NIDCR Oral Health Disparities and Inequities Research Think Tank Summary

Date of Event:

Point of Contact

Hiroko Iida, D.D.S., M.P.H.
Director
Oral Health Disparities and Inequities Program
NIDCR: (301) 594-7404

Background and Objectives

Despite considerable advances in the science and practice of preventing dental caries over the last 20 years, progress toward reducing dental caries disparities (caries experience, burden, and access to evidence-based prevention and management) among socioeconomic disadvantaged populations as well as underserved racial and ethnic groups has been inconsistent and limited. The objective of the Oral Health Disparities and Inequities Research Think Tank was to bring experts of oral health disparities and inequities (OHDI) research to seek inputs on gaps and opportunities, and data frameworks in OHDI research to inform future NIDCR Extramural Program activities. A white paper is planned that will summarize round table discussions on OHDI research and data frameworks to stimulate cross-sector, cross-disciplinary innovation for research to advance oral health equity in America.

Key Themes

• How can NIDCR support research to increase the uptake of evidence-based dental caries prevention strategies to reduce OHDI?
• How can NIDCR foster scientific knowledge that informs policies and practices to advance population oral health goals?
• How can research help address key upstream social, political, and/or commercial determinants of health to close population gaps in the prevalence and burden of dental caries and comorbid conditions of dental caries across the lifespan?

Recommendations

Gaps and Challenges

• Past multi-level oral health disparities research has focused primarily on children and early childhood caries (ECC) and short-term intervention efficacy; not much on implementation strategies, OHDI outcomes, long-term or life-course impact of interventions; and has not sufficiently addressed social determinants of health and upstream factors.
• Hard-to-reach populations remain underrepresented in research and underserved in public health caries prevention programs due to various structural barriers to obtain their consent to participate in studies, implement cost-effective workforce models, and coordinate access to care across the healthcare systems. Despite existing effective clinical strategies to prevent caries, evidence on external validity is limited on how they work in different settings, populations, clinical and or social contexts, workforce models, and their combinations.
• There is limited understanding of longitudinal disease trajectories in people with elevated caries experience, how risk factors interact with one another, how they change over the life-course, and how to intervene effectively.
• There is the need for more data/big data with intersectionality and granularity along the span (i.e. downstream to upstream, across the life-course, and longitudinal disease and risk trajectories) to advance research and practice for reducing dental caries disparities and inequities.
• Community-based participatory research is promising to ensure cultural centeredness of interventions, yet community engagement in OHDI research thus far has not been emphasized or supported enough.

Opportunities

• Develop a public health research network and data repository; facilitate data sharing and coordination across studies; test and evaluate alternative interventions and combinations, different sequences and frequencies, different workforce models, and different settings.
• Include individuals from under-studied, under-resourced populations across the lifespan in research, especially those at high risk/experience for caries; include multiple types of recruitment sites; explore opt-in approach to enhance participation of hard-to-reach populations.
• Encourage the use of implementation research methodologies to generate outcomes such as reach of interventions, sustainability, treatment time, feasibility, and effect on OHDI; apply outcomes that assess quantitative and qualitative level of reduction of OHDI.
• Incentivize community leaders to participate in research; engage with target populations early and co-design models of intervention; facilitate innovation in community engagement.
• Gather key partners of OHDI for research (i.e. health departments, providers, insurers, relevant community-based agencies offering services and goods, educators for school-aged population, and other intersectoral representatives) and intentionally make connections to accelerate the translation of research findings to policy changes.
• Include research on the impact of policy changes to inform public policies; evaluate organizational and policy change approaches; advance science of dissemination and communication.
• Test strategies for optimal interprofessional collaboration to address OHDI (e.g. reimbursement, EHR intervention, workforce innovation, use of new technologies, and coordination across settings and lifespan); advance long-lasting, less technique-sensitive strategies/materials for caries prevention and management that can be adapted in various settings.
• Encourage cross-discipline and cross-sector collaborations for collecting standardized data on common risk factors for addressing dental caries and other health conditions to advance whole-person chronic disease prevention strategies; identify compounding effects of caries risk factors and interactions of risk factors across the life course.
• Consider social, political, and commercial determinants of health in OHDI research to include more upstream interventions; apply measures of structural and systemic racism to address racial and ethnic oral health inequities.
• Advance machine learning in health systems; assess use of AI technology for disease monitoring, health surveillance, new data collection methods, and risk assessment.
• Generate high quality observational data (e.g. routinely collected standardized clinical data with diagnostic codes, population-based cohort studies, and capacity of data linkage) to optimize evidence by simulating real-life interventions for oral health inequities; leverage causal thinking and robust analyses in OHDI research with realistic policy reform in mind.
• Promote the use of research tools and resources made available by federal agencies for public use, especially as they relate to the development of rigorous and harmonized measures that can be integrated across research projects (i.e. PhenX).
• Shift focus from surgical treatment of disease to preventive disease management that can be implemented in multiple clinical and non-clinical settings; apply a common risk factor approach in caries prevention and management and promote reimbursement for enabling services such as patient navigation and care coordination; facilitate paradigm shift in oral health financing system through research (e.g. demonstration of cost-effectiveness of health promotion vs. disease management and treatment in short- and long-term).
• Use public-private partnerships to address access to care and workforce issues to meet the diversity of our society and improve outcomes.

Attendees

Julie Baldwin, Ph.D.
Regents’ Professor of Health Sciences
Director of the Center for Health Equity Research
Northern Arizona University

Marco Beltran, Dr.P.H.
Health Lead, Office of Head Start
Administration for Children and Families
U.S. Department of Health and Human Services

Luisa N. Borrell, D.D.S., Ph.D.
Distinguished Professor
Graduate School of Public Health and Health Policy
City University of New York

Natalia Chalmers, D.D.S., M.H.Sc., Ph.D.
Chief Dental Officer
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services

Hawazin Elani, B.D.S., M.Sc., M.M.Sc., Ph.D.
Assistant Professor
Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
Harvard University

Yvonne Owens Ferguson, Ph.D., M.P.H.
Program Leader, Office of Strategic Coordination, The Common Fund
Lead, Community Partnerships to Advance Science for Society (ComPASS)
National Institutes of Health

Margherita Fontana, D.D.S., Ph.D.
Clifford Nelson Endowed Professor and Professor of Dentistry
Director, Global Initiatives Program in Oral and Craniofacial Health
University of Michigan School of Dentistry

Chelsea Fosse, D.M.D., M.P.H.
Director, Research and Policy Center
American Academy of Pediatric Dentistry

David Frisvold, Ph.D.
Associate Professor
Department of Economics, Tippie College of Business
University of Iowa

Melissa C. Green Parker, Ph.D.
Senior Scientific Advisor/Health Scientist Administrator
NIH Office of Disease Prevention

Michelle Henshaw, D.D.S., M.P.H.
Associate Dean of Global and Population Health
Professor of Health Policy and Health Services Research
Boston University Henry M. Goldman School of Dental Medicine

Ashley M. Kranz, Ph.D.
Senior Policy Researcher
RAND Corporation

Jayanth V. Kumar, D.D.S., M.P.H.
Dental Director
California Department of Public Health

Mary L Marazita, Ph.D.
Distinguished Professor and Co-Director, Center for Craniofacial and Dental Genetics
University of Pittsburgh School of Dental Medicine

Molly Martin, M.D., M.A.P.P.
Professor, Pediatrics
Associate Director, Community Engagement, the Center for Dissemination and Implementation Science
University of Illinois Chicago

Christopher Okunseri, B.D.S., M.Sc.
Professor and Director of the Predoctoral Program for Dental Public Health
Marquette University School of Dentistry

Ryan Richard Ruff, Ph.D., M.P.H.
Associate Professor, Department of Epidemiology and Health Promotion
Director, Biostatistics Core, and Director, MS Program in Clinical Research
New York University College of Dentistry and NYU School of Global Public Health

Ankur Singh, Ph.D., M.Sc.
Senior Lecturer and Senior Research Fellow
Melbourne School of Population and Global Health and Melbourne Dental School

Gina Thornton-Evans, D.D.S., M.P.H.
Senior Dental Officer/Team Lead, Surveillance, Investigations, and Research
Director, CDC Dental Public Health Residency Program
Centers for Disease Control and Prevention

Jane A. Weintraub, D.D.S., M.P.H.
Gary Rozier and Chester W. Douglass Distinguished Professor
University of North Carolina Adams School of Dentistry