'A Different Mindset': Profiles in Public Health Dentistry

A passion. A love of caring for other people. For some dentists, a career in public health is more of a calling — a career path motivated purely by a passion for helping people, as it has been for Dr. Vo.

Public health dentistry can assume different forms. The purest definition focuses more on prevention and promoting oral health through organized community efforts. “It is a form of dental practice that serves a community rather than an individual as the patient,” according to the Centers for Disease Control and Prevention. “It is concerned with oral health education of the public, applied dental research, the administration of group dental care programs, and the prevention and control of oral diseases at the community level.”

Even so, most dentists in public health or community settings find themselves more frequently treating patients for disease, rather than preventive measures. In the US, it’s estimated that about three percent of the nation’s more than 6,000 dentists work in public health or dental safety net settings, including health centers, community clinics, health departments, government programs and federal dental services.

“My health center’s concept is to deliver patient-centered care,” said Vo of her facilities in Snohomish County. There are six clinics total: three in Everett, one in Lynnwood, one in Arlington, and another in Edmonds. “We provide coordinated patient care across the health system, meaning a patient comes in to see me, but may also see a medical provider, pharmacy, or behavioral health provider — everything is tied all together,” she said.

“Public health is extremely prepared for different emergencies. I feel like we are looked at under a microscope to ensure we are up to par on standards for everything. We see a lot of patients that come from nursing homes or have nowhere to go. So, we help take care of them.”

Stephen Davis, DDS, is another dentist who started out in the private sector and found he preferred the public model. Although at first, he didn’t even have dentistry on his radar: he originally planned to pursue a career in medicine at Ohio State. It was during a chance encounter with a dental club when something clicked.

“I like to take care of the people around me. I had originally planned to go into medicine and stumbled into a pre-dental club. I did a fake root canal on a plastic tooth,” recalled Davis. “I minored in art, and I like working with my hands. Dentistry has allowed me to do both,” he said.

Fresh out of dental school, Davis went to work in private practice in the Pacific Northwest, but found the volatility and the insurance challenges didn’t align with his career goals. That’s when he spotted an opportunity to move out of the Midwest to the Pacific Northwest and into public health.

Seventeen years later, the rest, as they say, is history.

He looked into initially working with Indian Health Services, but eventually found work with the Yakima Valley Farm Workers Clinic. For the past four years, Davis has overseen dental operations for the clinic, and now splits time each month between clinics in Oregon and Washington. He credits his mentor, Dr. Mark Koday, with contributing to his success in public health.

“When he retired four years ago, I took over his role,” said Davis. “I wanted to do something beyond direct patient care. He involved me in some of the leadership meetings and I was highly involved with onboarding new dentists, as well as working with statewide stakeholders. It’s been a real blessing for me.”

As he approaches 17 years in public health, Davis remains excited about his work and optimistic about the future. His clinic is one of the partners of the new Pacific Northwest University School of Dental Medicine that’s taking shape at the Pacific Northwest University of Health Sciences in the Yakima Valley.

“This is a unique model that will really serve our community,” he said. “The main struggle for all our health centers is that demand outpaces capacity. It’s just a reality of the way the current system is in the US. There is great need, but we are taking care of whole health needs.”

Combining Two Passions

For Ivy F. Lin, DMD, MPH, becoming a public health dentist meant combining two things she is passionate about: dentistry and the environment.

Lin grew up in Montreal, Canada, where the educational system provides a path for some students to skip over undergraduate studies and enter graduate level programs directly. At 18, Lin was dissuaded by her parents from pursuing a career in engineering — their chosen profession — and instead, encouraged her to pursue a more stable career. In considering various professions, she recalled that she liked her own dentist, and shadowed dental students to learn more.

“When I saw the minutiae work that they were doing, I thought that since I pay a lot of attention to detail myself and am very dexterous, I would be happy doing this,” she said.

Lin made the decision to pursue dentistry and went on to graduate from the dental school at McGill University in Montreal. She eventually made her way to the Pacific Northwest to conduct her General Practice Residency at the University of Washington and then to work at the Community Health Center of Snohomish County. Although she treasured the experience, she was troubled by what she felt was a tertiary care approach to a population that would benefit more from primary prevention.

“As I was going through dental school, I learned about people having trouble accessing care. And as I went through practice management courses, something didn’t feel right. That’s why I decided to work in a community clinic at first, where the emphasis is not on production.”

She next turned to Harvard School of Public Health, where she earned her master’s degree in public health and found a new interest in mitigating the effects of healthcare on climate change.

Today, Lin wears multiple professional hats, serving both as the assistant director for General Practice Residency at University of Washington School of Dentistry and continuing to offer direct care to vulnerable populations in various community clinics.

She has also continued her work in addressing climate change and reducing waste and greenhouse gas emissions in the practice of dentistry. Lin founded the UWSOD Climate Action and Sustainability Team, a group of students, faculty and staff who are passionate about climate issues, and organizes events to bring awareness to climate action within the SOD. She also advocates for waste and carbon emissions reduction in dentistry through education in the dental community and serves as the Dental Sustainability Advisor at the Community Health Center of Snohomish County.

“I talk about ways to reduce waste and greenhouse gas emissions in dentistry in my lectures to students and to the healthcare community,” she said. “Interestingly, one of the main avenues for climate action in dentistry also aligns with one of the main goals in public health dentistry in general — prevention. Doing fewer treatments creates less waste and fewer carbon emissions. A promising idea to steer the industry towards more prevention is to organize payment for dental services according to a value-based model rather than a production-focused fee-for-service one.”

Same Supplies, Same Care

Such perceptions just don’t hold up.

“I think a lot of people think that if you go to a public health clinic, you will get subpar treatment,” said Vo. “When I worked in a private office — I do the same steps as I do now in public health. There’s no difference in treatment. The quality of the care is the same — it’s the same supplies, same suppliers,” she said “We are licensed dentists trained to treat patients. We have the same tools, the same training. I have some patients that have private insurance that see me for a second opinion. We take all insurances and treat everybody the same. It just depends on where people come from. We are dentists who chose to work in public health.”

At Yakima Valley Farm Workers Clinic, Davis notes there is an emphasis on providing quality facilities.

“We want to make sure the facilities we have for patients are exceptional. They are beautiful places that reflect the region where they live and work,” said Davis. “I am really proud of the facilities we provide — they are often shocked by what they see when they walk in the door.”

As he sees it, public health dentists impact lives that have no other resource.

“I’m really proud of our emphasis on quality of care for patients,” said Davis. “I always, in my mind, want people to know that access to high quality dental care — or dental care in general — should not be based on patient’s socio-economic status. That’s really our goal.”

'A Bit of a Shock'

The native Washingtonian went east for dental school, graduating from Loyola in Chicago. But as is often the case with those who leave the PNW, its natural beauty eventually pulled him back. Baer and his wife chose to relocate to West Seattle where he found work at a community health center. It was a mix of dentistry — a lot of pediatric clients — working with ADA 2013 Humanitarian of the Year Sherwin Shinn, a mentor to Baer in his early years.

Although he enjoyed his time at the community clinic, he and his wife were starting a family; he thought a private practice experience could provide more financial stability. He eventually purchased a private practice, working first as a solo practitioner and later, with a partner.

“The transition from public health to private practice was also an eye opener, because now I had to be a business person. I saw a much different demographic — people that could afford dentistry, and that was a bit of a shock. People came in with pretty nice teeth,” he said.

Baer would spend 27 years in private practice before selling it — but he wasn’t quite done with being a dentist. As it turned out, he was limited by a five-year non-compete clause preventing him from working within a 10-mile radius of his former practice. But he could work in public health.

His foray back into public health dentistry was more “accidental,” as he describes it. So, he found a new home with Community Health Care in Pierce County, spending nearly five years there, including the height of the COVID-19 pandemic. Eventually, the workload began to take a toll.

“Many of those we saw were people who were desperate and in a lot of pain, and in public health, that’s all day long,” said Baer. “During the pandemic, they created plastic bubbles we had to work in heavy PPE for each patient, with a respirator. All of this had to be changed between each patient. And because of that — the emergencies and hazmat suits all day long — I got burned out. I had to take a break.”

He’s largely retired now, but keeps busy working a day or two for a private practice colleague in an area of dentistry where people can afford it, doing things that you can’t do in public health.

“Restoring people that may have significant dental problems but can afford implants or Invisalign — they can afford the kind of dentistry necessary to restore their mouth back to full function,” said Baer. “ln public health, you can’t do that. There’s no crowns, implants, root canals. You can make dentures, but the rule we had — and I think this still holds — if they were going to have a denture, you had to extract all the teeth and let them heal. It affects a patient’s dignity. In private practice, you can make the entire denture before teeth are extracted. In one day, you can take out teeth and insert dentures,” he said.

A 'Wonderful' Career

“We need a lot more people working in public health,” said Lin. “To anyone considering a career in public health, I’d say, don’t be scared that you don’t have enough experience — it doesn’t have to be a full-time thing.”

She acknowledges the different set of challenges her private practice colleagues face, too, and that many private practice dentists donate hours of uncompensated care whether in their own communities or through organized events like the Seattle/King County Clinic, where she volunteers as a Dental Deputy Director.

“It feels so good giving back to the community — such a strong shot of endorphins. I would encourage everyone to try it out,” she said.

“A lot of our patients have no ability to pay out of pocket. When I did private practice, patients would always follow up for treatment,” said Vo. “Here, we write antibiotics for patients — a tooth breaks and a lot of times they won’t follow up until it’s super painful. By then it’s too late,” she said.

“It’s a different mindset [in public health], and we’re putting out a lot of fires; sometimes patients haven’t been to dentist in 30-40 years. A lot are drug users, so they haven’t taken care of their teeth. I feel for them. It’s a different mentality than working in private practice.”

Baer concurs, acknowledging that public health can be emotionally challenging, but it also has a deeper impact.

“Public health can be a wonderful career. And you truly help people that really need dentistry. It is a wonderful opportunity to really help people.”

“This can be a career that’s really fulfilling,” added Davis. “That’s why I’m here.”

Need to Complement, Not Complete

Even so, there are differences between the public and private health dental models, and that can lead to robust discussions between providers.

Dr. Lin serves as a member of the Snohomish County Dental Society executive committee and aims to give public health dentistry a bigger representation within organized dentistry.

“Public health is kind of a small portion of the dentists in the society. Some of our goals unfortunately clash with those of private practice dentists,” she said. “Big topics of conversation within ADA include protecting dentists’ scope of practice and increasing production, whereas public health dentistry’s priorities are to increase access to care, make dental care more affordable, and promote prevention.

It’s sometimes difficult to not have as many people in the community who can relate to the public health perspective.”

In making the switch from private to public health, Baer said he was initially surprised by how massive the affordability problem is in dentistry.

“It also opened my eyes to the issue of poverty in this country and to gain a better understanding of how incredibly difficult it is to get out of generational poverty. I describe it as a bucket of crabs — when one tries to escape, the others pull it back in,” said Baer. “I really gained a deeper understanding for how incredibly difficult it is to escape that.”

The scope of the problem shouldn’t deter public and private dentists from working together to solve problems, said Davis.

“It doesn’t need to be either/or. I’m fortunate to work with the WSDA Legislative Task Force — a group of diverse dentists working on legislation where we can come together and solve the issues facing our health care system today,” he said.

“We need to complement each other, not compete against one another.”

This article originally appeared in Issue 2, 2024 of the WSDA News magazine.