When Northwest Dentistry received the following letter from pre-dental student Kelsey Utech* via the U of M’s Dr. David Born**, we shared it with several MDA members who have a special interest in this area. From their responses we learned that barriers to care come at all levels of the process even as so many of the state’s practitioners are more than willing to help. We asked prosthodontist Walter S. Warpeha, Jr.† if he would respond to Kelsey’s letter from his practice experience and understanding of the subject via his specialty, which he has graciously done. And so another conversation has started with someone asking a question and finding the initial answer unsatisfying. And in the process, we gather more than the information we work toward finding.
To the Editors,
As the daughter of the director of a battered women’s shelter, I am particularly sensitive to the many issues faced by women who are victims of domestic violence. As a pre- dental student, I was particularly interested in two issues these women face: accessing dental services for oral health problems that may have been built up as a result of isolation (a common characteristic of abused women), and trauma to their teeth because of physical abuse. In collaboration with Dr. David Born, I designed a study focused on access to oral health services for clients of battered women’s shelters in Minnesota.
After obtaining IRB approval for working with human subjects, we launched an online survey of some 34 women’s shelter directors. It is important to note that the directors are typically highly motivated and sensitive individuals who are constantly faced with stressful and sensitive challenges. In my experience, they are very concerned about the health and welfare of their clients. Consequently, the results of the survey were quite unexpected. Despite repeated attempts to obtain a statistically useful sample, we were successful in generating only four responses (about 12%). Typically, such surveys obtain response rates between 20 and 70 percent. Bewildered by our low response rate, we conducted a second inquiry aimed at determining why the directors were not responding.
Six (20%) of the non-respondents wrote in (via Survey Monkey) to explain their lack of participation. The combination of their explanations and the responses to the original questionnaire allow us to offer the following information.
The directors of the women’s shelters who chose not to respond did so because they felt either a lack of knowledge about oral health in general or a lack of specific knowledge about the oral health status of their clients. Furthermore, they reported they simply did not have enough time to complete the survey (about a 15 minute task). The responses we received noted a lack of access to dental care for women in battered women’s shelters. We are unable to generalize from such a small sample, but geographic distance from dental offices was reported to be a barrier to care, as was the fact that few dentists could be found who would accept public program patients Clients’ personal funds were also cited as reason care was not obtained. Frequently, abusive partners control financial resources, thereby preventing independent action (including dental visits) by the victim.
Three of the four responding directors noted that a critical factor related to children’s dental health was insufficient knowledge about oral health on the part of sheltered mothers and the fact that many “mothers don’t see dental care as important for children six or younger”.
When beginning this study, a literature search revealed virtually no articles dealing with women’s shelters and access to dental care. While we cannot draw any conclusions from such a small sampling of views, it is nonetheless clear that more research into this problem is warranted. Also worthy of note is the fact that all responding directors expressed an interest in attending an educational course addressing dental care for victims of domestic abuse and finding ways to help them navigate the dental health care system.
University of Minnesota
Thanks for you letter about an ongoing problem in health care — accessibility to care for certain patient groups. Certainly women escaping an abuse relationship have special needs, with obstacles in obtaining dentistry being one of many. The return to an appearance and function of good dental health can repair both physical and psychological damage, thereby helping women regain self-esteem and begin to rebuild their lives.
To address the specifics of your letter and the surprising results of your survey, I would advise the directors who felt they did not have enough information on the subject as follows.
First, there are several ways that dentistry can be accessed through public programs. Dental services may be available through state programs like Minnesota Health Care or the Minnesota Crime Victims Reparations Board. These programs are accessible to women who fulfill set eligibility requirements. Unfortunately, these programs have limits, and they leave many without the kind of comprehensive care they need.
A testament to the generosity of Minnesota dentists is the large amount of donated dentistry they continue to supply, giving where they not only volunteer their time and expertise but often the expense of staff, equipment, and supplies. The Minnesota Dental Association website has an extensive listing of clinics offering no cost or low cost care. Donated Dental Services, a national program that partners with the Minnesota Dental Association, recently reported that 260 dentists and 75 dental labs have provided $1.3 million of free dental services to 450 Minnesota patients since its inception.
There are also national groups who have recognized the special needs of battered women. The American Academy of Facial and Plastic Reconstructive Surgery “Face to Face” program estimates that 75% of women in abusive relationships receive battery to the face and head area. Understandably, dental damage is sustained by many of those same women. Two national dental groups with active Minnesota members offer pro bono care to battered women with traumatic dental injuries. Each requires that the woman has been out of the abusive relationship for a year. As well, the prospective patient needs to be assessed by a professional counselor to verify psychological healing is underway.
The American Academy of Cosmetic Dentistry has a program called “Give Back a Smile”, which provides restorative and cosmetic dentistry in the smile-zone to qualified survivors. This program has restored the damaged smiles of more than 1,100 survivors of intimate partner violence since 1999.
A second group, the American College of Prosthodontists, has a slightly different focus. The Minnesota Section of ACP has teamed with the Minnesota Battered Women Coalition and Donated Dental Services on a pilot program to do perhaps more comprehensive dental treatment when an individual has lost teeth, sustained jaw or joint injury, and needs appearance plus functional corrections. This care can be coordinated with the AAFPRS “Face to Face” procedures.
Kelsey, I commend you on your caring commitment and empathy for those less fortunate. These are invaluable qualities for a career in the helping professions. In recognizing those with physical limitations placed on them by circumstances beyond their control, individuals such as you display the attributes found in the finest dental care givers.
Walter S. Warpeha, D.D.S., M.S.D.
*Ms. Utech is a senior in the Nutritional Science major at the University of Minnesota, graduating in spring 2012. Email is firstname.lastname@example.org
**Dr. Born is Professor, Division of Community Oral Health, Department of Primary Dental Care, University of Minnesota School of Dentistry, Minneapolis, Minnesota 55455. Email is email@example.com
†Dr. Warpeha is a board certified prosthodontist in private practice in Minneapolis, Minnesota. He is a panel member of the Cleft Palate Clinics at the University of Minnesota School of Dentistryand Children’s Hospital/ Minneapolis, and is a prosthodontic consultant to the Minnesota State Board of Dentistry. Email is firstname.lastname@example.org