By: Jakob Holtzmann

Like many of you, I wasn’t around to witness the destruction brought upon the world in the 1940’s. Like some of you, I wasn’t around to witness the cultural and economic challenges of the 1970’s. But like all of you, I’m currently living in the racially strained, virally catastrophic reality of 2020.

It’s for this reason that I was honored to accept an invitation to write for this special issue of the MDDS Articulator. We are all in this together. No matter your race, ethnicity, political affiliation, or practice experience, we are all bound on the same train steaming into a future that has never seemed so uncertain. The way I see it, as we charge full-steam ahead into 2021, we have two options: one – throw on some shades to dim the daunting reality we face, or two – use our education, our voices, and our votes to conduct this train, leading it to a safer, more prosperous, and more equitable future for everyone.

For the purposes of this article, I’m assuming that we’re all in for choice number two. While our profession won’t be alone as we seek to control the progressive direction of our train1, I hope that I can effectively make the case for how our profession can do our part to set its course.

The Foundation
Before a train’s course can be set, us conductors need to know where we came from, and where we’re headed. Although I’ve already described the future that acts as our final destination, I think it’s important to briefly acknowledge our past and our present.

For centuries, the brutal practice of enslavement and subsequent forms of systemic discrimination have institutionalized racism and put our brothers and sisters of minority populations at a disadvantage ^{2, 3, 4, 5}. The Healthcare system, including the dental profession, have not been immune to the lasting effects of systemic racism.

As I learned from Dr. Bill Bailey and Dr. Deidre Callanan in my first community health class of dental school, social and physical determinants of health are real, consequential, based in scientific study, and responsible for a disturbing strain on our healthcare infrastructure^{6, 7, 8}. More specific to dentistry, as our profession has modernized, strengthening evidence continues to describe the persistence of racial and gender disparity in our dental workforce ^9-13, racially disparate access to oral health services^14-17, and racially disparate health outcomes due to these social and physical determinants of health^{6, 18}. In this broad context, we can’t ignore the challenges that we face as a profession during COVID-19. As a student, I know that graduating dental students all across the country lose sleep over the pitfalls of dental licensure and the weight of student debt^{19, 20}. I know that students like myself, a third-year dental student currently unable to schedule their patients during the pandemic, worry about their underserved patients who are currently unable to receive the dental care they need.

The Advocacy
This is our current reality. And if we truly wish to reach our final destination, we have to advocate like our profession depends on it – because it does. At the same time, we have to advocate like our lives depend on it – because for the most vulnerable and marginalized in our communities, it most certainly does.

Serving Our Communities
All across the country, industries and businesses have felt the devastating economic impacts of COVID-19. Hit especially hard – dentists²¹. And hit even harder still – Federally Qualified Health Clinics (FQHC’s)²². Alongside other clinics that accept Medicaid patients like our University, FQHC’s act as the safety-net clinics that care for the most underserved populations in our communities – which consist mostly of racial and ethnic minority groups²³.

Historically, dental FQHCs’ have been one of the first to be hit during financial recessions through bureaucratic budget cuts^{23, 24}. Facing unprecedented financial hardship during COVID-19, legislators are being forced to consider doing so again through cuts to Medicaid dental benefits, cuts to public health departments, and cuts to the Children’s Health Insurance Program – a program expected to serve over 67,000 children this year²⁵.

So first, as I highlight the recent incredible advocacy efforts of the Colorado Dental Association to protect a majority of Colorado’s Adult Medicaid dental benefits for this upcoming year²⁶, I want to stress that we need to build on their progress. Even before the pandemic, time and time again, our government failed to adequately invest in public health²⁷. So, as we advocate for the preservation of the historic government resources that fund oral healthcare, we also need to elevate the conversations surrounding the future of funding for public health initiatives – and therefore our consequential investment in healthcare equity.

Additionally, if we reasonably desire to provide more care for underserved populations, we need to incentivize such service by dentists. If Medicaid reimbursement fails to cover a private office’s overhead, how can an experienced dentist be expected to serve all members of their community? And how can a new dental graduate $280,000 in debt²⁰ even consider it? Together, we need to advocate for further expansion of the Medicaid dental benefits that have already provided nearly 10 million Americans dental coverage since the passage of the Affordable Care Act²⁷, and advocate for a sustainable increase in Medicaid dental reimbursement rates²⁸.

More abstract, but increasingly relevant during a pandemic that has left us with more questions than answers, is it time to advocate for the addition of vaccine administration into an expanded scope of dental practice?²⁹ Is it time to consider advocating for the qualification of adult dental services as an essential health benefit under the Affordable Care Act?³⁰

The Future
Working in concert with these evidence-based avenues to reduce barriers to care and enable dental professionals to more effectively serve their communities, we also need to commit to advocating for evidence-based policies that seek to diversify our dental pipeline^31-33, enact student debt reform²⁰, and increase funding for loan repayment programs³³ – because building a better profession requires a commitment to recruiting, training, and funding those who truly desire to serve the communities that need it most³³. Efforts by the Office of Diversity at the University of Colorado School of Dental Medicine and by various students at the school exemplify our future provider’s commitment to these initiatives and will serve as progress to be built upon by future generations.

The TLDR
I know I’m young and inexperienced. I know some of these ideas seem less practical than others, and I know that change isn’t made overnight after some dental student writes about it – but I know that it’s possible.

Aboard our train into the future (having opted for option number two), conversations like this one will be critical in ensuring that we have a say in where we end up. Through our advocacy efforts, our votes, and our commitment to the future – we can make a difference. I look forward to joining you all on our pursuit of a tomorrow that’s more healthy, sustainable, and equitable than today, and promise that I’ll keep advocating for it alongside you until we get there.

As a former University of Denver Pioneer and current third-year dental student at CU, Jake Holtzmann conducts public health research with mentor Dr. Tamanna Tiwari, helps lead COVID-19 volunteer efforts at the dental school, and currently serves in several capacities within the American Student Dental Association (ASDA). In one of his roles, a Legislative Coordinator for the Council on Advocacy, Jake employs his passions for public health, research, and organized dentistry to coordinate advocacy efforts by dental schools in Colorado, Texas, Oklahoma, Nebraska, Missouri, Iowa, and Minnesota. A Colorado native, Jake loves to ski, travel, and visit breweries in his free time.