DrBicuspid.com is pleased to present the next installment of Leaders in Dentistry, a series of interviews with researchers, practitioners, and opinion leaders who are influencing the practice of dentistry.
Dental care is out of reach for many senior citizens in the U.S. Often, the inability to get to a clinic coupled with high out-of-pocket expenses are insurmountable barriers for adults age 65 and older, many of whom are struggling just to get by. Dr. Karen Becerra wants to fix that.
Karen Becerra, DDS, MPH, is the CEO, dental director, and co-founder of the Gary and Mary West Senior Dental Center in downtown San Diego. The nonprofit clinic has been open for about 10 months and specializes in serving low-income seniors.
"The majority of the seniors who we work with live on $850 a month. That leaves them about $5 a day of discretionary income," Dr. Becerra said in an interview with DrBicuspid.com. "When they have to make choices -- for food, rent, and medications -- dental is simply not part of that equation. It's not that they don't want to get the care they need. It's just that they simply cannot afford it."
So far, Dr. Becerra and her team have helped more than 500 seniors by providing comprehensive dental care and oral health education. The services provided are what you'd expect from a dental clinic -- dentures, partials, fillings, extractions, and crowns, she said. However, because many of the patients are missing teeth and have not seen a dentist in decades, even typical dentistry has a big impact.
"People are writing us, sending us cards, telling us the impact this is having, changing their lives," she said. "We're not doing anything fancy. We're not doing aesthetics. We're basically just restoring function and taking them out of active disease."
While Dr. Becerra finds working with older adults challenging and rewarding now, it's not what she originally set out to do. She thought she was going to be a pediatric dentist.
Pediatric dentistry to geriatric dentistry
The granddaughter of a lab technician, Dr. Becerra knew she wanted to be a dentist from a young age. She was the first in her family to obtain a university degree, and when she moved from Colombia to San Diego in the mid-2000s, she was hoping to apply to a pediatric dentistry program. However, by the time she got her U.S. dental license, the program had changed, so she decided to remain a general dentist.
In the decade before deciding to go into geriatrics instead of pediatrics, Dr. Becerra worked in community clinics and private practices, doing research and providing care. She was planning to open her own private practice when she started volunteering at the Serving Seniors' Gary and Mary West Wellness Center by serving meals.
"I became exposed to these hundreds and hundreds of seniors who have access to a nutritious meal but didn't have the teeth to eat the meal," she said. "I had to make a stop in my life."
Once Dr. Becerra saw the opportunity to make a difference, she couldn't walk away. The result is the Gary and Mary West Senior Dental Center.
Holistic healthcare for seniors
The dental clinic is located on the second level of the Gary and Mary West Wellness Center, the same center where Dr. Becerra first volunteered serving meals.
"We provide a holistic approach. We bring healthcare to a community wellness center that is well-trusted and is well-attended," Dr. Becerra said. "We are removing some of the main barriers, such as transportation, affordability, and accessibility."
Through the center, seniors can access a variety of health and wellness services under the same roof, and care navigators make sure important health information about the seniors is shared among specialties. The clinic also performs clinical research, looking into the link between oral and systemic health for older adults.
To finance the care, the clinic accepts California's dental Medicaid program, Denti-Cal, and uses a sliding-scale system for procedures not covered by Medicaid. However, Dr. Becerra said that funding is one of the greatest challenges she faces.
"One of the real challenges is the financial sustainability," she said. "It's not easy, because right now ... there's a lot of attention going toward children, and, unfortunately for us, older adults, low-income older adults, are not on people's radars."
Both the clinic and the wellness center are funded in part by West Health, a nonprofit philanthropic organization with the goal of helping seniors age in place with access to health and support services. However, to keep the doors open, Dr. Becerra also needs to fundraise and apply for grants.
"I have to be creative, because I want to be that template or that blueprint that I can share later on with any other dentist in California or any other place in the United States, so that they can mimic or copy some parts or all of this," she said. "We're going to continue shining the light to see how we can make this model sustainable."
Dr. Becerra's advice to dentists
With an aging population, now is the time for dentists to prepare to see senior citizens in their own practices by attending conferences, volunteering, or taking continuing education classes, according to Dr. Becerra.
"I would like other dentists to understand that there's going to be more and more baby boomers coming into their practices," she said. "It's going to be very important for them to get used to and get very comfortable treating patients who are highly medically complex."
Her other piece of advice for dentists? Give back. While she realizes that not every dentist can or should give up private practice to open a nonprofit dental clinic, she hopes more dentists will get involved in efforts to better the overall community by volunteering or donating time or money.
"I know dentists are very good, but when I go to presentations that is not the perception that other people have," she said. "We need to be participating more, volunteering more, and engaging in other events. It doesn't mean that you have to complicate your life and create something that is going to make it very difficult. Maybe you like something that already exists. Try to help. Try to contribute, so that we can continue advancing our profession."