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Avenues to Access A Primer in Initial Development of a Dental Safety Net System.

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1 Avenues to Access A Primer in Initial Development of a Dental Safety Net System

2 © 2012 American Dental Association, All Rights Reserved In the Beginning: Someone, somewhere has decided to look into access to oral health in a particular area. If the leader is new to the public health arena, it can be a little overwhelming.

3 © 2012 American Dental Association, All Rights Reserved Expert Advice: You got to be careful if you dont know where youre going, because you might not get there. Yogi Berra

4 © 2012 American Dental Association, All Rights Reserved What is the purpose of this presentation? The most important need on this trip is to figure out where you would like to this journey to end. This is best accomplished with a few simple, though time-consuming steps.

5 © 2012 American Dental Association, All Rights Reserved Where does one begin? Just like eating an elephant, the job is best accomplished through small bites!

6 © 2012 American Dental Association, All Rights Reserved What This Presentation CANNOT Do: Answer all of the questions. Provide anything more than a starting point for a community discussion on how to best provide services for unmet oral health care needs. Pick the delivery method that will work best for a particular area.

7 © 2012 American Dental Association, All Rights Reserved What This Presentation CAN Do: Provide a very basic overview of different ways to create access to dental care. Spell out the common acronyms. Raise a few points to consider as one is developing a safety net system. Provide some links to additional information on many of the ideas introduced.

8 © 2012 American Dental Association, All Rights Reserved Overview 1.Do a quick assessment to get a sense of need. 2.Develop a team. 3.Investigate more deeply the existing conditions/resources and their growth potential, as well as the actual numbers and characteristics of those in need. 4.Understand the options available. 5.Create a plan: What will best address the needs the team have identified as top priority?

9 © 2012 American Dental Association, All Rights Reserved Quick Assessment: What? Gather and assess basic information that is readily available including: –Population –Overview of needs –Number of existing providers

10 © 2012 American Dental Association, All Rights Reserved Quick Assessment: Why? –Go beyond anecdotal. –Helps in recruiting team. –Requires little time and effort.

11 © 2012 American Dental Association, All Rights Reserved Quick Assessment: How? U.S. Census Data available at Health Resources and Services Administration (HRSA) –Medically Underserved Area (MUA) Data –Medically Underserved Population (MUP) Data –bhpr.hrsa.gov/shortage/bhpr.hrsa.gov/shortage/ State Department of Public Health –Association of State and Territorial Dental Directors (ASTDD) has links to all state programs –www.astdd.org/state-programs/www.astdd.org/state-programs/ County/Municipal Health Department State licensing agency quantity of providers in area

12 © 2012 American Dental Association, All Rights Reserved Developing a Team: Why? –Gain a better understanding of the needs and resources within the community. –Promotes buy-in, lends legitimacy. –Share the workload. –Sustain the operation over time.

13 © 2012 American Dental Association, All Rights Reserved Developing a Team Who should be on board? Think of all the necessary aspects of bringing such a project to completion.

14 © 2012 American Dental Association, All Rights Reserved Team Members: Who? –Provider Network –Governmental Units –Finance People –Social Services –Patient Representatives

15 © 2012 American Dental Association, All Rights Reserved Team: How to Invite Onboard A personal invitation is best. Now is the time to share a story, some enthusiasm and define the problem as you see it. Discuss why theyve been included; why their view matters. Be honest about the duration of commitment you expect at that point.

16 © 2012 American Dental Association, All Rights Reserved Team: Provider Network There MUST be a local dentist onboard: –Knowledge of community, delivery systems and a great resource for potential collaborative efforts –Serves as a conduit to the local dental society for information/idea exchange as well as a referral source

17 © 2012 American Dental Association, All Rights Reserved Team: Provider Network There SHOULD be a member of the County or Municipal Public Health Department: –Knowledge of the community and patient populations –Awareness of existing sources of care –Awareness of funding sources

18 © 2012 American Dental Association, All Rights Reserved Team: Provider Network If a local hospital exists, consider inviting the administrator or the ER supervisor to join. Urgent care clinic folks also have good information: –Great source of statistics for community need –Possible funding source –Familiar with many aspects of healthcare delivery, from governmental regulations on through inventory supply systems

19 © 2012 American Dental Association, All Rights Reserved Team: Provider Network Local dental schools and hygiene or assisting programs Hygiene society Community health workers School Nurses

20 © 2012 American Dental Association, All Rights Reserved Team: Governmental Representatives State and local officials County or municipal Board of Health State dental director

21 © 2012 American Dental Association, All Rights Reserved Team: Finance People Foundations Charitable civic organizations Corporate donors Bankers Grant writers

22 © 2012 American Dental Association, All Rights Reserved Team: Social Services 1.Agencies that work with special populations groups Homeless Aging Children (Head Start, WIC, school systems) Individuals with disabilities 2.Clergy 3.Other social service agencies (county, municipal, hospital)

23 © 2012 American Dental Association, All Rights Reserved Team: Patient Representatives Advocates for the homeless Local AARP representative Shelter residents Uninsured working poor

24 © 2012 American Dental Association, All Rights Reserved Investigate Existing Conditions/Resources How do you know what you NEED when you dont know what you HAVE?

25 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources Look at existing safety net resources: –How many and who are they serving now? –Can they/will they grow? Look at the unserved population: –Demographically –Geographically

26 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources Health Professional Shortage Area (HPSA)Designation? –Incentives (loan forgiveness) in recruiting providers. –HPSA determination: hpsafind.hrsa.govhpsafind.hrsa.gov Other scholarship type incentives for providers in underserved areas –As an example, Illinois has Bridge to Healthy Smiles:

27 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources Clinics Mobile Units School Programs Hospitals Private Dentists Accepting Medicaid Nursing Homes Professional Schools

28 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources Land Buildings/Clinics with extra space Nearby Federally Qualified Health Center (FQHC)possibility of satellite? Unused equipment or potential corporate donations of same New school being built?

29 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources Ask your team and Use your team! Where does the county refer patients? Does the hospital have a referral base? Current Provider Data: –CMS provides database of current Medicaid providers: –FreeDental.org is a searchable database that provides a breakdown of providers of free or sliding- scale care by state: –Identify low-cost/free care providers by zip code:

30 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources Geographical Information Systems (GIS) mapping –More accurate than by county analysis –See Kansas study data available at Hospitals: emergency room data School Nurses: oral health-related absences

31 © 2012 American Dental Association, All Rights Reserved Investigate Existing Resources From census data: –Age –Ethnicity –Location Languages spoken Special Needs Populations

32 © 2012 American Dental Association, All Rights Reserved Existing Conditions: Helpful Resources A Guide for Developing and Enhancing Community Oral Health Programs, National Maternal and Oral Health Resources, Available at Assessing Oral Health Needs: ASTDD Seven- Step Model The Association of State and Territorial Dental Directors, Available at html html

33 © 2012 American Dental Association, All Rights Reserved Systems Check 1.Youve established need. 2.Youve put together a team. 3.You assessed your existing resources. 4.You have taken a deeper look at your unserved population in order to better understand them. 5.What next?

34 © 2012 American Dental Association, All Rights Reserved Congratulations!! If your existing resources fulfill your existing needs:

35 © 2012 American Dental Association, All Rights Reserved However: IT SEEMS MORE LIKELY THAT THE NEED WILL OUTWEIGH THE EXISTING NUMBER OF CAREGIVERS! (The team needs to keep going.)

36 © 2012 American Dental Association, All Rights Reserved Options to Address Needs Bricks and mortar clinic –FQHC and Lookalike Clinic –Local Public Health Clinic –Hospital Clinic Mobile Clinic Portable Dental Unit School-based Program Temporary Fixes: –Mission of Mercy –Give Kids a Smile –Donated Dental Services Indian Health Service

37 © 2012 American Dental Association, All Rights Reserved FQHC and Lookalikes WHAT are they? HOW do they work? WHOM do they serve? WHY or why not? FQHC Madison, WI

38 © 2012 American Dental Association, All Rights Reserved FQHC: What are they? Federally Qualified Health Centers Nonprofit healthcare centers located in a high need or high-risk area (most provide some dental care). Provide comprehensive primary care to all. –Exceptions exist for FQHCs that target specific populations, such as the homeless or migrant farmworker communities. Provide support/enabling services for patients.

39 © 2012 American Dental Association, All Rights Reserved FQHC: What are they? (continued) Governing board of community members with at least 51% of its members coming from within the patient ranks. Meet other requirements regarding administrative, clinical and financial operations. Lookalikes are much the same, except they do not receive federal funding from Section 330 grants nor do they qualify for malpractice protection under the Federal Tort Claims Act (FTCA).

40 © 2012 American Dental Association, All Rights Reserved FQHC: How do they work? Made possible under Authorizing Legislation of the Health Center Program –Section 330 of the Public Health Service Act; –bphc.hrsa.gov/about/legislation/section330.htmbphc.hrsa.gov/about/legislation/section330.htm Partially funded by Sec. 330 grants, estimated by Cong. Research Center to cover 20% of cost (lookalikes do not get this grant money) –Federal Health Centers, Elaine J. Heisler, Congressional Research Service, March 21,2012, p.2. Available at

41 © 2012 American Dental Association, All Rights Reserved FQHC: How do they work? (continued) Many other grant sources can be tapped for funding. For example: –Ryan White HIV/AIDS –Healthy Start program –State and local grants –Health Professional Shortage Area (HPSA) designation Can help qualify for financial help by providing loan forgiveness assistance for providers; hpsafind.hrsa.gov/hpsafind.hrsa.gov Can hire staff through Natl. Health Service Corp

42 © 2012 American Dental Association, All Rights Reserved FQHC: How do they work? (continued) Medicare, Medicaid, private pay and insurance also accepted Federal Poverty Level = $22,350/family of four and is used as determinant in fees owed Patients above 200% of the FPL pay a fee set by board to align with local prevailing fees. A family at or below 200% of FPL is subject to sliding scale, though none refused if unable to pay. Private or corporate funding also accepted

43 © 2012 American Dental Association, All Rights Reserved FQHC: How do they work? (continued) Can elect to receive funding through a Prospective Payment System (PPS). –Per visit payment rate determined by baseline rate/visit from previous years, with Medicare Economic Index adjustments. –Helps FQHC determine budget. –Quadrant dentistry is performance goal; want to avoid practice of churning. Other Alternative Payment Methodologies (APM) exist.

44 © 2012 American Dental Association, All Rights Reserved FQHC: Whom do they serve? Designed to serve the community, absent of regard for personal resources (or lack thereof) with required primary health services. By statute must provide dental screenings for children and preventive dental services as part of requirements. –Preventive dental services are defined in regulations to mean oral hygiene instruction, cleanings, topical fluoride and/or fluoride prescriptions. –If FQHC does not provide dental, must make these services available by referral or contracting with providers. –See 42 U.S.C. Sec. 254b(b)(1)(A)(i)(III)(ff) & (hh)

45 © 2012 American Dental Association, All Rights Reserved FQHC: Whom do they serve? (continued) May get approval to extend services beyond those provided as primary. –Health and Human Services gives approval for supplementing services. –See 42 C.F.R. Sec. 51c(102)(j)(6). If so, then must offer this additional care to all residents of service area that fit the parameters defined.

46 © 2012 American Dental Association, All Rights Reserved FQHC: Why or why not? If an FQHC exists somewhere in the area consider a satellite office. Access to medical staff within system. Federal Tort Claims Act (FTCA): Centers are considered Federal employees and thus covered in malpractice lawsuits: bphc.hrsa.gov/policiesregulations/policies/pin html (click on policy manual link) bphc.hrsa.gov/policiesregulations/policies/pin html FQHC can contract with private dentists in providing care. A little more difficult to share space.

47 © 2012 American Dental Association, All Rights Reserved FQHC: Helpful Resources Operations Manual for Health Center Oral Health Programs National Network for Oral Health Access. Available at So You Want to Start A Health Center...? A Practical Guide to Starting a Federally Qualified Health Center National Association of Community Health Centers. Available at Safety Net Dental Clinic Manual National Maternal and Child Oral Health Resource Center, available at Increasing Access to Dental Care through Public Private Partnerships: Contracting between Private Dentists and FQHC Childrens Dental Health Project. Available at

48 © 2012 American Dental Association, All Rights Reserved Local Public Health Clinic (LPHC) Northern Dental Access Center Bemidji, Minnesota

49 © 2012 American Dental Association, All Rights Reserved LPHC: What are they? Includes many county, municipal and foundation-based facilities that provide services Regulation of each entity dependent on governing bodyusually a board-type governance structure

50 © 2012 American Dental Association, All Rights Reserved LPHC: How do they work? Very broad spectrum of operational plans exist. Funding sources: –Grants/donations: private, corporate and nonprofit –Governmental funding (but not Sec. 330 dollars) –Private pay, insurance, Medicaid –Donations of services often help defray costs

51 © 2012 American Dental Association, All Rights Reserved LPHC: Whom do they serve? The parameters for each individual clinic are defined when they are established: –Subject to modification by board –Subject to modification by county/municipal ruling –Subject to modification by supporting organization Often see a combination of programs run under one umbrella: e.g. a school-based sealant program with a local clinic or local private dentist providing restorative.

52 © 2012 American Dental Association, All Rights Reserved LPHC: Why or Why not? Can be less regulated than a federal clinic. Can make excellent use of shared facilities and/or community partnerships. Have a great deal of flexibility for structure. Mission can be altered a little more readily than federal clinic. Easier for dentists to volunteer. Do not qualify for federal Sec. 330 funds or malpractice protection under FTCA.

53 © 2012 American Dental Association, All Rights Reserved LPHC: Helpful Resources Talk to state dental director for referral and/or mentoring advice from some of the states best practice examples. Guide for Developing and Enhancing Oral Health Programs American Assoc. for Community Dental Programs. Available at Proven and Promising Best Practices for State and Community Oral Health Programs American Society of State and Territorial Dental Directors. Available at

54 © 2012 American Dental Association, All Rights Reserved Hospital Clinics Dental Clinic Childrens Hospital of Wisconsin Milwaukee, WI

55 © 2012 American Dental Association, All Rights Reserved Hospital Clinics: What are they? Located on-site or near the hospital with whom they are affiliated. Can range from limited services (emergency only, oral surgery only) to full-blown care. Hospital may elect not to build own clinic, but rather to contribute funding to some other safety net entity to whom referrals may be made.

56 © 2012 American Dental Association, All Rights Reserved Hospital Clinics: How do they work? Can choose from many options, based on mission/vision Often incorporate graduate programs: –Specialty –General Practice Residency Funding from parent hospital, grants, Medicaid, Medicare, private pay, insurance

57 © 2012 American Dental Association, All Rights Reserved Hospital Clinics: Whom do they serve? The parent hospital sets parameters for patient base as well as care offered: –Emergency care –In-patient care –Medically necessary care –Graduate programs Lose flexibility and control over definition of care if elect to contribute funds to some other entity to provide safety net services.

58 © 2012 American Dental Association, All Rights Reserved Hospital Clinics: Why or why not? Better service for oral pain patients in ER Better expenditure of dollars Can benefit from purchasing power of hospital for supplies and equipment Support of medical staff in-house for consultation on medically compromised patients

59 © 2012 American Dental Association, All Rights Reserved Hospital Clinics: Helpful Resources Emergency Department Visits for Dental Conditions, Romesh P. Nalliah, BDS and Veerasathpurush Allareddy, BDS, PhD; March 19, 2012; available at Dental Treatment in Floridas Hospital Emergency Rooms, an overview which illustrates the issue for one state, available at apha.confex.com/apha/140am/webprogram/Pap er html apha.confex.com/apha/140am/webprogram/Pap er html

60 © 2012 American Dental Association, All Rights Reserved Mobile Clinic DuPage County, IL Smile Squad Dental Care Van

61 © 2012 American Dental Association, All Rights Reserved Mobile Clinics: What are they? Self-contained mobile dental treatment facilities. –Vans or trailers retrofitted with total care units. –Completely self-contained water system, vacuum, compressor and (often) sterilization located within. Can be moved wherever desired to serve population.

62 © 2012 American Dental Association, All Rights Reserved Mobile Clinics: How do they work? Start-up funding through grants, corporate/private donations, fundraising. Continued support through much of the same, along with govt. funding, private pay and insurance. Services may be provided on a volunteer basis by local providers.

63 © 2012 American Dental Association, All Rights Reserved Mobile Clinics: Whom do they serve? Often used in conjunction with service provision to patients with limited access to transportationhomebound, school children, geriatric patients. –For example, Ronald McDonald Care van only available to children in specific service areas. May be limited in scope by grant parameters initially, but then may be expanded once grant requirements met.

64 © 2012 American Dental Association, All Rights Reserved Mobile Clinics: Why or why not? Work well to reach those with limited access to transportation. Introduce host of other issues: –Maintenance of vehicle –Driver: additional costs, background check, etc. –Need place to park: Possible access to electricity, water –Insurance on vehicle –Access for disabled patients

65 © 2012 American Dental Association, All Rights Reserved Portable Dental Unit

66 © 2012 American Dental Association, All Rights Reserved Portable Dental Unit: What is it? Discrete movable dental module that generally consists of a chair, light and self- contained treatment center with handpiece and suction hookups, compressor For transportation purposes is disassembled into pieces –Chair~30 lbs –Units range~30-50 lbs Easily reassembled on site

67 © 2012 American Dental Association, All Rights Reserved Portable Dental Unit: How does it work? All equipment can be wheeled/carried into the selected treatment area and assembled there. Unit has self-contained water supply and suction tanks, as well as compressor. Only requirement of host facility is power source and space. Operator and assisting stools also available.

68 © 2012 American Dental Association, All Rights Reserved Portable Unit: Whom Do They Serve? Nursing homes Senior centers Schools Homebound patients Remote access areas MASH-style charitable operations Just about anyone treated anywhere!

69 © 2012 American Dental Association, All Rights Reserved Portable Unit: Why or Why Not? Extremely adaptable for many delivery situations Sometimes a bit challenging for some special needs populations: –Chairs not as stable, so transfers over can be difficult –Weight limit on chairs (~350 lbs.) Ergonomically can be difficult for provider long-term

70 © 2012 American Dental Association, All Rights Reserved Mobile/Portable Care: Helpful Resource Mobile/Portable Dental Manual Association of State and Territorial Dental Directors. Available at portabledentalmanual.com/http://www.mobile- portabledentalmanual.com/

71 © 2012 American Dental Association, All Rights Reserved Charitable/Free Care Mission of Mercy June 8-9, 2012 Grayslake, IL

72 © 2012 American Dental Association, All Rights Reserved Charitable Care: What is it? Endless list of services fall into this category, the common factor being that the care is provided free of charge. Can be provided in ones own office or local clinic. May be offered in a temporarily established clinic. Generally offers basic preventive and extractions, as well as basic restorative treatment; variations occur.

73 © 2012 American Dental Association, All Rights Reserved Charitable Care: How does it work? For in-office treatment: dentist and staff commit to providing care either for a particular patient, a particular day or for a particular service Larger scale mobile clinics involve more planning: fundraising, donations, recruitment of volunteers, planning for follow-up care where needed and arranging for patients needs (lab services, transportation, pharmaceutical support, etc.)

74 © 2012 American Dental Association, All Rights Reserved Charitable Care: Whom does it serve? Planners set protocol. Some examples: –Give Kids A Smile: limited to pediatric patients –Mission of Mercy: open to all –Veterans Day: open to any former service man or woman –Donated Dental Services: patients prescreened to demonstrate needfinancial and otherwise (disabled, elderly, medically compromised)

75 © 2012 American Dental Association, All Rights Reserved Charitable Care: Why or Why Not? Provides a lot of care that might otherwise be left untouched. Capable of serving huge numbers of patients in short amount of time. Often fails to establish dental home. Does not address long-term solutions. Can be used to dramatically illustrate vast unmet needs in area: speaks to policy makers.

76 © 2012 American Dental Association, All Rights Reserved Charitable Care: Helpful Resources Americas Dentists Care Foundation Missions of Mercy: National Foundation of Dentistry for the Handicapped, Donated Dental Services: nfdh.org/donated-dental-services-dds nfdh.org/donated-dental-services-dds Dentistry from the Heart: dentistryfromtheheart.org/ dentistryfromtheheart.org/

77 © 2012 American Dental Association, All Rights Reserved School-Based Programs School-Based Program Photo courtesy of Dr. Martin MacIntyre

78 © 2012 American Dental Association, All Rights Reserved School Program: What is it? Usually means in-school delivery of care May incorporate off-site treatment, which may then be called school-linked program Often includes referral to private partners for follow-up May be limited to screenings, sealants, fluoride, oral hygiene instructions, but strive to identify options for needed restorative work: –Goal with prevention-based programs is to reduce incidence of disease, not prevalence

79 © 2012 American Dental Association, All Rights Reserved School Program: How does it work? Target school district is identified Verify unmet need Obtain permission from parent/guardian Obtain financial support –Childrens Health Insurance (CHIP) –Grants, donations Delivery most likely through portable or mobile units

80 © 2012 American Dental Association, All Rights Reserved School Program: Whom do they serve? Generally target students with no access to care otherwise –Identify potential patients via percent of children eligible for free/reduced lunch Good programs validate that patient does not have access to care otherwise: –Done via parent/guardian information provided –Generally accepted as no dental care/visit within last 12 months

81 © 2012 American Dental Association, All Rights Reserved School Program: Why or why not? Excellent way to reach target population effectively. Reduces out of school time for children. Easy way for parents to access care for their children. Difficulty is often in linking up with follow-up care, so need to establish system for that. If new school being built, good time to ask for dedicated space.

82 © 2012 American Dental Association, All Rights Reserved School Program: Helpful Resources School-Based Dental Sealant Programs; CDC available at ntal_sealant_programs.htm ntal_sealant_programs.htm School-Based Sealant Programs Introduction; Assoc. of State and Territorial Dental Directors (ASTDD), available at programs-introduction/ programs-introduction/

83 © 2012 American Dental Association, All Rights Reserved Indian Health Service (I.H.S.) Fort Defiance Indian Hospital Window Rock, Arizona Houses a 24 chair dental clinic

84 © 2012 American Dental Association, All Rights Reserved I.H.S.: What is it? The Indian Health Service is an agency within the Health and Human Service (H.H.S.) that is established to provide care for American Indians and Alaskan Natives. May be operated as an FQHC in some instances, but often run solely as a tribal unit. Often a physical clinic exists, but remote locations may be served by portable equipment.

85 © 2012 American Dental Association, All Rights Reserved I.H.S.: How does it work? Funding is provided through H.H.S., either paid directly in response to care or given to the tribe so that they may elect more specifically how to utilize their available healthcare monies. –This latter method is called 638 contracting as it is made possible under the Indian Self Determination Act, see Monies may also be funded through grants, donations and third-party payments. Providers are either Civil Servants, members of the Commissioned Corp of the U.S. Public Health Service or direct tribal hires, along with some volunteers.

86 © 2012 American Dental Association, All Rights Reserved I.H.S.: Whom do they serve? Care is limited to the two targeted populations of American Indians and Alaskan Natives. –Given budget restraints, all facilities are not operated the same –Some elect to focus most care on children, pregnant patients and those with diabetes –Some provide basic care to all

87 © 2012 American Dental Association, All Rights Reserved I.H.S.: Why or Why Not? Need for provision of services determined by I.H.S. –Resource Requirement Methodology (RRM) used to determine needs and provide data for Congressional Appropriation hearings –Tribal input –Bureau of Indian Affairs

88 © 2012 American Dental Association, All Rights Reserved I.H.S.: Helpful Resources I.H.S. Oral Health Program Guide, available at Indian Health Service, available at I.H.S./RRM planning worksheet available at Safety Net Dental Clinic Manual National Maternal and Child Oral Health Resource Center, available at

89 © 2012 American Dental Association, All Rights Reserved Next Steps?

90 © 2012 American Dental Association, All Rights Reserved Create a Plan: The committee will look at all the information gathered: –Population in need –Available resources –Options to provide care Engage in healthy debate and decision- making. And set goals for which road it wishes to travel!

91 © 2012 American Dental Association, All Rights Reserved Next Steps: Helpful Hints Respect the differences of opinion among the team. Be good listeners. Creatively seek mutually acceptable solutions. Remember that the project can be done incrementally. Focus on the mutual commitment to helping those in need!

92 © 2012 American Dental Association, All Rights Reserved Questions? Dr. Steven P. Geiermann Sr. Manager Council on Access, Prevention and Interprofessional Relations Dr. Elizabeth Betsy Shapiro ADA Hillenbrand Fellow


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