Deborah Jacobi, RDH, MA, has dedicated her professional life to helping others receive the dental care they need. Her wealth of experience ranges from Head Start programs to federally qualified health centers to the Indian Health Service (IHS). She is a tireless advocate for the underserved. Currently, Jacobi is the policy director for Apple Tree Dental— headquartered in the Twin Cities with multiple regional programs across Minnesota—an innovative nonprofit dedicated to improving the oral health of all people, including low-income children and families, long-term care residents, and people with disabilities. She is responsible for policy, advocacy, and community collaborations. Jacobi served as the dental clinic supervisor of the Uptown Community Clinic in Minneapolis, where she coordinated a private, nonprofit dental program offering a sliding-fee scale care for lowincome, uninsured populations.
What advice would you give to dental hygienists who are interested in a career in public health?
My advice is to follow your passion utilizing evidence- based and promising practices. Learn all you can about the needs of the community you would like to serve. Collaborate with dental colleagues, as well as the greater health care team. My first public health experiences were as a commissioned officer of the United States Public Health Service working in the IHS. The unmet treatment needs of this population were startlingly disproportionate to those of the patients I had been caring for in the previous 14 years I had worked in private practice. For me, this confirmed that, as oral health professionals, we have an ethical responsibility beyond the individual patient with the knowledge and resources to make regular dental appointments in the private practice setting.
At IHS clinics and hospitals, my work included on-site preventive care in Head Start Centers, school-based sealant programs, and representing oral health at prenatal and diabetes medical clinics and community wellness events. I worked more closely with dental assistants and community health workers than I had in private practice. These experiences gave me confidence in providing team-based care, in which each discipline contributes toward the goal of doing the greatest good for the greatest number of people.
A number of current issues highlight the potential for dental hygienists in public health: troublingly persistent oral health disparities, an aging population with more teeth than previous generations, and the recognition of connections between oral and overall health that are leading us toward integrated care systems. As a result, dental hygienists interested in public health may have additional opportunities for rewarding careers in new settings, including those they create themselves.
What prompted you to pursue a graduate degree?
Although working one-on-one with my patients in the clinic was very satisfying, I wanted to understand whether we were making a difference at the system, as well as individual level. My bachelor’s degree is in sociology and my master’s degree is in public policy and health administration. Maybe that broader lens is why the potential for dental hygienists to work in local public health and in primary care seems so exciting to me.
Which communities, despite the best efforts being put forth across the nation, remain underserved?
Health disparities are well documented with clear geographic, economic and racial/ethnic differences in rates of disease and access to care. To eliminate those disparities, we’ll need to understand the barriers from the community’s perspective. Beyond affordability, what else keeps people from achieving oral health? Another example is age. Older adults experience more dental disease than children and face greater health consequences from untreated mouth infections, yet dental benefits for adults are optional in Medicaid and not currently included in Medicare. Fortunately, some great work is being done to change those policies.
Are there any challenges to providing team-based care? What is the greatest reward?
Right now, the separation of dental and medical care unintentionally creates challenges for team-based care in terms of both care delivery and financing. The December 2016 oral health issue of Health Affairs includes a number of articles that propose changes for better integration.
The on-site care Apple Tree provides in nursing facilities is a great example both within the dental team and with long-term care staff. Apple Tree’s dental hygienists serve as front line providers, screening all residents. They alert our care coordinators to dental concerns so that the resident can be scheduled for needed treatment; create a daily care plan for each resident; and promote the importance of daily oral care with the direct care staff at the facility. The reward is playing a proactive and collaborative role as an oral health professional.
What do you wish you had known as a graduate student that you know now?
If I’d known then what I know now, my advice might have been, “Don’t worry, the importance of oral health to overall health will be better recognized. When it’s no longer just about white teeth, we’ll fully appreciate the role of the dental hygienist.”