You:
Hi, Dr. Owens. Can you hear me? I can hear you?

Participant:
Yes.

You:
Thank you so much for taking the time to speak with me.

Participant:
Of course. Pleasure.

You:
I really admire your work in both pediatrics and dentistry, especially your focus on increasing access to preventative oral healthcare for underserved communities. Before we dive into some specific questions, I want to start by learning more about your background and what inspired your career path.

Participant:
I knew that I wanted to work in either the health or education realm, and my thought was: you can't get education unless you're healthy, and you can't get healthy unless you're educated. But I was in an accident in college and was told I had been hurt in a way that meant I couldn’t do some of the pre-med work for health, so I went into public health for a while.
I was in Tanzania during the first Bush Gulf War, when USAID and the State Department had pulled out. There was a bomb threat made against the white person on the island — and I was that person. My colleagues helped me move somewhere safer, and that same day a woman came to the door and asked me in Swahili, “Can you help me with afya?”
The word afya means both “health” and “medicine,” and I realized I couldn’t actually help her. I could explain why her child was sick, I could talk about the health system structure that limited her access to care, but I couldn’t do anything. That was the moment I knew I needed to go back and earn a doctoral-level degree.
I debated between a theoretical doctorate and a clinical degree, and ultimately chose medicine. I thought I would go into family practice and return to international work.
I was doing research on asthma disparities in Washington, D.C., and I came across the statistic that oral health problems were five times as common as asthma and seven times as common as hay fever. And I thought, “That doesn’t make sense. Pediatricians don’t work with oral health. How are we, the doctors trying to prevent diabetes or infections, not preventing the most common chronic condition of childhood?”
That was the moment the light went on, and I switched into the world of oral health — specifically, how primary care medicine could help with prevention.

You:
Right, that makes a lot of sense, since a lot of people don’t understand the connection between overall healthcare and the impact of oral health. It seems like two separate things even though they’re interconnected.

Participant:
Right. And this goes back more than 100 years. Medicine and dentistry were originally connected, and when the split happened, we’ve been trying to catch up ever since.
A lot of my work focuses on oral health disparities in children from low-income and under-resourced backgrounds. Access is a huge issue, especially for families on Medicaid.

You:
So in your experience, what are the main barriers preventing children from getting the dental care they need, besides socioeconomic background?

Participant:
It’s important to tease out what we mean by socioeconomic background. There’s the issue of self-efficacy — if everyone in your family has lost their teeth, you don’t necessarily know there’s another outcome. There’s lack of early prevention. There’s lack of access. There’s dental anxiety in parents who had painful procedures themselves. There’s the family burden of transportation, time off work, and cost. And there’s the broader structure: state policies, insurance barriers, lack of fluoridated water, and community-level factors.
So it's not just the child in the dental chair — it’s the family, the community, the policies, and the history surrounding them.

You:
I feel like so much comes back to education.

Participant:
Yes — and not just educating the child, but also the parent and the grandparent. Sometimes the grandparent is the one buying juice, or caring for the child all day, or calming them with sweets. If we don’t reach all three generations, we’re not getting to the root of the problem.

You:
Do you primarily work with Medicaid patients?

Participant:
Yes. I used to work in a university practice, but I moved to a medical practice because I felt I could make more of a difference.

You:
How do you think Medicaid coverage impacts access to dental services? Do you see any gaps in coverage?

Participant:
Yes — reimbursement is a huge part of the problem. The dental system is built around private practice, and Medicaid reimbursement rates simply aren’t livable for many dentists. On top of that, the paperwork is a burden. One thing medical providers can do is advocate for better reimbursement, because when dentists advocate for it, it sounds self-serving. When we advocate, it's clearly for the health of our patients.
Another piece — slightly controversial — is expanding the types of providers allowed to deliver preventative oral care. If we had more auxiliary providers, it would help distribute the workload and reduce cost barriers.

You:
Have you seen Medicaid dental benefits improve over time?

Participant:
There have been improvements in certain states — Maryland, Massachusetts — and in some places where Medicaid expansion happened under the Affordable Care Act. But there is still no state that I would call the gold standard.
Where improvements have happened, it’s usually because there is strong integration between medical, dental, nursing, WIC, childcare, and public health programs. That’s why I use the term “oral health integration” rather than “medical-dental integration.” It needs to be broader than just two professions.
That makes sense. I was also going to ask about policy — since you’ve worked on advisory boards, what policy changes do you think would have the most impact on improving dental access for Medicaid recipients?

Participant:
If we’re thinking big, I would say:
Increase reimbursement rates so dentists can sustainably treat Medicaid patients.
Broaden licensure pathways so multiple levels of oral health providers can deliver prevention and basic care.
Embed dental hygienists in pediatric practices so prevention starts early and transitions into dental homes are easier.
We know it saves money — about $580 per child in the first five years if prevention starts early. Kids who get early varnish and risk assessments are less likely to misbehave in the chair later, less likely to need expensive procedures, and more likely to stay in care.
Another big one — not glamorous, but critical — is electronic health record integration between medicine and dentistry. Right now the systems don’t talk to each other. That makes referrals harder and coordination weaker.

You:
So technology could fix a big part of the access issue.

Participant:
Absolutely. Even simple things like making sure providers can see if varnish was already applied. We’ve shown that multiple varnish applications per year are safe and beneficial, but some dentists refuse to apply it if they know the pediatrician already did. Better shared records would remove that barrier.

You:
Circling back to demographics — is there a specific minority group in your area that struggles most with access?

Participant:
In my area, children from Black/African American families have lower rates of dental visits. But interestingly, the lowest rates of all are among children from Chinese immigrant families. We’ve been doing education with grandparents in that community because they are often the primary caregivers.
With Black families, the distrust of the medical system and the history of racism in healthcare plays a major role. I’m part of a San Francisco collaborative with three racial/ethnic task forces, and we’ve had success increasing fluoride varnish through community-led work — not top-down messaging.
And remember: children see their pediatrician up to 10 times before they ever see a dentist. That’s why we target prevention in primary care. By the time some kids reach a dentist, they already have cavities.

You:
Are you working on any current projects related to this?

Participant:
Yes — I’m part of a large collaborative in San Francisco called CavityFree SF, which includes early childhood education, public schools, medical clinics, dental programs, and community groups.
I am also finishing a research project in Oregon studying whether making dental care more standardized — less dependent on individual judgment — reduces disparities. The papers aren’t published yet, but I’m excited about the results.
Another project is training dental public health residents and pediatric dental residents on oral health integration and quality improvement. We can’t change how many dentists the system hires, but we can reduce no-show rates, improve follow-ups, and make every appointment more effective.

You:
That’s really interesting. Do you have any advice for people who want to help improve oral health education in vulnerable communities?

Participant:
Yes — don’t forget about water fluoridation advocacy. It has one of the highest returns on investment of any public health intervention. It’s safe and effective, and protects the children who have the least access to dental care. But misinformation spreads more easily than good research, and that has created backlash.
We already know that children from Black, African American, and Latinx families are more likely to drink bottled water instead of tap water — and they’re also the most likely to experience oral disease. Without fluoridated tap water, we widen that inequity.
And one more thing — when you control for socioeconomic status and insurance, Hispanic children actually do better than expected in dental access. That’s called the immigrant paradox. It reminds us that culture, not just income, shapes health behavior.

You:
Thank you for sharing your insights today. I learned so much from this conversation.

Participant:
I’m really glad you’re working on this. Oral health is still treated as a silent epidemic, even though it’s the most common chronic disease of childhood. Most policymakers don’t experience it firsthand, so they don’t think it’s urgent. That’s why your voice matters.

You:
Thank you — I’m a rising senior, and I want to write a publication focused on Medicaid and oral health because I feel like it’s overlooked.

Participant:
That’s fantastic. We need more people entering this field who understand the policy side, the equity side, and the human side. Keep going — you’re doing important work