Closing the dental divide

Makayla Dillon, Macy McCall, Frances Toth

In the U.S., nearly 80 million people live in communities with inadequate numbers of dentists, also known as health professional shortage areas (HPSAs). Each of these 7,600-plus HPSAs has more than 5,000 residents for every one practicing dentist. These areas have less than one-third the number of practitioners required to meet basic patient needs, according to the U.S. Department of Health and Human Services.

In Ohio, the numbers are worse: Adequately serving the populations of the state’s HPSAs would require a four-fold increase in the number of providers, or nearly 400 dentists.

A scarcity of health providers and facilities—and those willing to accept Medicaid or treat uninsured patients—frequently leads to insufficient care for people living in these communities, which are mostly urban and rural.

This chronic shortfall in services exposes patients, and would-be patients, to significant health risks.

But scholarships from foundations provide tuition coverage for students who commit to a year of service in an HPSA after graduation. And the financial freedom these scholarships provide empowers newly minted dentists from Case Western Reserve University School of Dental Medicine to begin their careers in medically underserved regions.

“[The work done by students in HPSAs is] making a meaningful difference by improving outcomes for many vulnerable patients,” said Kristin Williams, DDS (DEN ’89; GRS ’05, public health), assistant dean for admissions and student affairs. “It’s work that often takes place at the intersection of social justice and public health.”

Forging a path to service

Growing up in Columbus, Ohio, Makayla Dillon’s family sometimes struggled to maintain dental coverage. Still, they were consistent about taking her to the dentist.

“We were a low socioeconomic-status household,” said Dillon, a second-year student at the dental school. “So that definitely gave me a unique perspective and awareness of health disparities. I have been there; we experienced it personally.”

Because of her commitment to address oral health disparities, Dillon was invited to apply for a MolinaCares Accord Scholarship. Provided by the philanthropic arm of Molina Healthcare—a health insurance provider through state Medicaid programs—Dillon’s scholarship comes from a $1.2 million gift to the dental school earmarked for initiatives to increase diversity of the dental workforce and address practitioner shortages in HPSAs.

“The financial support helps me focus on my studies … and on becoming the best clinician I can be without thinking about a looming financial burden,” said Dillon, who was also a first-generation college student. “It’s a dream come true.”

Many of the dental school’s scholarship recipients come from underprivileged backgrounds, said Williams, who is also the dental school’s director of diversity, equity and inclusion.

“They know the difficulty of getting good quality care, and they’re just determined to give back in the ways they can,” said Williams. Still, she continued, though serving areas of need might be the goal, educational debt can weigh heavily on a new dentist’s career choices.

Often, graduates forgo such aspirations in the short term and find higher-paying jobs to start repaying loans. In 2022, more than 83% of dental school graduates in the U.S. had debt at graduation, with the average around $293,900 per student, according to the American Student Dental Association.

“These scholarships allow us to make our job decisions not based solely on where we can make the most money,” said Molina Scholar and first-year student Macy McCall. “We have opportunity and financial freedom to go where we want to go—and are most needed.”

Aiming for oral health equity

Built into the dental school’s curriculum is an emphasis on providing culturally competent care, helping students address each patient’s unique needs, sensitivities and history. They learn about the societal roots of inequities in access to dental care—and about effective approaches to decreasing disparities.

For instance, data shows minorities tend to seek medical services more frequently when they’re offered by providers who share similar backgrounds and ethnicities.

“Representation matters a lot to me, so I want to be a safe space for patients who can see themselves in me,” said McCall, who is Black and grew up in a predominantly white community in western Pennsylvania. “When a provider looks like their patients, people are more willing to trust and share what they’re going through—and health outcomes improve, too.”

Last fall, McCall was named a Molina Scholar just as she and her first-year classmates were taking part in the dental school’s long-standing Healthy Smiles Sealant Program with Cleveland Metropolitan School District. The experience of placing sealants on teeth of public school students of all ages—and arranging for care for their cavities—stuck with McCall and reaffirmed her dedication to starting her professional career practicing in an underserved community.

“It was eye-opening to see firsthand how oral health can be so easily overlooked. There’s so much work to be done,” said McCall. “It makes me excited to think about the changes we all can create over the long term.”

After graduating and completing their service to HSPAs, both McCall and Dillon want to eventually open their own practices and build communities of clients from a range of backgrounds.

“Every year, Molina’s support has new dentists waiting in the wings at Case Western Reserve who will go into HPSAs throughout our state,” said Williams. “Over a few years, they really can make a large difference. And they will carry their experiences and sensibilities to help others throughout their careers.”

A chair in the community

Eduardo Santos, DMD (DEN ’23), knows dental care can save lives.

Many years ago, his paternal grandfather developed an infection in his gums that went untreated and spread to his heart, causing complications that led to his death. The loss motivated Santos to pursue dentistry and dedicate himself to educating patients on the critical importance of oral health and its broader impact on well-being.

“My grandfather’s death was almost like a call to action to study and continue on this career path,” said Santos.

In 2023, Santos was chosen for the Delta Dental Foundation’s Community Commitment Award—$25,000 given annually to one student from the dental school with a track record of volunteer service in dentistry.

This summer, he will begin a two-year term practicing dentistry at Cincy Smiles—a federally qualified health clinic that treats the underserved and underinsured at schools, juvenile detention centers and other social service agencies in Cincinnati.

“As immigrants, my family was not so fortunate at times, so I feel a calling to serve in areas of need,” said Santos. “The difference between competent dental care and its absence can be significant, even lifesaving. It’s very powerful what we can do as dentists.”

To have a broader impact on HPSAs, the foundation extends scholarships to one student from each of the other four dental schools within its region of focus, spanning Michigan, Indiana and Ohio.

“We believe [HPSAs] are areas of opportunity, where people and neighborhoods deserve care and dignity and providers who are going to be there for them,” said Jen Anderson, a spokesperson from the Delta Dental Foundation. “To our scholarship winners, we say, ‘Just give us a year practicing dentistry in an HPSA, do the most good, and see how it goes.”’

After their year ends, most of the scholarship winners continue to practice in an HPSA or a community health clinic, or provide discounted or free treatments to underinsured patients, Anderson said.

“They demonstrate that you can have a very fulfilling life and lucrative career in an economically disadvantaged area—and you can make a really big difference,” said Anderson. “They are inspirations for others, showing that practicing in an HPSA really is an option.”

Wen Zhou, DMD (DEN ’23), saw that example up close as a dental student when he volunteered on his weekends in Youngstown and other nearby cities to perform root canals and fillings with fellow members of the Greater Cleveland Dental Society.

His service contributed to him winning the 2022 Community Commitment Award from the Delta Dental Foundation. He served a year at Akron Family Dental, a safety-net clinic serving a diverse patient population.

In Akron, it quickly became apparent that many of Zhou’s “patients had not seen a dentist for many years—or never at all,” he said.

According to the U.S. Centers for Disease Control and Prevention, the likelihood of U.S. adults to have visited a dentist in the last year decreases the lower the level of their family income, in both urban and rural areas.

“Some patients face so many challenges,” said Zhou. “Few dental practices accept Medicaid, so patients must often travel far for treatment. Many don’t have a personal car, and have a job and family duties, so they don’t get treated when problems come up.”

To ensure each office visit has the most benefit to each patient, Zhou—who hails from China and has advanced degrees in medicine and biomedical research—tailors care to each person who sits in his chair, even helping them establish a regular dental routine.

Moreover, Zhou also eases patient apprehension by engaging them in treatment decisions. This fosters trust, builds relationships and encourages return visits, Zhou said.

“I try to maintain as many teeth as possible—many patients are surprised to learn their pain can be eased in other ways [than extraction]. It’s better for their long-term health and makes them happier,” said Zhou. “When a patient says I helped them, it’s more rewarding than anything else.”

Zhou now serves on the board of the Greater Cleveland Dental Society and recruits dental school students to participate in service activities: “It shows them that when patients trust us and participate, it makes each of us a better dentist.”

Zhou is practicing at a private provider in Westlake that offers comprehensive dentistry, regardless of a client’s insurance coverage. Many of his patients from Akron now seek treatment at the clinic, despite the hour drive, given their preference for Zhou’s approach.

“It’s simple,” he said. “Every person deserves good, competent care.”