Taking On A Crisis In D.C. — Oral Health In Underserved Communities

Posted in GUMC Stories

Jan. 23, 2016–In January 2007, Deamonte Driver, a 12-year-old African-American boy in Maryland, came home from school complaining about a headache, caused by an infected tooth. Less than two months later, Driver died from complications related to the infection.

Lucile Adams-Campbell, PhD, associate dean of community health and outreach and associate director of minority health and health disparities research at Georgetown Lombardi Comprehensive Cancer Center, remains haunted by Driver’s death. “No one should die because of lack of access or knowledge about oral health and dental care,” she says.

Disparity in health care for African-Americans is an acknowledged issue in the U.S., and is especially recognized in some cities, such as the nation’s capital. But few may realize that disparities in dental care represent a crisis in Washington — perhaps the worst example of oral health disparity in the nation.

Former Surgeon General David Satcher, MD, described dental and oral disease as “a silent epidemic in America,” but the D.C. area has top billing in one aspect of that blight, Adams-Campbell says. Based on the information from the D.C. Cancer Registry, the District of Columbia has one of the highest incidence and lowest survival rates of oral cancer in the U.S.

Now, she is taking on oral health disparities in D.C., aided by a $1.2 million grant from the George E. Richmond Foundation of Chicago. After learning that the foundation was interested in oral health, Adams-Campbell put together a comprehensive plan to address the issue from the “disparities perspective,” informed by  her record of research on health disparities, including her work on breast cancer in African-American women.

Engaging with the communities in need

Adams-Campbell and her team will undertake a set of research and community outreach projects led by the Office of Minority Health & Health Disparities Research as part of Georgetown University’s Health Disparities Initiative.

The goal of the project is to conduct a community-based assessment of oral health needs, barriers, knowledge, attitudes and behaviors in medically and dentally underserved areas in D.C. This will include a survey of 800 residents, ages 18-74, as well as outreach to public housing residences and churches to educate the community about the importance of dental care.

Adams-Campbell is especially focused on oral cancer and will test her hypothesis that poor oral health conditions and oral infectious diseases — including HPV and HIV — cause the oral health disparities seen in D.C.

The work will be innovative because Adams-Campbell will take it right to the communities in need, engaging them in an approach that encourages their participation in addressing the reasons for the disparities and the need for intervention in high-risk communities.

Among other benefits to the community, the project will create a comprehensive manual that identifies dental and oral care providers, clinics and resources for the underserved, implement an oral health awareness program and offer dental health screenings and referrals.

The project will also establish community research pilot programs, including an oral biorepository from saliva samples. The repository presents the opportunity to conduct future research on the oral microbiome for diagnostic and preventive purposes to assess HPV and other infectious diseases, Adams-Campbell says. “Precision medicine is the direction of all clinical medicine and begins with getting individuals, particularly disparate populations, to agree to give biospecimens as the first and key step toward individualized treatment.”

Examine the policies governing oral health

Perhaps the most progressive element of the project is the medical-legal partnership that will be developed between Office of Minority Health & Health Disparities Research and the O’Neill Institute for National and Global Health Law at Georgetown Law, Adams-Campbell says.

“I am pleased that we are able to partner with the Georgetown Law Center,” she says. “This will enable us to determine how effective the existing policies relative to oral health are among underserved communities. 

“So, by working in partnership with community leaders and residents, we will be able to better understand the legal and oral needs of the community,” Adams-Campbell says. “Then we can determine whether the existing policies work or whether new policies and practices are warranted.”

Renee Twombly
GUMC Communications