne, Salmon Creek Dental Offices

CONCLUSIONS

Our data indicate that integrating medical and dental care can effectively close care gaps among older adults and may be an effective, relatively lowcost way to improve health outcomes for this population.

CONCLUSIONS

As payer, consumer, and provider awareness of the value of integrated care grows, dentists will almost certainly find themselves drawn into the mix. Dentistry’s value in that environment must be clearly articulated by everyone who cares about the profession’s future.

Third-Party Payors/Reimbursement Models

“Treat your patients well and the financial rewards will follow.”

Dr. Ron Inge

Medical - Dental Integration and Me

Oral Health in America: A Report of the Surgeon General

Message from Donna E. Shalala Secretary of Health and Human Services

“The terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health”

Aetna weighs in on medical dental integration

Aetna’s Dental Medical Integration Program May Help Lower Costs and Result in Better Health (2003)

American Dental Association (2004)

“There is not enough science to support the claims of medical-dental integration.”

Chief Science Officer, ADA

“The mouth is the domain of the dentist! Physicians should not be providing dental services to children under 4 years of age!”

ADA Board of Trustee’s member

Delta Dental of Washington

Bringing research to practical application

Oral Health Integration Resource

What do you think of when you hear the words:

Medical – Dental Integration

Who is responsibility for Medical – Dental Integration?

Integrated Care Systems

• Kaiser Permanente – Oregon

• Health Partners – Minnesota

• USAble Life and Blue Partners

The Path Forward It is not about reimbursement! It is about “plan design!”

• Dental Medical

• Medical Dental

A Case Study

networkhealth.com

Network Health’s Dental Strategy

• Objectives:

• Reconnect the mouth with the rest of the body by integrating the medical and dental care delivery systems

• Create a comprehensive plan offering that offers both medical and dental benefits; enhanced dental benefits will be available when members select high- performing dentists who collaborate directly with clinically-integrated PCPs

• Connect and integrate dentists and PCPs to allow for ease of bi-directional referrals and improved care collaboration

Dental Strategy Guiding Principles

• Develop an innovative, proprietary dental network and benefit plan offering that addresses current industry short-comings for members, dentists and PCPs

• NH’s medical/dental care delivery model will be beneficial to all stakeholders: PCPs, participating dentists, and members

• Dental clinical quality data will be used to identify high-performing dental network participants; participants will be trained to offer additional medical management services to members and bill accordingly

• Aim to ease administrative burden of traditional insurance and offer additional incentives for high-performing dental network participants

• Connect and integrate high-performing dentists and PCPs based on geographic location (Network Health’s Pods)

• Referral workflows will be user-friendly for both PCPs and dentists

• Offer enhanced, personalized dental benefits to members when they use NH’s high-performing dental network

Breaking Down the Silos: Dentistry's Ethical Responsibility as a Partner in Healthcare: Research Pillar

Dr Jennifer Webster-Cyriaque, DDS, PhD

Acting Director

National Institute of Dental and Craniofacial Research

Oral health for all … the needs of the underserved and underrepresented remain unmet …how does research help us get there?

Strategic Priorities:

• Integrate Oral and General Health

• Precision Dental Medicine

• Translate and Implement Findings

• Partner and Collaborate

• Diversify Research Pipeline

Research that considers integration

clinical care

Image source: Dr. Monica M. Bertagnolli: Renewed Focus on Caring for and Learning From Patients | ASCO Connection

Improving Health Outcomes and Research Equity through Integrating Research in Primary Care Settings

Facilitate and accelerate research advances for adoption and implementation into everyday clinical care

Improve health outcomes and advance health equity for all Americans

NIH Common Fund

Program to Support Clinical Research in Primary Care Settings

• Problem: The health and oral health of the U.S. population is declining. Decline is steepest among the underserved and underrepresented.

• Goals:

• Establish a primary care-focused clinical research network that is disease-agnostic, facilitating clinical research in mission areas across all ICs

• Integrate innovative research with routine clinical care in real-world settings

• Create a foundation for sustained engagement with communities underrepresented in clinical research

• Timeline: Gather Feedback in Spring 2024  Quick Launch in 2024 

Expand in 2025 and Beyond

fundamental science

multicomponent interventions or therapeutic systems multisystem or multiorgan outcomes

Whole Person Research and Coordination Center

Number: RFA-AT-24-010

Mechanism: U24

Due date: November 01, 2024

Partners: NCCIH, NHLBI, NIA, NIAAA, NIAID, NIBIB, NIDCR, NIDDK, NIDA, NIEHS, NIMH, NINR, ODP, OBSSR, ODS, ODSS, ORWH

Purpose:

• Solicit applications for the establishment of the Whole Person Research and Coordination Center under the NIH Whole Person Initiative. This center will be integral in coordinating the initial and future research programs in whole person health research.

Objectives:

• To build a healthy human whole person physiome conceptual map to represent all physiological organ system functions and identify Common Data Elements appropriate for each major physiological function.

• To select and test existing datasets for the conceptual map and Common Data Elements and build at least one prototype in silico model of whole person.

• A challenge: The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is currently insufficient for recommending oral health screening and preventive interventions for children aged 5 to 17 and adults in primary care settings. (May 23, 2023)

• Studies are needed to encourage implementation and dissemination research that will advance the adaptation and sustainability of primary and dental care integration at safety-net care facilities serving uninsured, underinsured, and/or Medicaid-eligible individuals and other vulnerable and underserved populations.

• Hypothesis: Education + intentional referral with subsequent comprehensive dental care will result in improved medical and economic outcomes

• Focus on co-located sites:

• RAM- remote area medical, IHS- Indian Health Service, FQHC- HRSA, BOP- Bureau of Prisons, IHSC/ICE- immigration, DHS-coast guard, VA

• Intervention-Provider training , dental and medical Comprehensive Dental Care

• Assessment of medical outcomes, QOL, economic savings

• Design Intentional referral vs Standard of care

Challenge:

Exposure

speech and surgical treatments

Cystic Fibrosis

pediatric stem cell transplant

Anesthesia

fluoride varnish

Fluoride Varnish

Pregnancy and Postpartum

emergency room setting

Notice of Intent to Publish a Funding Opportunity Announcement for TMD-IMPACT (NOT-DE-25-029)

• Generalized joint pain: musculoskeletal, myofascial

• Comorbid joint diseases: arthritis, arthralgia, spondylitis

• Pain sensitivity

• Tinnitus

• Headaches

• Inflammation

• Autoimmunity: Sjogren’s disease

• Cardiovascular involvement: hypertension

• Respiratory involvement: breathing difficulties, asthma

• Visual disturbances: dry eye, light sensitivity

• Chronic fatigue

• Sleep disorders

• Psychological disturbances: depression, anxiety

• Endometriosis

• Vulvodynia

• Irritable bowel syndrome

• Sex as a biological variable

• Substance use disorders screening

• Mental health screening and referral in dental practices

• Treatment of patients on conventional and direct oral anticoagulants in the dental office

• Dental management of patients with special healthcare needs

• Effectiveness of nicotine replacement sampling in dental practices

• The common practices of head and neck examinations in US dental offices

• Stakeholder engagement and multi-risk assessment in dental care settings

• Management of painful temporomandibular disorders

• Retrospective cohort study of ONJ

• CONDOR study of osteonecrosis of the jaws

• Primary care management for TMJD pain

• Practice-based root canal treatment effectiveness among diabetics and non-diabetics

• Hygienists’ internet tobacco cessation study

• Blood glucose testing in dental practice

• Concept cleared- PBRN requirement for medical dental integration

Women’s Health Research

Notice of Special Interest: Women's Health Research (NOT-OD-24-079)

• In alignment with the White House Initiative on Women’s Health Research

• Trans-NIH endeavor

• Focus on diseases and health conditions that predominantly affect women, present and progress differently in women, or are female-specific.

NIDCR interests:

• Sex differences in dental, oral, and craniofacial diseases/conditions, especially those that contribute to susceptibility and disparate treatment outcomes for women

• Prenatal environmental and physical stressors experienced by women during pregnancy that affect their child's dental, oral, and craniofacial tissues through altered maternal physiology

• Salivary disorders, Sjögren’s disease, and other oral manifestations of autoimmune/rheumatologic conditions

• Research on temporomandibular muscular and joint disorders and other acute and chronic dental and orofacial pain conditions

• Oral health disparities in women across lifespan, including pregnant women and menopausal women.

• Oral health measures and data science approaches that focus on dental, oral, and craniofacial outcomes to understand multi-morbidities and whole person health of women.

• Impact of innate (hormonal) and social factors (violence, trauma) on oral and craniofacial structures.

Number: RFA-HD-25-003

Mechanism: U19

Due date: December 11, 2024

Partners: NICHD, NIAID, NIDCR, NIDA, NIMH

Purpose:

• To support the Pediatric HIV/AIDS Cohort Study (PHACS) as a transformative and agile program addressing the developmental and clinical course of persons living with HIV, and perinatally acquired HIV, with an emphasis on youth through reproductive age in the US

Oral health component: prevalence of caries and periodontal disease, salivary metabolites and periodontal diseases, oral inflammation, oral microbiota, oral diseases and ART, oral HPV and HIV.

Research

that considers upstream factors

Oral Health and Improved Health for All Data

Working Group Report on NIDCR Data Science Strategy

Axel Visel – Lawrence Berkeley National Lab (Working Group Chair)

1. Create data infrastructure tailored for DOC research

2. Modernize DOC-specific data ecosystems

3. Develop data management, analytics, and visualization tools

4. Enhance data science workforce development with inclusive training

5. Promote data stewardship and sustainable data policies

Report is now posted: Working Group Report | National Institute of Dental and Craniofacial Research (nih.gov)

Hub (Launching Winter 2024)

• The Data Driven Science (DDS) Hub is NIDCR’s response to the growing need for a central hub to connect dental, oral and craniofacial researchers spanning the translational spectrum to data-science resources.

• The Hub will highlight FAIR data sources, offering access pathways and summary information on the diversity and demographic breakdown, where applicable, of each dataset.

• The Hub will feature computational resources for data-science research, including workspaces, notebooks, code repositories and training modules.

• The Hub will provide guidance on effective data reuse and sharing, including DMSP guidelines and tutorials.

DDS Hub

(Launching Winter 2024) 2

Grants & Funding

Data Generation

Highlight NIDCR & NIH funding opportunities focused on datadriven science

Analytic Resources

Beginner friendly computational resources: tutorials, cloud workspaces, & notebooks

Guidelines to generate FAIR data with standardized terminologies & common data elements

DDS Hub

Data Curation & Reuse

Curate existing population & individual-level clinical, & basic science data for research

Data Management & Sharing

Guidelines and tutorials to promote transparency, reproducibility, & data reuse

Problem:

• Progress towards reducing dental caries disparities across the socioeconomic spectrum has been inconsistent and limited.

• Prevalence of dental caries was highest among children with the lowest household income.

Aim:

• To form a research consortium and data hub, ADAPT-Caries EQ, to support community-based participatory approaches to design, implement, and evaluate population-based intervention strategies for reducing dental caries disparities and inequities in target populations.

• Opportunities to leverage co-located medical and dental services to improve oral and overall outcomes

Goal:

• To utilize community engagement and data science to acquire the evidence that will help diminish oral health disparities.

Collaborators:

• NIDCR and NIMHD

https://www.nimhd.nih.gov/resources/schare/

Number: NOT-DE-24-011

Partners: NICHD, NIAID, NIDCR, NIDA, NIMH

Purpose:

Mechanisms: R01, R21

• To encourage research on the interplay of nutrition/food insecurity, oral diseases, and comprehensive health across the life span

Background:

• Diet-related metabolic and cardiovascular diseases are among the leading causes of death and disability in the U.S.

• One in 10 Americans have type 2 diabetes. More than 4 in 10 Americans have hypertension, which is linked to heart disease and stroke, the leading causes of death for Americans. Diseases related to poor nutrition and food insecurity are largely preventable conditions.

• White House National Strategy on Hunger, Nutrition, and Health: “HHS NIH will research the interplay between nutrition, oral disease, and comprehensive health”.

Number: NOT-MD-23-008

Mechanisms: R01, R21

Partners: NIMHD, NIAMS, NIDCR, NCI, SGMRO, ODP, OBSSR, ORWH

Purpose:

• To support research on strategies and interventions to increase vaccine uptake and implementation among populations experiencing health disparities in the United States

NIDCR Interests:

• Research on vaccination programs to prevent oral diseases and conditions (e.g., HPV vaccination) as well as opportunities for dental care providers to contribute to broader public health efforts (e.g., influenza or COVID-19 vaccination), as allowable by state practice acts.

• Research to develop improved methods of promoting vaccine uptake among groups that experience health disparities.

• Research to understand the feasibility and acceptability of vaccine programs in dental settings among health disparity populations. Research to characterize barriers to and facilitators of vaccine uptake for health disparity populations.

Integration is feasible and leads to improved dental and medical outcomes

A need to move beyond associations

Multilevel Interventions and Dental Attendance in Pediatric Primary Care: A Cluster Randomized Clinical Trial

• Cluster randomized clinical trial conducted at 18 pediatric primary care practices to test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among children aged 3-6 years at baseline attending well-child visits (WCVs)

• Clinicians in the intervention group received electronic medical record changes to document oral health (practice-level) and oral health education and skills training (clinician-level) interventions. The primary outcome of dental attendance was determined through oral examinations and Medicaid claims data.

• Dental attendance was significantly higher in the intervention group (170 children) vs control group (150 children), adjusted odds ratio 1.34 (95% CI 1.07-1.69)

• Study findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs

Nelson S et al. Multilevel Interventions and Dental Attendance in Pediatric Primary Care: A Cluster Randomized Clinical Trial.

• Goal: Develop a parent-completed, easyto-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for developing caries.

• Longitudinal, prospective, multisite, cohort study enrolled and followed 985 1-year-old children and their primary caregivers (PCGs) until age 4. PCGs completed selfadministered caries risk questionnaire, and children underwent caries examinations at baseline, 2.5 years of age, and 4 years of age.

• A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.

A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children

• To improve oral health disparities and outcomes among US children impacted by dental caries, pediatric oral health prevention program models were compared in a cost-effectiveness analysis, simulated in a hypothetical cohort of 50,000 US children aged 1-18 years.

• Oral health and economic outcomes were assessed with three prevention strategies: 1) current practice, delivered to children who currently receive prevention; 2) risk-based prevention, targeted to children identified as high-risk; 3) prevention-for-all, delivered to 100% of children.

• Study findings suggest that using a risk-based approach that identifies children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs. Janusz CB et al. A Cost-Effectiveness Analysis

Knowing when oral interventions provide systemic benefit

• No significant positive association between invasive dental procedures and development of late periprosthetic joint infection

consideration- antibiotic resistance

the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis. J Am Dent

Thornhill MH, Gibson TB, Pack C, Rosario BL, Bloemers S, Lockhart PB, Springer B, Baddour LM. Quantifying

Challenge:

Building our external workforce

• task force

• SEPA grants,

• collaboration educational community and other science agencies

• ‘A world of dental research’ A world of opportunity in dental research - Futurum (futurumcareers.com)

• MSI- targeted engagement of MSI

• engagement of R grant traineesNIDCR Scholars

• extramural network

• shared BB curriculum

• Research opportunities increase awareness

• FNIH

• Professional societies(clinical + NIDCR research)

• Industry- diverse clinician scientist candidates

• Expansion to RDH

Goal: diverse demographic/ diverse scientific expertise

Challenge:

Research is need to support:

• Whole person integration in primary care settings with economic and medical outcomes

• Understanding of medical dental outcomes across disease systems

• Understanding the evidence needed to support guidelines that can be incorporated into both medical and dental practice

• Data re-use to answer questions

• A research workforce that is ready to answer these questions

• feasibility of integration and demonstration of improved outcomes

• Intervention studies, moving beyond associations

• How can these questions be asked better, who else needs to be involved, are there other ways to close these gaps, can we consider building an inclusive framework for stepwise approach

GOAL: ORAL HEALTH FOR ALL, GETTING THERE:

• Dental buy-in is an imperative to move this forward

Oral Health Advancements: Update from the Centers for Medicare & Medicaid Services

Natalia I. Chalmers DDS, MHSc, PhD Chief Dental Officer, Office of the Administrator

Centers

For Medicare & Medicaid Services

Every day, CMS ensures that 156.6 million* people in the U.S. have health coverage that works

Source: https://www.cms.gov/pillar/expand-access as of 08/30/2024

CMS Vision Statement and Strategic Pillars

CMS serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes

Source: https://www.cms.gov/cms-strategic-plan updated May 16, 2023

CMS Cross-Cutting Initiatives

ORAL HEALTH

CMS will consider opportunities to expand access to oral health coverage using existing authorities and health plan flexibilities. Access to oral health services that promote health and wellness is critical to allow beneficiaries and consumers to achieve the best health possible, consistent with the current program authorities for Medicare, Medicaid/CHIP, and the Marketplace. Therefore, CMS plans to partner with states, health plans, and healthcare providers to find opportunities to expand coverage, improve access to oral health services and consider options to use our authorities creatively to expand access to care.

Source: https://www.cms.gov/files/document/strategic-plan-overview-fact-sheet.pdf May 16, 2023

CMS Oral Health Cross-Cutting Initiative Fact Sheet

Source: https://www.cms.gov/files/document/oral-health-cci-fact-sheet.pdf

Dental Visit in the Past Year By Poverty

Source: Yarbrough and Vujicic Oral health trends for older Americans JADA

Children With A Dental Visit In The Past Year

Source: ADA Health Policy Institute analysis of data from the Medical Expenditure Panel Survey Proportion

Adults With A Dental Visit In The Past Year

Source: ADA Health Policy Institute analysis of

Seniors With A Dental Visit In The Past Year

Proportion

Source: ADA Health Policy Institute analysis of data from the Medical Expenditure Panel Survey

Percentage of Child Population Enrolled in Medicaid or CHIP, by State, July 2022

Notes:

Enrollment in Medicaid or CHIP includes individuals with full Medicaid or CHIP benefits and excludes individuals who are eligible only for restricted benefits, such as Medicare cost-sharing, family planning-only benefits, and emergency services-only benefits. The percentage of each state’s population enrolled in Medicaid or CHIP was calculated by dividing administrative, monthly point-in-time counts of Medicaid and CHIP child enrollment by estimates of each state’s resident population of children. Children enrolled in Medicaid or CHIP in each state include children and adolescents up to age 19. Estimates of each state’s resident population include children under age 18. AZ did not report age-specific enrollment data to CMS. Results for all other states were rounded to one decimal place, and then states were assigned to quartiles.

Sources:

CMS. Updated July 2022 Applications, Eligibility, and Enrollment Data (as of November 3, 2022).

Available at:

https://www.medicaid.gov/medicaid/program -information/medicaid-and-chip-enrollmentdata/monthly-reports/index.html

U.S. Census Bureau. Estimates of the Resident Population for July 1, 2022. Table SCPRC-EST2022-18+POP.

Available at:

https://www.census.gov/data/tables/timeseries/demo/popest/2020s-nationaldetail.html

Source: 2023 Medicaid and CHIP Beneficiary Profile, https://www.medicaid.gov/medicaid/quality-of-care/downloads/beneficiary-profile-2023.pdf

Percentage of Adult Population Enrolled in Medicaid or CHIP, by State, July 2022

Source: 2023 Medicaid and CHIP Beneficiary Profile, https://www.medicaid.gov/medicaid/quality-of-care/downloads/beneficiary-profile-2023.pdf

Notes:

Enrollment in Medicaid or CHIP includes individuals with for full Medicaid or CHIP benefits and excludes individuals who are eligible only for restricted benefits, such as Medicare cost-sharing, family planning-only benefits, and emergency services-only benefits. The percentage of each state’s population enrolled in Medicaid or CHIP was calculated by dividing administrative, monthly point-in-time counts of Medicaid and CHIP adult enrollment by estimates of each state’s resident population of adults. Adults enrolled in Medicaid or CHIP in each state include adults and seniors age 19 and older. Estimates of each state’s resident population include adults age 18 and over. AZ did not report age-specific enrollment data to CMS. Results for all other states were rounded to one decimal place, and then states were assigned to quartiles.

Sources:

CMS. Updated July 2022 Applications, Eligibility, and Enrollment Data (as of November 3, 2022).

Available at:

https://www.medicaid.gov/medicaid/program -information/medicaid-and-chip-enrollmentdata/monthly-reports/index.htm

U.S. Census Bureau. Estimates of the Resident Population for July 1, 2022. Table SCPRC-EST2022-18+POP.

Available at:

https://www.census.gov/data/tables/timeseries/demo/popest/2020s-nationaldetail.html

Where Patients Present with Oral Health Needs

Health Information Technology Divide Diagnostic Coding

Integration and Coordination of Care

Where People Manage Oral Health

8758 h

8760 hours in a year

2 h

People spend more hours managing their oral health at home than in a clinical setting.

Population with Any Dental and Medical Visits, 2018

Source: Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Medical Expenditure Panel Survey, Household Component, 2018.

Source: Manski, R., Rohde, F., Ricks T., and Chalmers, N. Trends in the Number and Percentage of the Population with Any Dental or Medical Visits, 2019. Statistical Brief #544. October 2022. Agency for Healthcare Research and Quality, Rockville, MD. https://meps.ahrq.gov/data_files/publications/st544/stat544.shtml

Children and Adolescents Who Received Oral Examinations or Topical Fluoride Treatments, 2018

Beneficiaries with at Least One Oral Examination

Source: 2023 Medicaid and CHIP Beneficiary Profile https://www.medicaid.gov/medicaid/quality-of-care/index.html

Parents Dental Care Experience

is Key to Coverage and Access

Child with Dental Visit Child without Dental Visit

Proportion

Parent with Dental Visit Parent without Dental Visit

Source: Isong et al. Pediatrics 2010

Source: Lipton et al. Health Affairs 2021

Poor Oral Health, Infection and Inflammation

Total inflammation surfaces are approximately the same.

periodontal disease

Nonhealing Ulcer over the Ulnar Aspect of the Left Forearm

Chronic

Fitzgerald Arch Dis Child 2005

The New England Journal of Medicine, 2002

Periodontal Disease and Associated Inflammatory Comorbidities

Periodontitis Inflammatory Comorbidities

• Cardiovascular disease

• Type 2 diabetes mellitus

• Rheumatoid arthritis

• Inflammatory bowel disease

• Alzheimer disease

• Nonalcoholic fatty liver disease

• Cancers

Dissemination

• Bacteremia, hematogenous

• Oro-pharyngeal dissemination

• Oro-digestive dissemination

Source: Hajishengallis and Chavakis Nat Rev Immunol 2021

Association Between Maternal Periodontal Disease and Adverse Pregnancy Outcomes

Maternal periodontal disease increases the odds of low birthweight by 10%

Maternal periodontal disease increases the odds of preterm birth by 15%

Source: Choi et al. Family Practice, 2021

Maternal periodontal disease increases the odds of spontaneous abortion by 34%

Maternal periodontitis increases the odds of any maternal complications by 19%

National Health Expenditure

Dental is 4% of all Health Expenditures, $124 Billion

Source: National Health Expenditure, Centers for Medicare and Medicaid Services, 2016

Dental National Health Expenditures By Payer, 2021

Dental Services (4 percent share): Spending for dental services rose 16.1 percent in 2021 to $161.8 billion, following a decline of 3.0 percent in 2020. In 2021 CMS spending on dental services was $ 22.58 billion.

Source: https://www.cms.gov/files/document/highlights.pdf

2016 Health Care Spending

Percentage of Medicare FFS Beneficiaries with the 21 Selected Chronic Conditions: 2018

Source: CMS Chronic Conditions Chartbook

EMERGENCY DEPARTMENT VISITS FOR DENTAL CONDITIONS

Poor Oral Health in Top 10 First-listed Diagnoses Among Treat-and-release

ED visits, 2018

Source: Weiss AJ (IBM Watson Health), Jiang HJ (AHRQ). Most Frequent Reasons for Emergency Department Visits, 2018. HCUP Statistical Brief #286. December

2021. Agency for Healthcare Research and Quality, Rockville, MD

Percentage of Emergency Department Visits by Adults

at which Opioids were Prescribed

Source: National Center for Health Statistics Report 135, 2020

Emergency Department Visits for Non-Traumatic Dental

Conditions per 100,000 Adult Beneficiaries, by State, 2019

Source: https://www.medicaid.gov/medicaid/quality-of-care/downloads/beneficiary-profile-2022.pdf

Population: Medicaid and CHIP beneficiaries ages 21 to 64 with full Medicaid or CHIP benefits and not dually eligible for Medicare

Notes:

Non-traumatic dental conditions (NTDCs) are dental conditions such as cavities or dental abscesses that might have been prevented with regular dental care. Emergency Department (ED) visits for NTDCs may indicate a lack of access to more appropriate sources of medical and dental care. CMS assessed state-level data quality in the 2019 TAF file using the following metrics: total enrollment, inpatient (IP) and other services (OT) claims volume; completeness of diagnosis code (IP file); completeness of procedure code (OT and IP files); and expected type of bill code (IP file). States with an unusable data quality assessment (TN, SC) are shown in white.

Results for remaining states were rounded to whole numbers, and then states were assigned to quartiles. States with a high concern data quality assessment are shown with a hatched overlay. For additional information regarding state variability in data quality, please refer to the Medicaid DQ Atlas, available at: https://www.medicaid.gov/dq-atlas/welcome.

Source:

CMS analysis of calendar year 2019 T-MSIS Analytic Files, v 5.0.

Additional information available at: https://www.medicaid.gov/medicaid/benefits/ downloads/adult-non-trauma-dental-ed -visits.pdf and https://www.medicaid.gov/medicaid/benefits/ dentalcare/index.html

Medicaid and Children’s Health Insurance Program (CHIP)

Barriers to Oral Health Care

Office of Burden Reduction & Health Informatics, 2023

Barriers to Oral Health Care

• Patients and providers report encountering various barriers to receiving and providing quality dental care under Medicaid, a joint federal/state program administered by states under broad federal guidelines. Oral health is a cross-cutting priority for CMS, and patients, providers, and state governments all have a role to play in improving oral health.

• This visual summarizes interviews with interested parties to better understand experiences of barriers to oral health care.

Source: CMS, Office of Burden Reduction & Health Informatics, Barriers to Oral Health Care, 2023

https://www.cms.gov/priorities/key-initiatives/burden-reduction/about-cms-office-burden-reduction-health-informatics/barriers-oral-health-care-illustration

Barriers to Oral Health Care

Source: CMS, Office of Burden Reduction & Health Informatics, Barriers to Oral Health Care, 2023

https://www.cms.gov/priorities/key-initiatives/burden-reduction/about-cms-office-burden-reduction-health-informatics/barriers-oral-health-care-illustration

Source: CMS, Office of Burden Reduction & Health Informatics, Barriers to Oral Health Care, 2023

https://www.cms.gov/priorities/key-initiatives/burden-reduction/about-cms-office-burden-reduction-health-informatics/barriers-oral-health-care-illustration

Source: CMS, Office of Burden Reduction & Health Informatics, Barriers to Oral Health Care, 2023

https://www.cms.gov/priorities/key-initiatives/burden-reduction/about-cms-office-burden-reduction-health-informatics/barriers-oral-health-care-illustration

Source: CMS, Office of Burden Reduction & Health Informatics, Barriers to Oral Health Care, 2023

https://www.cms.gov/priorities/key-initiatives/burden-reduction/about-cms-office-burden-reduction-health-informatics/barriers-oral-health-care-illustration

Poor Oral Health Has Impacts Beyond Healthcare

Poor oral health is linked to all-cause mortality.

Poor oral health is linked to substance use disorders.

Poor oral health is an obstacle to employment.

Poor oral health impacts children's school attendance and performance.

Advancing Oral Health Prevention in Primary Care

Affinity Group Map

14 States participated in the Affinity Group from February 2021 – March 2023

A principal objective of the affinity group was to support states in developing sustainable solutions for improving the delivery of FV by PCPs for children enrolled in Medicaid and CHIP. CMS supported state teams in conducting quality improvement (QI) projects and facilitated peer-to-peer learning and sharing of promising practices across states.

Many teams used the Topical Fluoride for Children (TFL-CH) measure to monitor changes in the delivery of fluoride varnish.

Topical Fluoride for Children (TFL-CH) The TFL-CH quality measure assesses the percentage of enrolled children ages 1 through 20 who received at least two topical fluoride applications within the measurement year. The Dental Quality Alliance (DQA) is the measure steward. The measure was added to the Medicaid and CHIP Child Core Set in 2022.

Source: Highlights from the Advancing Oral Health Prevention in Primary Care Affinity Group https://www.medicaid.gov/sites/default/files/2024-01/oral-

Focus Areas Recommended by the Oral Health Initiative Workgroup

• Focus Area 1: Increase emphasis on preventive, minimally invasive, and timely care. Within this focus area, the Workgroup identified four strategic priorities:

• Improve coordination and integration of care to increase utilization of recommended care

• Improve oral health care for pregnant and postpartum people

• Improve oral health care for adults with intellectual and developmental disabilities

• Reduce avoidable emergency department utilization for dental needs

• Focus Area 2: Enhance managed care plan engagement and accountability. Within this focus area, the Workgroup identified three strategic priorities:

• Build capacity for using managed care quality tools such as the Quality Strategy (QS), Quality Assessment and Performance Improvement (QAPI), and External Quality Review (EQR)

• Identify and share best practices for care coordination in managed care settings

• Increase managed care accountability for providing high-value, high-quality care

• Focus Area 3: Enhance capacity for quality measurement and analytics to track progress toward the primary aim.

Source: https://www.medicaid.gov/media/176321

Medicare

Community Who Had at Least One Dental Exam in 2019

Source: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File and Cost Supplement File, 2019

https://www.cms.gov/files/document/dental-coverage-status-and-utilization-preventive-dental-services-medicare-beneficiaries-poster.pdf

Total Health Care Service Expenditures per Capita for Selected Service Types Among Medicare Beneficiaries Living Only in the Community, in Dollars, 2020

Total Out-of-Pocket Health Care Service Expenditures per Capita for Selected Service Types Among Medicare Beneficiaries Living Only in the Community, in

Source: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File, 2020 and Cost Supplement File, 2020.

https://www.cms.gov/research-statistics-data-and-systems/research/mcbs/data-tables/2020-medicare-current-beneficiary-survey-annual-chartbook-and-slides

Medicare Statutory Dental Exclusion

Under section 1862(a)(12) of the Social Security Act: “no payment may be made under part A or part B for any expenses incurred for items or services”…“where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services”

Source: https://www.ecfr.gov/current/title-42/part-411/section-411.15#p-411.15(i)

Calendar Year 2023 Medicare Physician Fee Schedule

Final Rule 87 FR 69404

In CY 2023, CMS finalized:

1) Our proposal to clarify and codify certain aspects of previous Medicare FFS payment policies for dental services.

2) Payment for dental services that are inextricably linked to other covered medical services, such as dental exams and necessary treatments prior to organ transplants (including stem cell and bone marrow transplants), cardiac valve replacements, and valvuloplasty procedures.

3) A process to review and consider public submissions for potentially analogous clinical scenarios under which Medicare payment could be made for dental services.

4) Medicare payment, beginning in CY 2024, for dental exams and necessary treatments prior to the treatment for head and neck cancers.

Source: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule#_ftn1

Calendar Year 2024 Medicare Physician Fee Schedule

Final Rule 88 FR 78818

For CY 2024, we are building up on our efforts in the CY 24 PFS final rule and are finalizing:

1. A codification of the previously finalized payment policy for dental services for head and neck cancer treatments, whether primary or metastatic.

2. The codification to permit Medicare Part A and Part B payment for dental or oral examination performed as part of a comprehensive workup prior to medically necessary diagnostic and treatment services, to eliminate an oral or dental infection prior to, or contemporaneously with, those treatment services, and to address dental or oral complications after radiation, chemotherapy, and/or surgery when used in the treatment of head and neck cancer.

3. Our proposal to permit payment for certain dental services inextricably linked to other covered services used to treat cancer prior to, or during:

1. Chemotherapy services.

2. Chimeric Antigen Receptor T- (CAR-T) Cell therapy.

3. The use of high-dose bone modifying agents (antiresorptive therapy).

Source:

Source: Efficacy of Dental Services for Reducing Adverse Events in Those Receiving Chemotherapy for Cancer

https://effectivehealthcare.ahrq.gov/products/chemotherapy-dental/research

Source: Efficacy of Dental Services for Reducing Adverse Events in Those Undergoing Insertion of Implantable Cardiovascular Devices

https://effectivehealthcare.ahrq.gov/products/cardio-dental/research

Medicare Dental Coverage

Medicare Recognizes The Following Dental Specialties For Enrollment

• Dental Anesthesiology

• Dental Public Health

• Endodontics

• Oral and Maxillofacial Surgery

• Oral and Maxillofacial Pathology

• Oral and Maxillofacial Radiology

• Oral Medicine

• Orofacial Pain

• Orthodontics and Dentofacial Orthopedics

• Pediatric Dentistry

• Periodontics

• Prosthodontics

Source: https://www.cms.gov/medicare/coverage/dental

The CMS Dental Claims Processing System is Live!

As of July 1, 2024, CMS can officially accept electronic 837D dental claims. This is a huge milestone for the MPSM modernization efforts— the ability to accept, process, and pay dental claims in the cloud!

This is a culmination of work that began when the CY2023 Medicare Physician’s Fee Schedule clarification expanded Medicare coverage to include additional medically necessary dental procedures. MPSM embraced this challenge head- on and established four Dental Services Teams to identify necessary functionality and develop the Dental Minimum Viable Product (MVP). However, this achievement is representative of the collaborative efforts and expertise of all the MPSM Teams, program management and support teams, as well as our business owners and stakeholders across the agency. Throughout the past 18 months, MPSM leveraged these partnerships to assist with prioritizing the functionality of the MVP and ensuring that key issues, gaps, dependencies, and risks were understood and proactively addressed.

How Do I Submit a Claim?

Marketplace

PY 2025 Final Rule Update: Essential Health Benefits

Essential Health Benefits (EHBs)

All Marketplace plans must cover these 10 essential health benefits:

1. Ambulatory patient services, like doctor and clinic visits

2. Emergency services, like ambulance, first aid, and rescue squad

3. Hospitalization, like surgery and overnight stays

4. Pregnancy, maternity, and newborn care

5. Mental health and substance use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices, like therapy sessions, wheelchairs, and oxygen

8. Laboratory services

9. Preventive and wellness services and chronic disease management, like blood pressure screenings, and immunizations

10. Pediatric services, including dental and vision care

Dental Care as Essential Health Benefits

• Dental coverage is an essential benefit for children.

• Routine adult dental coverage is not included as an essential health benefit, and most Marketplace plans don't offer it.

• States may offer stand-alone dental plans for purchase Source:

Overview: PY 2025 Final Rule - Adult Dental Benefits

CMS removed the regulatory prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefits (EHBs) at § 156.115(d).

• States may now add routine adult dental benefits as EHBs by updating their EHB-benchmark plans pursuant to § 156.111.

• Removing the prohibition removes regulatory and coverage barriers to expanding access to adult dental benefits.

• This policy is consistent with our current state-based approach to EHB, in that it is up to each state to determine whether to add routine adult dental services as an EHB.

• For states beginning the EHB-benchmark application process in 2025, adding routine adult dental services as an EHB would become effective for their issuers’ PY 2027 plans.

• This proposal would not require states to add such services as an EHB, nor would CMS consider any existing language regarding routine non-pediatric dental services in any state’s current EHB benchmark plan to have the effect of adding such services as an EHB.

Source: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2025-final-rule

Overview: PY 2025 Final Rule- Adult Dental Benefit

The rule also allows states to:

• Include routine non-pediatric dental services as EHB for purposes of their Alternative Benefit Plans (ABPs) or Basic Health Plan (BHP).

• Improve adult oral health and overall health outcomes, which could help reduce health disparities and advance health equity since these health outcomes are disproportionately low among marginalized communities.

Source: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2025; Draft Rule (November 24, 2023), 88 FR 82597, available at https://www.govinfo.gov/content/pkg/FR-2023-11-24/pdf/2023-25576.pdf.

Allowing States to Add Routine Adult Dental Benefits as

Essential Health Benefits (EHBs)

CMS has expanded access to dental benefits by finalizing measures to allow states the option to add routine adult dental services as an essential health benefit (EHB). For the first time, and starting on January 1, 2027, every state will be able to update their EHB-benchmark plans to include routine non-pediatric dental services, such as cleanings, diagnostic X-rays, and restorative services like fillings and root canals, through the EHB-benchmark application process.

More than 21 million Americans signed up for high-quality, affordable health care coverage through the ACA Marketplaces in 2024. We want to build on this success to make Marketplace plans even better,” said HHS Secretary Xavier Becerra. “This rule will allow coverage of routine dental benefits for the first time, expand requirements to ensure reliable access to health care providers, and ensure consumers with lower incomes can sign up for coverage when they need it.”

Source: https://www.cms.gov/newsroom/press-releases/hhs-finalizes-policies-make-marketplace-coverage-more-accessible-and-expandessential-health April 02, 2024

National Context

Advancing Oral Health Across the Lifespan: A Workshop

The National Academies of Sciences, Engineering, and Medicine November 18-19, 2024

Topics discussed at the workshop may include consideration of:

•National oral health goals for “Zero at Six” (zero cavities at six years of age for all children), and “Twenty at Eighty” (all 80 year olds to have 20 teeth).

•Sustainable solutions that improve access to oral health services in public and private spaces (urban, suburban, rural, and Tribal communities and territories)

•Models that achieve meaningful oral and systemic health integration.

•Models to empower all consumers to make informed choices related to oral health and models that encourage healthy workplace and school policies

•Investments in public oral health education campaigns, including celebrity and social media influencer voices

•Innovations that will improve oral health in the next 5-10 years.

A proceedings in brief of the presentations and discussions at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines.

Source: https://www.nationalacademies.org/our-work/advancing-oral-health-across-the-lifespan-a-workshop#sectionCommittee

The National Academies of Sciences, Engineering, and Medicine November 18-19, 2024

Source: https://www.nationalacademies.org/our-work/advancing-oral-health-across-the-lifespan-a-workshop#sectionCommittee

Questions