Statewide antifluoridation initiatives: a new challenge to health workers. C A Evans, Jr, and T PicklesCopyRight https://doi.org/10.2105/AJPH.68.1.59 Published Online: August 29, 2011
The Task Force on Community Preventive Services has conducted systematic reviews of interventions designed to increase use of child safety seats, increase use of safety belts, and reduce alcohol-impaired driving. The Task Force strongly recommends the following interventions: laws requiring use of child safety seats, distribution and education programs for child safety seats, laws requiring use of safety belts, both primary and enhanced enforcement of safety belt use laws, laws that lower the legal blood alcohol concentration (BAC) limit for adult drivers to 0.08%, laws that maintain the minimum legal drinking age at 21 years, and use of sobriety checkpoints. The Task Force recommends communitywide information and enforcement campaigns for use of child safety seats, incentive and education programs for use of child safety seats, and a lower legal BAC for young drivers (in the United States, those under the minimum legal drinking age). This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, and provides information to help apply the interventions locally.
As a recipient of the Robert Wood Johnson's Pipeline, Profession, and Practice: Community-Based Dental Education grant, the Extramural Education Program (EEP) at the University of Illinois at Chicago College of Dentistry was charged with developing partnerships with community-based oral health programs throughout Illinois. These programs are to be used for clinical service-learning rotations for fourth-year dental students, relying on the utilization of the dentists employed at the community site as preceptors for the students. Because the College of Dentistry had essentially no community-based service-learning experiences prior to the Robert Wood Johnson grant, procedures and protocols needed to be developed to standardize a process for site and preceptor selection. An administrative process was developed to engage, recruit, and partner with community-based oral health programs that provided direct clinical services. This article will discuss the development of criteria used to select sites and preceptors for extramural clinical rotations; the development of a set of standardized assessment instruments; and the credentialing process for community-based adjunct faculty that leads to the affiliation agreements. These community-based rotations have been integrated into the College of Dentistry curriculum as a required extramural service-learning course referred to as Extramural Clinical Experience (DADM 325).
As past presidents of the American Public Health Association, we were quite surprised to read the commentary coauthored by Dr. Sekiguchi,1 a past president of the American Dental Association (ADA), and ADA staff in the May 2005 American Journal of Public Health opposing the use of dental therapists in rural Alaska.1 This commentary, which was published without an Op-Ed piece, would be comparable to the Journal publishing a commentary from only the American Medical Association in the 1960s stating that there is no need for pilot programs for nurse practitioners, physician assistants, or nurse-midwives, even in high-need areas, and that only physicians should provide health care. I am sure our readers would be quite upset.
New Zealand has successfully trained dental therapists for more than 80 years, and many other countries also use them.2 The Alaskan dental therapists are receiving state-of-the-art training, and they are being monitored and evaluated from A to Z.3 Although the ADA has a good track record of supporting preventive measures, such as community water fluoridation and most public health programs, they have a long record of preventing anyone except dentists from providing treatment, even to the underserved.
This commentary includes some useful information and correctly documents the array of ongoing efforts of the Indian Health Service and the Tribes to respond to the dental access crisis of Alaskan Natives. However, the authors’ opposition to a pilot program for 6 to 12 dental health therapists without any evidence, data, or studies marginalizes the credibility of the authors and the ADA.
Beginning in 1966, the American Public Health Association Governing Council has supported the use of expanded duties at least 3 times.4 This commentary by itself would not normally create much concern; however, because organized dentistry is lobbying state and federal decisionmakers to stop this pilot program, including a full-page ad to the governor in the Juneau Empire newspaper,5 we can not help but think that there was a hidden political agenda for their publication.
In these times of dwindling resources, complex access issues, and evidence-based medicine, dentistry, and public health, now is not the time to block innovative programs trying to serve the underserved. Let the Alaskan Natives, a sovereign nation, decide for themselves who can best meet their long-standing, unmet dental needs.
The aim of this qualitative study was to examine the perspectives of key personnel at partner sites providing community learning experiences to dental students to gain more understanding of the effects that community-based programs have on the sites themselves. Fourteen semi-structured interviews were conducted in 2015 with individuals from nine extramural sites. Interviewees had a range of roles from clinicians to CEOs, with six also reporting they were faculty preceptors. Three of the researchers developed a coding scheme focused on the benefits and challenges that community sites experience from participating in a community-based dental education (CBDE) program. Each coder then reviewed the interview transcripts independently before final group discussions and recoding to agreement. The main themes related to benefits were recruiting future dentists, staying current with clinical developments, sites' indirectly improving their missions by exposing students to broader roles of oral health providers, raising awareness regarding the need for dentistry in community settings, and nurturing a positive workplace environment. The main themes related to challenges were balancing education and training for students with clinical demands, communication with the university, and managing distinctive clinical and professional characteristics of students. This study's participants reported that the main benefit of CBDE for partner sites was dentist recruitment. The study also provided insights for both partner sites and dental schools to consider when developing and maintaining these partnerships.
