Greater Than the Sum

Compassion is an inherent and fundamental attribute of the practice of dentistry. However, with the pressures of ever changing treatment technologies, of imaging, of health records, of billing, of infection control, and of practice management, this fundamental virtue may often go unnoticed.

Though most dentists provide care in relative isolation, when they join together in groups or as part of the local dental society, their compassionate sense comes to the fore and is amplified beyond the boundaries of the traditional practice setting. Through this larger lens dentists view themselves and their colleagues as part of the larger health-care community, with a greater willingness to address not only the needs of their patients and families but also of the communities of which they are a part.

By joining with other professions, dental professionals become integral to the ability to address the root causes of many health conditions. This engagement with others reflects the value of compassion and motivated collective action. It enhances a sense of self -worth and it has a positive impact on the health of individuals and the public at large.

When dental students come into the field many possess a desire to help people and make a difference, but this heartfelt motivation can get lost in the rat race of daily office and practice management. Expressions of compassionate patient care or service inside and outside the office setting mostly go unheralded. When dentists do choose to care for socio-economically, culturally, or physically disadvantaged patients, the cacophony of criticism about the failures of the system tends to obscure and render these sincere efforts as invisible.

This edition of the Journal entitled Greater Than the Sum is intended to shine a light on the power of the collective by dentists who, with even small steps taken together, can effect system change. The relatively recent examples described in the following articles demonstrate the exceptional power of dental providers overcoming historical isolation by working collaboratively with other dentists, working within a larger group such as the local component dental society and with the California Dental Association, working across professional disciplines, and working with others with a common mission, such as schools, churches, policymakers, and health departments.

In the first article, Dr Huong Le and Dr Ariane Terlet describe the history of CDA Cares. This program emerged as an extraordinary manifestation of compassionate service to those left without a source of care when the state budget deficit led to the elimination of the “optional” Medi-Cal dental benefit for adults. An initiative of the CDA Foundation, the program has served thousands with needed dental care since 2009. The unmet need made evident by the CDA Cares program poignantly underscores the need for dentistry’s critical advocacy role. In this case, it contributed to re-instating the adult dental program for millions of adult Californians.

In the second article, the key role of dentistry in the passage of the historic sugar-sweetened beverage tax in Oakland is described by Dr Jared Fine and colleagues. From its inception, the “soda tax” campaign was an attempt to alter the disease trajectory of diabetes, obesity and dental caries through community-wide education and advocacy. This effort, in a sense, reintegrated the oral cavity with the rest of the body as well as with the body politic. It underscores the opportunity for medical-dental integration and collaboration at the policy level.

In the third article, Dr Kristin Hoeft and colleagues give a window into the strengths of creating a Community of Practice through the Alameda County Healthy Teeth Healthy Communities Program, a Local Dental Pilot Project funded by the Dental Transformation Initiative. This article reveals how dentists, bound by a shared professional discipline and sense of individual and collective service, thrived within a framework and infrastructure of learning together and supporting each other. Aiming to meet the oral health needs of children enrolled in Medi-Cal by reducing the barriers to dental care, the program offered educational and referral opportunities for participating providers. It involved a new team member, the Community Dental Care Coordinator, who helped connect the dots in care and support both patients and dentists. Dentists working in collaboration with the Community Dental Care Coordinators and each other experienced a sense of shared purpose and responsibility.

Taken as a whole, the three articles describe an alternative to the extant general pattern of isolation and fragmentation. They are examples of dentists developing ways to collaborate, to identify gaps in the dental care systems and to organize to fill the gaps, to redefine their professional identity, to become integral players in public policy, and to effect system change: to be greater than the sum of the parts.