August 3, 2022
Patrick Smith, DMD, MPH, recalls the experience like it was yesterday.
“A few years ago, I was part of a team that would drive in a dental van to underserved communities throughout Chicago to perform free tooth extractions,” Smith said. “And many of the patients we’d see were Black men in severe pain. There was one man concerned about a bump in the back of his mouth. He had Medicaid, but his providers didn’t know what the bump was and were unable to perform a biopsy. We were able to refer him to clinics in the area, but a question resonated with me: How many more men didn’t have the wherewithal, trust, comfort, and confidence to approach the dental van? How many more men were suffering in silence, potentially not even trying from the expectation that their needs would still go unmet even if they sought care?”
Smith has worked for the Division of Prevention and Public Health Sciences and the Department of Pediatric Dentistry at the University of Illinois Chicago since 2017. In his role as clinical assistant professor, he supports the public health dentistry curriculum through several academic activities, including extramural clinical experiences with an emphasis on access to care and the social determinants of health. Dr. Smith’s career has focused on raising the level of consciousness for how oral health fits into our health care system and, more specifically, better understanding community engagement in low-income, predominantly Black communities.
Dr. Smith took some time out of his busy schedule to share his perspective on the unique oral health challenges Black men face and how the effects of racism and discrimination create barriers to accessing the care they need. He was also part of a panel of experts who explored this topic and anti-racist solutions for dental public health during a July 21 CareQuest Institute webinar.
What initially sparked your passion for dentistry?
The first time I thought about dentistry was in high school. My sister’s college roommate went to dental school, and I thought it sounded cool. I had zero knowledge about the profession and wasn’t interested in going to college beyond wanting to be independent and create opportunities for myself.
I attended Morehouse College, an all-male historically Black college, and majored in biology. By my junior year, I started studying for the MCAT, and after two weeks, I walked out on a prep course that I was taking. While doing so, I ran into a classmate, told him what I had just done, and he invited me to a pre-dental meeting. I sat in on a panel of dentists and it just felt right. I still didn’t know if I really wanted to be a dentist, but I liked the sound of having the option to do dentistry from time to time to make money while I pursued other interests and/or learned more about what I really wanted. I made up my mind that night and never looked back.
Since graduating from Harvard School of Dental Medicine in 2006, it seems like improving the oral health of Black men has been a focus for you. Why?
For me, Black man is how I identify and communicate with the world. At that time, there was a lot of dialogue about oral cancer disparities and Black men that resonated deeply with me. I felt a sense of responsibility and didn’t see others raising hell about it. I took that as a sign that there was a need I could fill. From there, exploring how to get involved served as a catalyst for how I got introduced to dental public health.
Once you got involved, what unique oral health challenges did you discover that Black men face?
Not all Black men face the same challenges, but I think a lot of it has to do with the importance of relationships in facilitating the transfer of health information and behavior modification. This applies to not just patient-provider interactions but social networking as well.
The challenges are based on several factors. In society, being a Black man can be dangerous and stressful physically, socially, and emotionally. Issues like negative stereotyping, misplaced assumptions of intellect and character, and social isolation can place Black men in harmful situations. How Black men react to those stressors may cause them to lack trust in new relationships or withdraw. Many Black men are taught as young boys to be cautious and guarded as a strategy to survive, stay out of trouble, or succeed in life. This can place Black men in social networks where there is a lack of information, misinformation, or more pressing priorities to discuss beyond oral health.
What gaps in care between Black and white adults surprise you most?
The narrative will likely always be that white populations collectively have better oral health, simply because they tend to fall on the better end of the spectrum of how social determinants affect health. Balancing the scale with interventions to reduce inequities will require more resources, priority, and political will. It would also mean simultaneously maximizing the opportunity for social determinants to improve health for people of color while supporting cultural influences on health that are protective. In our society, there are a host of issues halting efforts to improve access to care, including economic opportunities and neighborhood stability.
How can the oral health community address some of those disparities?
Community programs can close the gap in care when they are appropriately resourced, given the agency to lead and innovate, integrated into the health care system, and given more consideration for their contribution to reducing health care costs. It starts with trying. I like what I’m seeing regarding public insurance reform, workforce expansion, and improving collaboration with our colleagues in other health professions to support oral health as the agenda and have dental care be a part of that.
We’re a scientific profession, so we need to develop new models to study and perfect instead of preserving a system that isn’t working for millions of people and will likely get worse. It could make a big difference if research and funding institutions provided the resources to develop and test out new models of care delivery that are equity-focused and not just Band-Aid solutions that support existing models.
As an educator, how are you teaching the next generation of providers to pursue oral health equity?
My philosophy is that students need to know how health care systems work beyond the dental chair if we’re ever going to accelerate the pace. Simply providing dental care is not enough if we are unwilling or unknowing of how to change payment and practice structures accountable for achieving better access and treatment outcomes. As a profession, we don’t teach how the system works administratively, so we’re missing opportunities. Having conversations with students and getting them to ask questions and think critically rather than just accept the status quo is an important process.
What can today’s providers (and future providers) do to promote anti-racist behaviors?
This is a tough question. On a personal level, I think that there’s a lot that people can do to simply connect and create safe spaces for people to be themselves, with full acceptance of diversity and without judgment. You never know what people may be dealing with that may be race-related, and sometimes allowing people to sit in isolation socially, professionally, and creatively only exacerbates the problems. At the end of the day, I believe that people just want to know that you genuinely care about them.
I also think that providers can challenge decisions that are made without the shared input and perspective of racial groups most impacted by those decisions. It’s not enough to ask people what they want or think and then still do what you want to do. Be open to a different way, and trust that a good idea is a good idea — and, if non-concordant leadership doesn’t share perspective with their target populations, that those ideas should be explored as exciting moments for expanding inclusivity, learning, and innovation.