FELLOWS FORUM 2022

Moderated by Keisha Ray, PhD

two different things, because you have some people who are talking about, “It’s so much better. Oh, my gosh. We have 95 students in the dental class and five or six of them are Black. There were no blacks in my class in 1972.”

That’s true. It’s true of your experience and it is better. That “better” is relative. A colleague this morning brought up when we talk about a moral compass and how that is a relative term, because my moral compass and moral center can be different from Lisa’s, which is different from Francisco’s, which is different from Scott’s. And so when we talk about race and racism, I think one of the challenges and why it’s so difficult and why it’s so hard, we’re entering from so many different vantages and we almost can never get to a place where we’re actually talking about the same thing. That’s why the colleagues questioned, when Lisa threw out white supremacy, I cringed a little bit because I don’t tend to do that. But I’m in a different skin than she is. Right?

–Keisha Ray

Glad you did.

–Lisa Simon

I’m privileged to be able to make that claim.

–Carlos S. Smith

Yes. And so I know that’s an uncomfortable point or it’s a trigger where I lose 75% of the audience, so I can’t say it if I want to get something across.

But that’s because we’re entering from these different vantage points. And as the conscience of dentistry, I think it’s the ACD and it’s incumbent upon them, and I think they have been doing this, is to push these conversations. Because I think what can make a difference is the advocacy of everyone in this room who can leave and say, “I understand this from a totally different perspective than I have and I can go tell someone at the Texas Dental Association meeting, ‘Look, maybe you should think about this a little bit differently. I was at this meeting and they said, da da da.’” I think that power is one that really could make a difference in the ACD. Otherwise, we’ll stay in these silos, we’ll stay in these vacuums, we’ll keep shouting over each other, and the inequities will remain.

–Keisha

Ray

And then also too, remember discrimination of any sort is a social determinant of health. And so that can also prevent people from getting the oral healthcare that they need. Let’s go to one more question. We’ll get one more.

–Audience Member 2

Hi, I’m a new Fellow, so I guess I probably shouldn’t be talking, but I will. For anybody who is doubting the role of White supremacy or race-based marginalization, at least, in medical and dental education, I would just refer you to the Flexner Report and the implications of that resulted in the closure of all but two historically Black medical colleges in the United States and the somewhat dubious claim of quality. Just something to think about. I encourage you to look at the Flexner Report and understanding what the implications of that were for medical education as we know it today, basically throughout the 20th century. I do have a positive comment, though. And would you comment on the use of technology to address some of the healthcare disparities? I don’t think that was talked about fully. It’s kind of a double-edged sword. And they can go a couple different ways. There are limitations and advantages. But I would just love to hear some of your thoughts on the use of technology leveraging, like telehealth, to reach some of these underserved areas.

–Keisha Ray

Scott? Or Francisco? You want to take this one?

Well, I mean I really appreciate your comment, and if anything good COVID has left us or is leaving us with is this amazing opening to use technology for all socioeconomical status or races or formats. Everyone is familiar with Zoom. Telehealth was so unused before 2019, especially in dentistry, and now to have this opportunity. Everyday, I deal with children’s oral health disparities and the lack of understanding and awareness of the families to have oral health in their regular screen in health and not in disease. Because it might be priority number 385 if the child is okay, but if the child is in pain it becomes one, two and three. And that’s where the problem starts. That’s the conundrum of where to find a pediatric dentist or a dentist to take care of my child.

The idea is to bring pediatric dentistry to people’s households. And we have such amazing learning experiences. Families do not want to have to travel two, three hours to get to an appointment for 20 minutes, three buses they might have to take, you name it. Paying for parking at the university. Everything. The fact that we can bring pediatric dentistry to them, wherever they’re at, is just amazing. We do a lot of risk assessments now. We do screenings. Something that we learned that we really were so excited about is the use of cell phones in low-income families. It’s like using their television. So we’re able to connect, even the more rural or where there are frontier areas where there were no access to care.

We did a very exciting study that we just finished where we were assessing toothbrushing at home, because, as you know, it’s a huge challenge. Regardless of your socioeconomic status or race, parents’ biggest nightmare is to brush their child’s teeth at night. And we really wanted to see if we could learn from the cash incentive programs from vaccinations, where in some countries, like India, Africa, Mexico, we learned that by adding a $5 phone card to families, vaccination rates in some communities went from 38% to 90% in six months. It was just incredible. So we wanted to see if these incentives will work for families. We just finished that trial with Stuart Gansky and a group at UCSF and UCLA, where we found that really families are very engaged.

We’re giving feedback to the families. It was so powerful to have this kind of technology into the households, bringing them to their families, to a place that they feel safe, and really addressing the issue of oral health disparities. We are thrilled with the findings of not just to help but really interactive approaches where everyone can do it from our health center, our community, and you don’t need to use the dentist to do that. We have amazing community of healthcare workers who are the bridge between the providers and the families, which will be an amazing opportunity for each and every one of you, wherever you’re from, to really endorse and engage with community or healthcare workers. They really make the magic. They can do risk assessment, they can do the counseling, they can counsel, they can really handhold the parents to do this kind of work, which is very simple, but for them might be challenging.

–Keisha Ray

Thank you.

–Carlos

S. Smith

I do want to say something about the advancing technologies, because I teach ethics I get to ask questions and not always provide the answer, so that’s fun to me, but one of the things I think is important is that the typical inequities that we see with anything, we see with advancing technologies as well. So I would say that when you’re dealing with these various advancing technologies, say that is a teledentistry type of thing, if it’s in a very rural, super rural area, is there WiFi that’s going to enable the folks in that community to be able to log on to your technological advancement?

I think in the same way, even with say augmented reality or artificial intelligence, I’ll use an example, most of us are very familiar with automatic sinks or automatic hand dryers. And so they’ve fixed most of that now, but when they very first came out years ago, they were not recognizing melanated skin because most of the testing had been done only on white skin. When someone that’s darker complected, like myself, would put their hand under the warmer, nothing happened. I think we have to think about as technologies advance and that connects to clinical trials ... larger question.

–Keisha Ray

It still happens.

–Francisco Ramos-Gomez

Right now we’re working with Migrant Head Start programs, which are in very rural communities where there’s no access. We linked through their WiFi. I was really surprised, because one of our first years of planning was how many of these low-income families had access just to a cell phone and we’re surprised almost 98% of them have them.

It was really incredible that we still have so much to discover and to do, especially to reach out.

–Keisha Ray

Right. Let’s do one more question.

–Audience Member 3

Hi, I’m an affiliate professor in School of Dentistry in University of Washington. My comment or question is some panel members mentioned that there is obviously a lot of need in the underserved communities for medical and dental care. In the State of Washington, I know there is a lot of Native American areas but where there is very little