Researcher Leading Effort to Improve Health of Vulnerable Populations
By David Enders
The COVID-19 pandemic has exposed the fact that access to adequate health care is sadly in short supply for many seniors, and oral health care often is ignored, postponed, or cancelled altogether. Suman Challa, BDS, MSPH, associate dean for advanced education programs and strategic initiatives for the School of Dentistry, believes this disturbing trend can be reversed with a more robust public health system armed with new technology.
“I did my master’s thesis on the correlation between oral health and general health in nursing home populations, and I found poor oral health factors have a huge impact both on morbidity and mortality rates in older adults,” Dr. Challa says. “That has stuck with me for a long time.” He is now the principal investigator on a $5.7 million grant from the Center for Medicare Services to bring advanced oral health care to the underserved in nursing homes in and around San Antonio.
The 2000 “Oral Health in America: A Report of the Surgeon General” pointed to a “silent epidemic” of poor oral health afflicting the elderly and impacting physical, psychological, and social well-being through pain, diminished function, and reduced quality of life. By 2030 aging baby boomers over 65 will make up 20 percent of the population, so the problem isn’t going away.
Dr. Challa believes these older, special needs populations can sometimes be marginalized in the research community through a kind of societal cost versus benefit approach. “But I’ve always felt these are individuals who have already donated their resources and their time to society to make it better, and we need to take care of them in their golden years.”
The UT Health San Antonio School of Dentistry delivers on the three-year grant in the form of two customized trucks that carry state-of-the-art advanced dental equipment to nursing homes throughout San Antonio and within a 65-mile radius. “We want to give them the same experience any other paying customer would get going to a dental office; the only difference is our equipment has wheels. We are delivering the best comprehensive oral health care possible with the best equipment and supplies. Sometimes, just that perception makes a big difference.”
The care doesn’t end there. “We know when we leave, the nursing staff are the ones who take care of these individuals on a regular basis, so we give them both didactic and hands-on education—and maybe a little inspiration—by explaining why routine oral care matters so that they might do it more purposefully and mindfully.” The immediate goal is to deliver care to at least 7,000 patients in every nursing home within the service radius.
The COVID-19 pandemic has added a layer of protocols and complexity to the operation. “But just seeing and talking to someone who cares about them can make a world of difference for these folks. Our motto is to be kind throughout the process. We are not just providing oral health care; we also are listeners. We know this is our chance to make somebody’s life better.”
As data reveals the project’s impact on overall health, he is optimistic the grant will be renewed. “Imagine having less of these residents accessing emergency rooms in the middle of the night, and the kind of costs that drives up. Imagine somebody’s heart health improving because we are improving their periodontal health. We know the amount of value in the care we are delivering will far exceed the amount of our funding, and whoever looks at this data will be excited to give us more funding.”
Dr. Challa is also the primary investigator on a $3.5 million Primary Care Dentistry for South Texas grant that aims to enhance the number, diversity, and capacity of primary care dentistry residents to provide culturally competent health care for underserved and vulnerable populations, and provide primary care residents with experiential learning with vulnerable populations. This grant helps support developing a collaborative, multidisciplinary program that incorporates existing and new resident training and care delivery models, enhanced by interprofessional training with nursing and medical schools.
Dr. Challa is also the primary investigator on a $2.1 million Faculty Development grant that has helped increase the number of dental and dental hygiene faculty in the workforce.
“We will increase the number of residents getting training and get oral care into rural areas like Carrizo Springs and Gonzales where they may not otherwise have access to advanced dental health care. The odds of rural folks traveling to San Antonio to get needed advanced oral care are not good, so we want to send our residents to them to deliver care in their local community health centers where we have developed some fantastic partnerships,” he said.
More recently, Dr. Challa, along with Peter Loomer, BSc, DDS, PhD, MRCD(C), FACD, professor and dean of the School of Dentistry, got the green light from the Texas Department of Health and Human Services in the form of a $1.9 million grant to support the Phil and Karen Hunke Special Care Clinic to be located at the school’s Center for Oral Health Care & Research. “It will be a sustainable clinic to provide advanced dental care for special needs populations while training the next generation of students in how to care for these individuals.”
“With an aging population, students need to know how to handle complex cases, because the majority of our seniors will have complex medical histories alongside their oral health problems. We see in the nursing homes that just a list of medications for some can be 20-pages long.”
Whether bringing mobile dental care to nursing homes and rural areas or developing a new special needs clinic at the dental school, UT Health San Antonio aims to do its part to end the silent pandemic. “I am honored and humbled to get to work with a great team of people who are all motivated to go out and serve and make other people’s lives better,” Dr. Challa says. “We have wonderful leadership in Dr. Loomer and Dr. (William) Henrich (UT Health San Antonio president) who believe in making ‘service’ one of the main components of our mission. But they don’t only say it, they also actively support and live it.”