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Addressing caries through the lens of social justice, health equity, human rights

UCLA faculty member proposes shift of strategies in preventive care through forum, JADA commentary

January 29, 2020

By David Burger

Los Angeles — Social justice. Health equity. Human rights.

Those themes aren’t often included in typical conversations at the dental office.

 Photo of Francisco Ramos-Comez
Dr. Ramos-Gomez
But Dr. Francisco Ramos-Gomez hopes for a change and a new way of thinking.

He hopes that when dental providers think about children’s caries, they think about those three themes.

“The mixed success of attempts to fight early childhood caries might be linked to the fact that many past strategies have tended to focus only on providers, while failing to consider the impact that social determinants have on families’ health and behaviors,” said the UCLA School of Dentistry faculty member and executive director for the UCLA Center for Children’s Oral Health. “Shifting the focus of the battle against early childhood caries to social justice, health equity and human rights can improve oral health among underserved children and vulnerable populations through practical, interprofessional strategies.”

Dr. Ramos-Gomez’s beliefs and passion is rooted in his and others’ inventive opinions that the systems in place and dialogues about preventing early childhood caries need to evolve, and he is planning on imparting his message to his students and residents at the dental school throughout 2020 and beyond. He also is embarking on an advocacy campaign that he hopes will educate and garner support.

“This is a new year and a new decade, and I’m hoping that in 2020 we have a systems change,” said Dr. Ramos-Gomez.

It’s a conviction that was published in the November issue of The Journal of the American Dental Association and the basis for a 2018 forum that he fostered, where dentists, physicians, nurses and public health and public policy experts proposed, discussed and recommended solutions for preventing early childhood caries through the lens of social justice, health equity and human rights.

Many of his ideas crystallized at the forum, and it is now time, he said, to gain supporters in his advocacy efforts and teach the next generation of dentists to share his principle and join in.

These students are going to be in the workforce for the next 30, 40 years,” Dr. Ramos-Gomez said. “It’s like building LEGOs, from the bottom up.”

The trio of themes are highlighted by the United Nations, which adopted the Declaration of the Rights of the Child more than six decades ago, which defines children’s rights to protection, education, health care, shelter and good nutrition. The practices and world views of the U.N. influenced Dr. Ramos-Gomez’s opinions about addressing early childhood caries, he said.

Call to action

Dr. Michael Glick, editor of The Journal of the American Dental Association, said that he looks for published commentaries that are challenging and illustrate issues that we usually don’t think about. He liked calls to action, and said that Dr. Ramos-Gomez’s JADA commentary fit the bill and “it was important for us to highlight.”

The forum in Los Angeles identified not only the significance of collaboration between dentists and physicians in preventing caries, but also the important role community oral health workers could play to help improve oral health outcomes and reduce socioeconomic and culture-based disparities.

“Community oral health workers are valuable underutilized resources, particularly for high-risk and vulnerable communities and are an important link between the community and utilization of health care services,” Dr. Ramos-Gomez said. “They can provide triage, counseling, referrals and follow-up appointments. Studies in the U.S. have shown that using individuals from the community who share the same culture and language of specific target populations has proven useful for increasing knowledge, education and skills regarding the importance of oral health and improving oral health and access to care.”

Findings from the forum resulted in suggestions for promoting social justice, health equity and human rights in oral health and early childhood caries prevention for children and underserved populations, according to the JADA commentary:

•    Encouraging oral health and medical care providers to promote and advocate for mandatory age-one year oral health visits for all children.
•    Supporting a patient outcome-based reimbursement system that emphasizes early oral health prevention for children.
•    Establishing a collaborative partnership between oral health care providers and community oral health workers.
•    Supporting interprofessional education and encouraging collaborative practice between oral health, medical and other pediatric primary care providers.
•    The use of dental homes and teledentistry to promote patient-provider relationships that build trust, cultural competency and continuity of care.

The key is for dentists to partner with pediatricians, physicians and other primary care workers, Dr. Ramos-Gomez emphasized, so that the availability of oral health care is equal for all children, regardless of ethnic origin, gender, immigration status, economic standing race or religion. Not every young patient lives in Beverly Hills, he noted, so every young patient should be given equitable care across the spectrum of care.

“Since infants and toddlers on average visit a primary care provider eight times by the time they are 3 years old, there is a need for more cross-trained pediatric primary care providers willing and capable of consistently conducting oral health exams, including caries risk assessments and application of fluoride varnish and checking for white spot lesions as first indicators of disease progression,” he said.

Equality for all

“Inequalities in children’s oral health are evident considering that among children in the United States,” he said. “The highest caries rates exist in low-income and minority children, and disadvantaged children are less likely to have accessible oral health care. Findings such as these highlight that at present not all children have equal access to basic oral health care. This continues to be a crucial human rights issue worldwide.”

The forum refined and focused Dr. Ramos-Gomez’s views on preventing early childhood caries.

“Both dental and medical care providers play important roles in addressing early childhood caries,” he said. “The integration of oral health into primary care using a multidisciplinary approach is the future of dentistry.”

Dr. Jay Kumar, California Department of Public Health state oral health director and a presenter at the forum, echoed Ramos-Gomez’s opinions on preventing early childhood caries.

“Health care providers can work together to promote policy, system and environmental changes to facilitate embedding tooth brushing and healthy options in early education and care settings as well as to create an office environment for communicating appropriate health messages,” Dr. Kumar said. “Although the knowledge exists to prevent and manage early childhood caries, it has been difficult to translate this into practice. Addressing early childhood caries requires improving not only clinical care but also living conditions such as poverty, safe neighborhood, housing and other adverse influences that affect health literacy.”

Dr. Paul H. Krebsbach, dean and professor of periodontics at the UCLA School of Dentistry, was also a presenter at the forum and shared Dr. Ramos-Gomez’s views on health equity.

“The topics and issues that Dr. Ramos-Gomez brought to the UCLA Health Sciences are both necessary and forward-thinking,” Dr. Krebsbach said. “Health equity is woven into our strategy and vision and is something we strive for. My hope is that all our student dentists, residents, trainees, and faculty implement and work towards the solutions that were presented at the forum.”