Thank you, Carmen, for writing such a heartfelt and inspiring article. Your thoughtful exploration of OKCIC’s innovative approach to integrated dental care highlights the power of compassion and culturally competent health care in addressing systemic disparities. It’s a beautiful reminder of the impact that dedication and forward-thinking can have on transforming lives and communities.
By: Carmen Shea Brown, Freelance Journalist
Anyone who doubts that oral health is just as important as systemic health should listen to Monica McKee, Vice President of Allied Services at Oklahoma City Indian Clinic (OKCIC). Now celebrating its 50th year, OKCIC is a 501(c)(3) nonprofit that provides health care to more than 20,000 Native American patients from over 200 federally recognized tribes in central Oklahoma every year. McKee recently hosted a webinar sponsored by the American Institute of Dental Public Health to discuss an innovative concept being implemented at the clinic that I found truly fascinating: training traditional dental hygienists to become Integrated Dental Hygienists (I-RDHs).
A New Approach to Dental Hygiene
Integrated dental hygiene is a new practice that incorporates treating oral health as part of overall systemic health, acknowledging the bidirectional relationship between poor dental health and other conditions including heart disease, diabetes and obesity. Although this practice is applicable to anyone, Oklahoma City Indian Clinic is using I-RDHs specifically to address health disparities among Native Americans (McKee, 2024). After watching this webinar, I was so intrigued that I checked out its website and learned that the clinic also offers counseling, cooking and nutrition classes, optometry and a vast array of holistic services. I believe that Oklahoma City Indian Clinic is the embodiment of what it means to promote health equity by using the I-RDH model to serve Native Americans through preventative services, education, and a collaborative approach that treats the whole person.
A Need to Prioritize Dental Health Within the Native Community
Statistics reveal the importance of treating dental problems in this ethnic group. American Indian/Alaska Native children have the highest incidence of tooth decay among all minorities in the United States. The effect of poor oral health pours over into other areas, as one-third of these children miss school due to tooth pain (Nash & Nagel, 2005). McKee does a great job of explaining how it creates a vicious cycle.
“We’re starting to see more and more science come out about oral health being associated with other chronic diseases,” McKee said. “People with health problems are more likely to have oral health problems. Oral disease is associated with risk-behaviors like tobacco use [and consuming] sugary foods and drinks.”
The Domino Effect of Poor Oral Health
McKee explained how poor oral health creates a domino effect that plays a role in other societal ills like unemployment: adults must take time off work for unplanned dental treatment, either for themselves or their children, and 18% of these adults are reporting that the condition of their teeth has negatively affected their search for a job.
This is a perfect example of how being born into a group that experiences systemic racism and poverty can affect the trajectory of their entire lives, but also how generational practices can develop where people in these groups learn what they consider “normal behavior,” (TEDx Talks, 2020), McKee said these “cultural norms” are what they are trying to turn around. She often hears Native American mothers say, “My mother never went to a dentist, so I never went.”
OKCIC’s Plans for Improving Health Care for Native Americans
With this knowledge in mind, OKCIC conducted a six-month study that found that out of 482 pregnant patients at OKCIC’s women’s health clinic, none had received a dental screening or treatment at that clinic. The dental hygienists were asked to start “recruiting” patients from the women’s clinic to do a dental screening.
“We were able to start merging with our pediatric, our women’s health, and our OB providers, and start having a lot of those conversations with them, collaborating with them, talking about the oral systemic link,” McKee said.
Now they’re taking it a step further by intervening the moment the woman reports a positive pregnancy test.
“We can start tailoring the education to how we need to care for the baby. We can start talking about maybe tongue ties, lip ties or taking care of the gums,” McKee said.
I admire OKCIC’s thinking outside of the box. McKee said they get “buy-in” from providers by finding out where they need help. For instance, they’re now training I-RDHs to do retinal imaging to detect diabetic eye disease.
“We can get portable retinal cameras, and if we can take X-rays, we can take pictures of an eyeball. If we can do this, then why not? That has become our slogan around here. Just why not?” McKee said.
Some may be surprised to know that their pediatrics pilot program was funded by a behavioral health grant. “Our pediatrics team needed assistance with Ace survey administration; the higher the Ace score, the more likely you are to have chronic diseases and poor health outcomes. There are so many resources on how you can implement this in different settings,” McKee said.
This place is where one can see cultural competence in action. OKCIC’s website states that it is “a contractor of the Indian Health Service to provide culturally sensitive health and wellness services.” However, what I like even more is that they teach patients that they are not resigned to a certain fate just because of their ethnicity. A short video produced by the Veterans Health Administration in 2021 painted a picture of what the ideal health clinic should be doing to address health disparities, and OKCIC fits this description very well. The narrator stated that the clinic should work with stakeholders in the community to examine each inequity and customize treatment and services to that specific ethnic group or culture. OKCIC is a proponent of community engagement and helps them optimize their health through educational courses and activities. OKCIC deploys their hygienists to community events, particularly health fairs. Carequest, one of its sister clinics, does more physical deployment on mobile units that go out into the community. They are continuously finding ways to tie in dental health and systemic health, and the effects are far-reaching. Sometimes, I-RDHS can even detect eating disorders, abuse or neglect through the plaque index and absence of sealants.
OKCIC’s vision statement is “to be the national model for American Indian health care.”
“Our goal is dentistry in every department. We want dentistry everywhere,” McKee said. “We’re getting there one year at a time.”
This webinar made me realize just how important it is to help people in marginalized communities feel heard, cared for and, dare I say, loved. However, the truly beautiful aspect of this is that, as the same philosophy that guides the research and activities through this clinic can be applied to other marginalized groups as well and, in turn, will have a ripple effect that will improve society overall. Like Shona Kelly said (Tedx Talks, 2020), it isn’t us versus them; “it has to be us.” As she explained, the steeper the gradient between these people and those with a higher income, everyone’s well being is affected. If other health care professionals and organizations could say “Why not?” and think outside the box the way OKCIC has, so many health disparities could be drastically reduced and possibly eliminated.
