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Sinking teeth into rural Minnesota

October 30, 2012


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Dental students from the School of Dentistry spend 6-8 weeks treating patients under faculty supervision at one of the school’s six community outreach sites.

By Adam Overland

"Never in a million years," says dentist Meghan Rambow, "did I think I'd be living in Morris, Minnesota." But just four years after graduating from the U of M School of Dentistry, she and her husband Eric, a 2009 dentistry grad, own and operate the Morris Dental Clinic. By her account, they're right at home. Eric wanted a rural area where he could enjoy hunting and the outdoors. And the business opportunity was just what they both wanted. They've already added five staff members and have no shortage of patients. In fact, the only shortage in Minnesota when it comes to dental care—is the dentists who provide it—especially in rural areas.

"The only other dentist nearby is in his 60s; and we're the youngest by far," says Meghan Rambow.

It's a common and chronic challenge, and one the U of M has partnered with the state and with local communities to address. After all, 100 percent of the dental degrees granted in Minnesota are granted by the U—the state's only dental school.

A nationwide challenge

A new degree: dental therapist
In 2008, the Minnesota legislature authorized licensure of a midlevel provider called a dental therapist to help ease access to care challenges for patients in underserved areas of the state. Dental therapists are licensed to perform a subset of dental procedures (until then) provided only by a licensed dentist. The U answered the call with the creation of a dental therapy degree. The first class began in 2009 and graduated in 2011 to become among the first in the nation in this newly created career. The U's program is the only dental therapy education program in the country that grants a baccalaureate degree (the program also grants an M.S.) and that is affiliated with an accredited school of dentistry. Learn more.

The U's Board of Regents also recently approved a proposal for a new Doctor of Dental Surgery/Master in Public Health dual degree program. It will begin in the fall of 2013.

Access to dental care is a widespread challenge—and not just in Minnesota. Nationwide, about 50 million Americans struggle to get access to oral health care, according to the U.S. Department of Health and Human Services. They live in federally designated HPSAs—Health Professional Shortage Areas—essentially geographic areas where there's one dentist for every 5,000 or more patients. By last count there were about 4,500 HPSAs in the United States—104 of them in Minnesota, with some as large as a county and others as small as a few city blocks. 

For the last eight years, the U's School of Dentistry has been tackling the challenge through a variety of creative strategies. The approach involves both providing care for patients in underserved communities and adapting dental education in response to workforce needs and changes in the dental care delivery system.

One key to addressing the rural access challenge has been positioning students in rural areas so that they get firsthand experience with underserved communities, says U outreach director Paul Schulz. In fact, all U of M dental students go through weeks-long rotations in underserved Minnesota communities before graduation.

Exposing students to clinical experiences in those communities increases the likelihood that they will, like the Rambows, begin to imagine these areas as potential practice locations after graduation.

The dental clinic at Rice Memorial Hospital in Willmar is one of a half-dozen examples of outreach partnership sites the U has set up around the state. At these sites, the U's dental students are required to live and learn in the community—seeing patients, but also shopping at the local grocer, or taking a walk down Main Street. And when students actually relocate to rural communities, the presence of health care services attract and retain residents and businesses.

"They learn how to be part of a community—they're going in and caring for their neighbors. And when they graduate, they're going to remember that experience fondly," says Schulz. "If we don't teach them about it, they're not going to think about it."

Those partnerships also help the U keep infrastructure costs down. The School of Dentistry has 377 dental chairs on the Twin Cities campus, which makes for a very expensive physical plant.

In contrast, the Willmar clinic is owned by the hospital but staffed by University of Minnesota students under faculty supervision. It provides care to residents of 17 counties in south-central Minnesota, contributing to both the needs of area residents for health care and the U's educational efforts.

For those hard to reach areas…
2012 marks the 10th year of operation for the 3-chair, 43-foot-long Mobile Dental Clinic. Staffed by U of M students and faculty, the clinic travels around the state—about 15,000 miles per year—to communities in the Twin Cities and in greater Minnesota that have oral health access issues. Learn more.

"The beauty of these partnerships is that we don't own the clinics—the communities do. They help us to educate our students with state-of-the-art facilities…and our students are filling a gap by providing much-needed care to residents, to the tune of millions of dollars of service (over the last seven to eight years)," says Schulz.

Still, with 104 HPSA's in Minnesota, there's work to do. But with the number of dentistry graduates up 33 percent from 2004—to 108 new dentists per year—underserved communities, including rural areas, might soon find their smiles beaming a little brighter.


An example of Operational Excellence
The School of Dentistry's partnerships with the state and local communities are just one example of how colleges, departments, and units around the University are working to reduce costs while enhancing services as part of the U's commitment to Operational Excellence. Learn more and contribute your ideas at Excellence.umn.edu.

Tags: Academic Health Center

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