Closing the Gap: A Conversation on Community, Access, and Oral Health

In Chicago and across the world, millions face painful, preventable dental diseases because the system isn’t built to reach them. To understand why dental care matters far beyond the dentist’s chair, and what can be done to close the growing gap in access, I spoke with Dr. Alejandra Valencia, DDS, MPH, MS. As the Director of the Oral Health Forum and a Diplomate of the American Board of Dental Public Health, Dr. Valencia brings a rare and powerful perspective on the intersection of dentistry and public health. What emerged from our conversation was a powerful reminder that fixing oral health inequities means looking at communities, systems, and the very way we think about care.

 

For Dr. Alejandra Valencia, the connection between oral health and public health was something she learned long before her work in Chicago. It all started in her home country of Colombia, where she completed her dental education and worked as a practicing dentist. “From the time that I was in dental school,” she explained, “I always felt very drawn to working with low income communities”. She quickly began to notice a recurring set of barriers: “the high cost of dentistry, the location of dental offices that are not as accessible in low income communities as they are in affluent communities, and the difficulties to follow-up treatment.” Dr. Valencia saw firsthand how social conditions, from shared family toothbrushes to exhaustion from working multiple jobs, could make even the most basic oral hygiene instructions nearly impossible to follow. This experience early on in her career was when Dr. Valencia became passionate about bridging that gap and improving oral healthcare. 

That insight eventually pulled her away from the clinical chair and toward public health. After moving to the United States, Dr. Valencia chose not to continue practicing dentistry, but instead, to deepen her understanding of the social forces behind public health access. She earned a Masters of Public Health at the University of Illinois Chicago, and later completed a residency in Dental Public Health at the University of Iowa, saying she fell “even more in love with public health and the understanding of all these important factors.” Now board-certified in dental public health, Dr. Valencia sees herself as a bridge between clinical providers and the communities they serve—someone who understands both the struggles of patients and the challenges faced by dentists.

Today, that commitment to bridging gaps is central to Dr. Valencia’s work as Director of the Oral Health Forum (OHF). OHF is a community-centered initiative housed in Heartland Alliance Health, a non-profit organization focused on improving oral health equity across Chicago. She’s helped build community-based programs that go beyond traditional dental care, partnering with schools, immigrant support organizations, and public health agencies to bring oral health education and resources directly into our neighborhoods. “I have been with OHF since the beginning of my dental public health career, and fell in love with the connection with the community,” she said. What sets the OHF apart, she explained, is its “upstream kind of learning”, a model that starts with listening. Staff learn directly from patients and community members, gaining insight into the real barriers they face. That knowledge is then carried upward, educating public health departments, universities, and health officials about the difficulties that their communities face, and showing them how they can be advocates for better change.

Even with the progress the OHF has made in expanding community-based care, Dr. Valencia continues to see major structural barriers. “I think the main challenge is the high cost of dental services in general for our communities,” she said, noting that while coverage has improved for children in Illinois, “parents and their families, young adults, and working adults, really face difficulties accessing care because of the high cost.” For many low-income families, Medicaid is often the only form of dental coverage available, since private insurance is either too costly or not offered through their employers. But finding care can still be difficult, since relatively few dentists accept Medicaid. She added that while sometimes dentists will offer limited appointments for Medicaid patients, it is still hard for people to find an opening. In Chicago, the problem isn’t getting to the dentist; it’s finding a provider who will take your insurance, and being able to afford the services.

Beyond cost and coverage, the deeper issue, she believes, is how health systems are designed. Many families the OHF works with are focused on more pressing needs like food insecurity and housing, causing oral health to understandably become secondary. There are different priorities low-income families have to give to many other social determinants of health. “We call many families and they say, ‘I know my child needs dental care, but I don’t have a home,’ or ‘I don’t have enough food on my table.’” Dr. Valencia sees oral health not as a separate issue, but as one piece of a larger web of unmet needs. “If they need housing, we help them with housing. If they need food, we help them with food. And then we can come back later on to address the oral health needs that they have.” She also points to a structural flaw in the dental system itself: the way providers are paid. “Dental payment is normally based on a fee for services, which means if I do a tooth, if I fill a cavity, they pay me for that. But we haven’t been able to move to a more preventive approach—being paid for preventing disease instead of curing disease. That is an important change in the system that would help us improve oral health for our community. Preventative rather than responsive.”

When asked about creating a more equitable oral healthcare system, Dr. Valencia emphasized that “the person is the important part. We are taking care of a human and their rights, and oral health should be a part of that.” As for what else is important, “bridging communication between providers and the community is vital.” She wants people to understand that oral health is not separate from overall health. “The misconception that it is just one tooth, and not understanding the connection between oral health and your general health is one component that I would love for people to understand,” she said. But how to actually change communities and achieve an equitable oral healthcare system, that’s the difficult part. She explained that “the majority of public health initiatives come from the top down, like a prescription, and we need to reverse that.” She believes we need a more integrated, informed, and understanding system that looks into the specific needs of each community. It’s complicated, and no one has the exact formula, but the message is simple: oral health matters. While there is a long way to go, people like Dr. Valencia are doing vital work to bridge gaps in access, bringing essential health services to communities in need.

 

This blog post is based on an interview with Dr. Valencia. To learn more about dentistry’s connections to public health, check out Hayden’s blog post Why Dentistry Matters: The Overlooked Key to Public Health.