Access to dental treatment and preventive dental care is not equally available to all members of society. Studies have shown that youths from low-income families have a higher risk of caries,1 are the most frequent users of dental services for pain relief,2 and access general dental practices less than those living in wealthier wards.3 The Urban Institute in Washington investigated the level of preventive care received by children in low-income families without health insurance and found that more than half of these children had no preventive dental care visits.4
We believe that something as vital as adequate dental care should be available to all young people—regardless of their ability to pay for these services or where they live. One study5 found that public dental care programs for children equalized utilization in smaller villages and urban centres, and strongly contributed to improving children’s oral health in those regions. As this study shows, access to care can help reduce inequalities in dental health. These findings set a strong precedent for advocating free dental care for the underprivileged.
Youth Helping Youth
In 2004, a group of University of Alberta dental and medical students recognized the need for inner city health services and created the Student Health Initiative for the Needs of Edmonton (SHINE) clinic. With its motto of “youth helping youth,” the clinic brought together students from dentistry, medicine, nursing, social work and nutrition to provide free clinical health services to young people between the ages of 15 and 25. The clinic is located in the Boyle McCauley Health Centre, a community owned and operated health care centre treating patients “challenged by multiple barriers, including poverty, homelessness, mental health, addictions, and social isolation.”
SHINE Dentistry operates as a separate entity through the efforts of volunteer dental students and community dentist preceptors who supervise the students throughout the treatment of a patient. The SHINE Dentistry clinical operations are funded through corporate sponsorship, donations of equipment and fundraising activities. Recently, using funds generated from the SHINE Dentistry annual charity golf tournament, the Boyle McCauley Health Centre was able to renovate its dental facilities and added another operatory, radiograph units in 3 operatories, new dental chairs, a panoramic machine, hosing and a sterilization unit.
The clinic provides such essential dental services as scaling and root planing, oral hygiene instruction, basic restorative procedures, extractions and consultations. Patients who need more complex work, such as treatments that require multiple appointments, are referred to other sources. SHINE Dentistry also has a mandate for public education, and distributes materials about the oral manifestations of cocaine and methamphetamine use as well as information about oral piercings and smoking.
What Do the Patients Say?
SHINE Dentistry students, under the supervision of a University of Alberta faculty member, undertook an evaluation project to assess the patient demographics at the clinic along with the clinic set-up, logistics and perceived value. All patients who attended the dental clinic between January 2007 and March 2009 were asked to complete a written, anonymous, 15-question survey on site. Consent and participation were voluntary; in all, 62 of 106 surveys were completed, for a return rate of 58% (Box 1).
Among the key results, more than half the patients arrived at the clinic via public transportation or walking, indicating that the clinic’s location in the heart of the inner city is convenient for those living nearby. In terms of convenient times to attend the clinic, 89% (54 of 61 replies) said that Saturday afternoon was the best time. Because SHINE Dentistry currently operates exclusively on Saturdays, this seems to benefit both the vast majority of patients and the dental students who can volunteer their time on weekends to provide care.
In assessing how comfortable patients felt with being treated by student volunteers, 58 of 61 participants (95%) were confident with the treatment they received. Patients were also questioned about what they would do if SHINE Dentistry was not available to them. The most common replies were “visit a regular dentist” (44% or 27/61),“see a physician for an emergency” (23% or 14/61) or “do nothing” (25% or 15/61).
We believe that the results of this survey are very encouraging as they show that patient satisfaction with the clinic is very high. Because many patients who attend the SHINE clinic would not choose or be able to access a dentist if there was a problem with their teeth, the volunteer students and dentists fulfill a crucial need for dental services in Edmonton’s inner city.
Filling a Gap
SHINE Dentistry began as a vision by dental students interested in helping fellow youths and has evolved into a fully functioning dental clinic which provides an opportunity for dental students to contribute to the community and to improve their skills as clinicians. Over the years, the success of the clinic has shown that a student-operated dental clinic will be accepted by the community. Since 2004, the project has grown considerably. In 2009, SHINE Dentistry was open for 25 sessions and logged 113 volunteer hours of dentists and students. As of January 2010, 30 preceptors and 87 students volunteered regularly at the clinic, compared to 5 preceptors and 11 students at its inception.
Future plans for SHINE Dentistry include incorporating the experience as part of community service learning for all University of Alberta dental students, not just those who volunteer. The SHINE program also has a goal of generating sufficient funds to expand its hours and services to other age groups.
Support from the community, and collaboration between volunteer students and practitioners, has sustained this valuable initiative. It is important for both students and dental professionals to recognize their roles and responsibilities as health care providers by offering their skills to the community, particularly to those who do not have the resources to obtain dental care privately. In a time when some in society may question the motives and morals of health professionals, the SHINE student-run initiative displays a deep sense of commitment to helping others. Hopefully, this will result in more dental students and dental professionals stepping forward to help improve the oral health of underprivileged members of society.
- Hjern A, Grindefjord M, Sundberg H, Rosen M. Social inequality in oral health and use of dental care in Sweden. Community Dent Oral Epidemiol. 2001;29(3):167-74.
- Edelstein BL. Disparities in oral health and access to care: findings of national surveys. Ambul Pediatr. 2002;2(2 Suppl):141-7.
- Maunder P, Landes DP, Steen N. The equity of access to primary dental care for children in the North East of England. Community Dent Health. 2006;23(2):116-9.
- Kenney GM, McFeeters JR, Yee JY. Preventive dental care and unmet dental needs among low-income children. Am J Public Health. 2005;95(8):1360-6.
- Pinilla J, González B. Equity in children’s utilization of dental services: effect of a children’s dental care program. Community Dent Health. 2006;23(3):152-7.