July 15, 2019

Two new papers co-authored by B. Alex White, DDS, DrPH, at the UNC Gillings School of Global Public Health promote the improvement of oral health in communities by providing better training and support for the practitioners who serve those communities.

Dr. Alex White

Dr. Alex White

White, an associate professor in the Department of Health Policy and Management at the Gillings School and associate professor of dental ecology at the UNC Adams School of Dentistry, is co-author of the papers “Preparing students for what lies ahead: Teaching dental public health leadership with simulated community partners,” published April 2 in the Journal of Applied Research in Higher Education, and “Development of a Silver Diamine Fluoride Protocol in Safety Net Dental Settings,” published in the January issue of the Journal of Dentistry for Children.

Preparing dental students for real-world practice

As a faculty member at East Carolina University, White participated in a study that used simulated community partners to improve leadership and relationship-building skills in future dentists. The study was the first of its kind, says White, and was designed to teach students how to best work within the communities they serve — both inside and outside the clinic.

“Dentists have always been seen as leaders in their communities,” says White, who joined the Gillings School faculty in 2014. “Our idea was to create groups that realistically simulate community members, reflecting the gender differences, racial differences, personality conflicts and other situations that dentists might face in a community where they work. How will they handle those things?”

In the first half of the course, second-year dental students learned leadership skills. In the second half, they rotated in groups as simulated patients from the fictional town of Bell City, North Carolina. Each group session met around a table for nearly an hour, during which time students were faced with simulated situations that were recorded for later analysis. Students discussed their experiences with faculty members and completed self-assessments to evaluate their strengths and weaknesses as leaders.

Leadership training that focuses on improving community health is important with the increased emphasis on dental primary care, particularly in rural communities where patients drive long distances to see dentists and where there are great health disparities. Dental education must evolve in ways that creatively addresses these challenges, says White, and using simulated community partners as part of classwork is an experiential practice that can help North Carolina better train dentists to meet the challenges of the places where they will serve.

“The course sends a good message about the role dentists play in their communities — not only in their own spaces where they are in control, but also beyond, where they have the opportunity to build relationships,” says White. “It’s a good reminder of the nature of dentistry. Being a patient stuck in a chair where you can’t say anything for 30 minutes is disempowering. Developing meaningful relationships can really impact your patients, who you need to actively partner with you in taking care of their oral health.”

Training community dental providers in SDF implementation

The Journal of Dentistry for Children paper, meanwhile, explores how pediatric dentists can support the implementation of silver diamine fluoride (SDF) in community health clinics. By removing existing decay and applying SDF to an area of the mouth, dentists can prevent the spread of cavities around those teeth and decrease bacteria in the mouth overall. This treatment is particularly helpful for young children with a high risk of dental cavities and inadequate access to dental care — until this study, however, little had been done to develop a protocol to support clinics in implementing SDF in their practices.

“This treatment will be very helpful for the thousands of dentists in community health clinics, public health departments and school-based programs across the state, but it also has a few unique challenges that pediatric dentists can help these clinics address,” says White. “SDF permanently darkens the part of the tooth where the decay is, so clinics will need to thoroughly educate families on the treatment and get their informed consent. Everyone in the clinic, from the administrative staff to the dentists, will benefit from in-person, on-site training about what the product is and what it does.”

White and his team convened an expert panel of pediatric dentists experienced with SDF and recruited three safety-net dental clinics (SNDCs) in North Carolina to pilot the new protocol, participate in focus groups and give feedback for improved implementation. A pediatric dentist provided on-site didactic and interactive trainings over two visits and returned to the clinics for observation and feedback. This process resulted in the creation of multi-step protocols that combined both academic expertise and practical feedback from the clinics and included multiple communication pieces targeted at clinic staff and families.

White says being on-site at the clinic and involving each member of the staff, rather than asking representatives to travel to Chapel Hill for training, was key to the uptake of SDF.

“Our take-away was that bringing this treatment for which we have such good evidence into practice is doable, but the clinics are most successful with on-site expert support,” he says. “The education and communication pieces are vital for preparing the clinics and getting them the resources they need to support their patients.”

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