Alum Champions Dental Public Health

Katie Conklin (SPH’23) has long taken dental care for granted. Conklin grew up in the dental industry, and it wasn’t until she completed training as a dental hygienist herself and volunteered to screen kindergarten children at a rural health center that she realized not every child was getting regular Oral health care.

As a hygienist in a private dental practice in Davis, California, Conklin treated many professors at the state university. They have health insurance and are well taken care of, she said. That's in stark contrast to the lack of resources at Stockton and other health clinics in the San Joaquin Valley where she volunteers. Many of the kindergarten students she screens are the children of immigrant farm workers with limited incomes.

Some of these families have to drive four to five hours to take their children to the dentist, Conklin said. “It really opened my eyes. We would go out and screen kids in kindergarten and we could see their [younger] Brothers and sisters are doing better because we have education and fluoride and all these things that you can do to prevent oral health diseases.i just fell in love [the program]”.

After more than a decade of volunteering part-time, Conklin moved full-time into dental public health with the hope of expanding access to children’s oral health services on a larger scale.

As a student in the School of Public Health's Master of Public Health (MPH) program (now an online MPH program), Conklin completed internships at the California Oral Health Technical Assistance Center (COHTAC) at UCSF (UCSF) and the California Department of Public Health ( CDPH ) Office of Oral Health, to help pilot a program to train county health departments on evidence-based strategies for implementing state-mandated kindergarten oral health assessments in their communities. Conklin said the pilot went well and her internship program became a model for implementing the system in California.

Today, as COHTAC's Program Coordinator, Conklin works with more than 20 counties across the state to assist in the planning, implementation and evaluation of data-driven oral health promotion programs. She also coordinates a postdoctoral grant from the Health Resources and Services Administration (HRSA) called the UCSF Open Smiles Collaborative to increase the number of dentists trained in public health.

Conklin said the biggest challenge facing oral health care is access. Half of California's children are on Medicaid, but few dentists accept Medicaid patients, especially children, she said. Through her work, Conklin works to recruit and train the next generation of pediatric dental public health visionaries and leaders. She spoke with SPH about the often-overlooked connection she has discovered between oral health and public health.


With Katie Conklin (SPH'23)

Can you elaborate a little bit on what you did for the MPH internship program and how it has grown since you graduated?

My project involves implementing a new system in California called Results-Based Accountability (RBA). This is a performance management system adopted by the state through the California Department of Public Health. The Office of Oral Health began piloting the system in four counties in 2019. I worked with the dental director, monitoring director, and the entire county to get them to start understanding the “why” behind the program. [Strengths, Weaknesses, Opportunities, and Threats] Analyze, review their needs assessment, and then work with them to get started [RBA].

I started with one county, and then COHTAC said, 'Wow, this is going so well. We hope to implement your model across the state. So, then I started building the RBA Learning Collaborative.Our first goal is to promote oral health assessment in kindergarten, a law passed in 2005 [mandating that] all children entering [public] Kindergartens are screened. We found that one in two children entering kindergarten already has cavities, and if you think about equity, you find that 25% of untreated cavities belong to vulnerable groups. We really want to be able to target these kids so they can have the best experience possible in school.

Why is it important to support the county in this way?

The data from these screenings should be entered into a statewide repository so we can see it and then we can formulate policy. However, the entire cycle did not happen.There's a lot of turnover, and it's a collaboration between the school district and the local oral health program to oversee it, but the law is non-binding, so it's hard to enforce, and [schools] There are many other priorities. My whole project is trying to do mandatory kindergarten oral health assessments and help counties get the data, put it into a database, and understand the laws so they can make changes in their communities.

If a child is diagnosed with tooth decay during a school screening, is there a way for them to contact dental services?

Yes, there is, that's the whole reason this law is in place, to make sure every child has a dental home and not allow insurance to be a barrier to care. We work closely with Medicaid to help ensure children receive benefits, find a dentist and receive follow-up care. This is an important part of our job.

You are also involved in the UCSF Open Smiles Collaborative, HRSA's postdoctoral training grant program training dentist dentistry public health. While MPH and MD programs have existed side by side for some time, is this a relatively new option for dentists?

A dental public health resident teaches children about good oral hygiene through the Smile Keepers program. Photo: Katie Conklin

This is. Dentists typically earn an MBA, a business degree. We are working to bring them into public health. It's exciting and it's working -[of] More of the graduating dental residents are now holding leadership positions in oral health offices and local health jurisdictions, and more are entering [federal] Health centers started working, which reduced waiting times and enabled health centers to treat more serious cases without having to refer them. One of the purposes of our grant is to build a pipeline of dentists into the field of dental public health, as there is not enough awareness of dental public health as a profession and the future employment opportunities it offers.

What types of public health work do dental residents perform as part of the Open Smiles Collaborative?

Another purpose of the grant is to have students work with federally qualified medical centers, so we train medical centers on how to integrate medical and dental care. New mothers typically take their babies to 8 to 10 medical appointments in the first year, but children don't see a dentist until they are 5 years old. They already have cavities.We want them to feel happy when they visit the dentist for the first time, so what can we do with MDI? [Medical Dental Integration] We can apply fluoride varnish to children's teeth during their dental appointments, which can reduce their chances of developing cavities.Because you get your first teeth at six months old, we want to start talking to parents about their oral health [early]. This is very important.

Patients receive dental care through the Smile Keeper program.

One of our other programs is a school-based program. Imagine a school dental office in the foothills of Yosemite. The nearest dentist is an hour away, down a winding road. We have a team called the Smile Keepers who drive out there every Wednesday morning. They have a whole suite of equipment – dental chairs, X-ray machines, computers – so the hygienists can take X-rays, upload them, clean them, sealants, fluoride varnish. About 60% of children's needs can be met in school.So needy children [advanced] care and we can refer them out. This is the beautiful relationship between the school and the Smile Keepers.

Recently, we published a poster on our website [the American Public Health Association annual meeting] According to entrance and exit surveys, dental residents' attitudes and confidence in treating diverse patient populations improved while participating in the Open Smiles Collaborative.

What advice do you have for MPH students interested in oral public health? Are there opportunities to get involved outside of your job as a dentist or hygienist?

We can do a lot through policy [such as] Advocate for and express the importance of oral health to those who do not receive services. [Tooth decay] is the most common chronic disease in the world, yet it is ignored, so [we are] Try to change this mindset to a prevention mindset. BU gave me the skills and confidence to grow. Every week I learn something new that I can take back to my internship. If you want to get an MPH one day, go for it.

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