Episode 6 - EXPANDING FUNCTIONS FOR DENTAL ASSISTANTS: A CONVERSATION WITH DR. EMILY BOWEN

SUMMARY: In this episode of The Fulcrum Podcast, Paul Logan interviews Dr. Emily Bowen, Program Director of Mountain Empire Community College's Dental Programs. Dr. Bowen discusses the challenges and advancements in dental education and workforce development in rural Virginia. She highlights the success of Mountain Empire’s Dental Assistant and Dental Assistant II Expanded Functions (DA II) programs and their impact on the local community. Dr. Bowen also explains the role of DA IIs in enhancing dental practices and improving patient care. She emphasizes the importance of community support, faculty involvement, and innovative educational models in addressing the dental workforce needs in Virginia. 

HOST:

Paul Logan of the Virginia Dental Association. Paul focuses on member advocacy, developing resources for dental students and early career dentists, and working with a broad array of stakeholders to elevate and address Virginia’s dental workforce needs. Paul currently serves on the executive committee of the Coalition for Modernizing Dental Licensure and the College Board of J. Sargeant Reynolds Community College. Outside of work, he’s trying to keep up with his three- and six-year-old daughters.

GUEST:

Emily Kate Bowen, DDS, MA, MPH

Dr. Bowen graduated from Virginia Tech with a bachelor’s degree in biology. She received her Doctor of Dental Surgery degree from Virginia Commonwealth University’s School of Dentistry, a Master of Arts from Michigan State University in Higher, Adult, and Lifelong Education (HALE), and a Master of Public Health with emphasis on policy and leadership from East Tennessee State University. She currently serves as the Dental Programs Director for Mountain Empire Community College in the Division of Health Sciences. 

As a Virginia native, Emily is focused on improving access to care through strengthening the allied health workforce across the Commonwealth. She is a graduate of the Appalachian Regional Commission’s (ARC) Leadership Institute, while also serving on multiple public health-related projects, including the Virginia Dental Association’s Workforce Committee, the University of Virginia’s Cancer Center SWVA Community Advisory Board, and Health Catalyst’s Future of Public Oral Health Taskforce.

LinkedIn: https://www.linkedin.com/in/ekb-dds/

MENTIONED IN THIS EPISODE:

Understanding Emergency Room Visits for Nontraumatic Oral Health Conditions in a Hospital Serving Rural Appalachia: Dental Informatics Study: https://formative.jmir.org/2022/12/e31433

Dental Assistant II (DA II) Expanded Function Program - https://www.mecc.edu/dental-assistant-ii-expanded-function-gcc

Mountain Empire Community College: https://www.mecc.edu/

Dr. Emily Bowen

ebowen@mecc.edu

Germanna Community College: https://germanna.edu/

Misty Mesimer

mmesimer@germanna.edu

EPISODE CREDITS

Producer/Host:

Subscribe, share, and send your feedback and topic ideas to thefulcrumpodcast@vadental.org.

The information, opinions, and recommendations presented in this Podcast are for general information only, and any reliance on the information provided in this Podcast is done at your own risk. This Podcast should not be considered professional, medical, or legal advice.

Music in this episode from Epidemic Sound

Transcript

[00:00:00] Paul Logan: Hi, my name's Paul Logan. Today on The Fulcrum Podcast, we're joined by Dr. Emily Bowen, the Program Director of Mountain Empire Community College's Dental Programs. Dr. Bowen shares her insights on the future of Allied Dental education and meeting the dental workforce needs of rural Virginia.

Dr. Bowen, I am so glad you're able to take some time out of your busy schedule to share some insights on rural oral health workforce and education programs today. 

[00:00:28] Dr. Emily Bowen: Yeah. Thanks for having me, Paul. 

[00:00:30] Paul Logan: Something you've shared with me a couple years ago that stuck in my head when we talk about our dental workforce. Virginia, we have 72 dentists per a hundred thousand Virginians. You shared a Marshall study that said in the 420 counties that make up rural Appalachia, including the county served by Mountain Empire Community College’s dental programs, there's an average of four dentists per a hundred thousand people. And I think that's important context for our conversation today because when we're talking about the county served by your dental programs, you're part of Virginia, but you're also right there on the border with Kentucky and closer to a lot of cities in Tennessee, West Virginia and North Carolina than you are to Richmond.

I started at the VDA in 2020, and in just the short time since you first reached out about the program and partnerships, you were building a community that year. I don't think it's overstated. It's a no region of the state has seen more progress in addressing oral health workforce needs with innovative models between Mountain Empire establishing Virginia's second expanded functions dental assisting program, the rapid growth of Appalachian Highlands Community Dental Center and Dental Residency Program in Abingdon. Attracting dentists from all parts of the country to the area. And those programs are also complementary to recruit and retain dentists in the region. You also need dental assistance, and the other team members who all play crucial roles in patient care. So, I wonder if just to start, you could share some about your path to dental education, how this all got started, and how you returned to that area of Virginia to help meet a workforce need in the region.

[00:02:05] Dr. Emily Bowen: As you just hit on, I'm a proud Appalachian. I was born and bred in southwest Virginia, and that was always my goal to return. When I graduated dental school, I knew that I didn't wanna practice clinically and I didn't know what that looked like 'cause everybody goes to, to come out and practice, right? And so, I was trying to figure that out and I actually took a job as an adjunct at the local community college just to kind of tide me over until the next thing. And little did I know that the next big thing was creating a dental program there. 

So, Mountain Empire, if you're not familiar with it, it is located in Big Stone Gap, Virginia, which is in Wise County. A lot of our VDA members probably recognize Wise from the many MOM Projects that we've had now. But Mountain Empire submitted a grant to the Tobacco Commission in Virginia, and we were fortunate enough to be fully funded. And so, we started a dental assistant program. We admitted our first class in January of 2020, and we promptly sent them home in March of 2020 when the world was ending or so we thought. But since then, we've had so much growth and we've had over 50 graduates from the program, and we continue to grow every year. And for a class of 12 spots, we had over 30, almost 40 applicants last year, which really shows the demand. A lot of these individuals do have aspirations of going on to hygiene and or dental school.

And so that there's a lot of interest. In Southwest Virginia, but as you hit on, we've got some challenges in Southwest Virginia and in Central Appalachia in particular. However, I think we're making really big strides in that area as well, which I'm really proud of. 

And so, as you mentioned, one of our partners is Appalachian Highlands. They host our students clinically. And they've been fantastic to work with. But I can't speak highly enough of our local dentists as well who welcome our students into their clinic’s semester after semester. They will take my calls, and they will take my visits. And I am so grateful for that because we could not have done this program without the community support.

It's an incredibly expensive program to operate. It's very labor-intensive. We've got clinical hours, lab hours, and all of these things. And so, if we did not have a community who really backed this program? I don't even know if it would be possible, let alone it certainly would be way more difficult. But yeah, there's a lot of, a lot of potential. We're really proud of what we're building; we know we have a long way to go as well. 

[00:04:32] Paul Logan: And something you touched on with 50 graduates already in, in just last five years, from the dental assisting program. Something we see in other programs is they typically remain in that region. These are usually local students in dental assisting and dental hygiene. You could look at a map of Virginia and where hygienists are practicing and guess where those programs are. So, it, it really meets that local need when you have the program there.

[00:05:01] Dr. Emily Bowen: Absolutely, our students, with just maybe a couple of exceptions. I know we had one student who went on to join the military. And so, the vast majority of them are staying in our area. And as you touched on, we are right in the corner. So, we have a kind of a tri-state area with Tennessee and Kentucky. So, some of our students may be practicing over the state lines particularly if they wanna go into specialty clinics. Lenowisco only has one dental specialty clinic, and it's an orthodontist in our, our area. So, for those of our students who might be looking to practice an oral surgery or assist with that. We've had students who've gone on, we have one who's currently working at the VA in Jackson City, Tennessee.

And we have a lot of students who want to go on to work with those specialized populations. And for that, they're going across state lines, but the vast majority of them are still staying here in Southwest Virginia. Or our region you know, broader. 

[00:06:02] Paul Logan: And that goes both ways. Both for the students but also patients are in that region, like you might be... 

[00:06:09] Dr. Emily Bowen: Absolutely. Yeah.

[00:06:09] Paul Logan: ...crossing state lines to find the right dentist or the specialist that you need for care. 

[00:06:14] Dr. Emily Bowen: Absolutely. If, If we don't have them, you've gotta go somewhere, so... 

[00:06:16] Paul Logan: mm-hmm. 

[00:06:17] Dr. Emily Bowen: ...a lot of our, our patient population is also traveling.

[00:06:20] Paul Logan: You also have the expanded functions dental assistant program there. I wonder if you could give an overview of what that curriculum looks like, how you see them utilized in dental practices and safety net clinics, particularly in a rural area. 

[00:06:35] Dr. Emily Bowen: Yeah. So, I think that's one thing that we were really excited about when we were able to get the DA II program. We partnered with Germanna Community College, which had been the only place where you could get this training in Virginia, and we actually had a local student who would drive; it was over five hours, one way. And she did that over the course of a couple of semesters. And that was really what started the conversation of there is a demand in Southwest Virginia for this, but a lot of people just don't have the resources to, to travel that far. You need childcare, you've gotta have money, and your employer has to be willing to support that. And so, we had the conversation about could we expand this curriculum so it, it's operated through our learning management system, which is Canvas. A lot of us may have used Blackboard in college or something. This is that, now. And so, we will share that online. So, our curriculum is there. But they do all of their clinical work with a licensed dentist on our campus.

For those of you all not familiar with the DA II program, I like to describe it in a nutshell, particularly for those people who aren't clinical or don't understand it. I really simplify it by saying Reader's Digest version is, the dentist still drills the tooth, but this person fills the tooth. They are not doing any sort of um, irreversible procedure, so they're only doing things that can be reversed. So, placing composites, placing amalgams or submitting crowns, doing also final impressions for crown and bridge. So, things like that. That's what the DA II is utilized for.

But when we talk about this treatment model, some clinics have reported up to 30% production increase, which is huge. And that's your bottom line. But I think it also really speaks to how much more effectively we can treat patients. If we're seeing that many more patients, if we have an increase in the population that we're serving, we know that we're getting patients out of pain faster, we're getting disease taken care of. And so, there are a lot of wins like that, particularly in a rural area where providers are in such short supply. We've gotta get creative. And I know that dental therapy has been discussed or whatever. The beauty of DA II is that the dentist is still in control, that we're not giving over all of that treatment planning to someone else. Like I said, you still start the procedure, you will still do the final check off before the patient is dismissed. And honestly, the restorations that our students are doing are beautiful. Because they get so efficient at it, they're so good at it. That's all they're doing all day long is placing composites. They're gonna get really darn good at it. And so, I think it's a real win for the profession for our patients. Like I said, we still have control of our treatment planning, which is super important, but this is just a way to become much more efficient in our clinic practices.

[00:09:37] Paul Logan: And it's such a benefit, as you said, a rural area where there's no shortage of patients for dentists. 

[00:09:44] Dr. Emily Bowen: Oh, no. 

[00:09:45] Paul Logan: Dentists are very busy and allows them to increase efficiency in their processes, see more patients. 

[00:09:52] Dr. Emily Bowen: Yeah. 

[00:09:52] Paul Logan: It's also important for the dental assistants who, this is a path for them to advance in their career. Something we see across the state is like dental assistants, they don't get into a hygiene program or go on to a dental program that a lot of them want to do more and you lose them. Some of them go to nursing or other health professions or just switch careers completely. It allows them to do more and grow in their experience within a dental office. Are you seeing most of the assistants who go through those programs are already working in a dental office? 

[00:10:28] Dr. Emily Bowen: Absolutely. So, the vast majority of them are, some of our students have had 20 plus years with dental assisting, maybe not in the exact same office or whatever. But this is clearly their profession. They are very committed to it. And I think that giving them the DA II certification or giving them that option really opens up more doors. Like you just said, a chance for kind of, growth in their own career, but more importantly, it really leads to longevity in their career. If they're more satisfied with it, they're more likely to stay. And so, as we see retention being an issue, and burnout, particularly post-pandemic, everybody in healthcare, not just dentistry healthcare broad, we all keep hearing that, that word burnout. Giving them more ownership of their profession, like this, is another way to ensure that you have continuity in your practice, and that's really important. Danby, which is the Dental Assistant National Board, I think that they estimated that for every day a dental assistant is out, you lose about six percent in your overall production. And it can cost up to about 50% of their salary or something like that to retrain a new assistant. So, if you have a revolving door of assistance coming in and out, that's a challenge. But really looking to, to your local training centers, whether that be a community college, whether that be a vocational program, 'cause I know some schools in our Commonwealth are starting that.

But if you find a student who has gone through and has at least committed to the academic program, you know that they have a level of interest and a commitment already. And so, if you can encourage them to get into the profession and you see the potential that they have, DA II might be a good thing.

And I love that. DA II, I call it the à la carte option. And so, we have three certificates, composite, amalgam, and then crown and bridge. You can do one of three. You can do all three of three. It really is catered to what you want. A lot of our students, for example, aren't placing amalgams 'cause that's not super popular in clinics anymore. And so, they may choose not to get that one. But again, it depends on what your practice is seeing and what your patient population demands. 

[00:12:48] Paul Logan: So, as you're talking about incorporating DA II into a practice for an office that doesn't currently have one. It's really a conversation both with the assistant and with the practice to help them understand this is what it will look like. Can you talk a little, what does that conversation look like? 

[00:13:06] Dr. Emily Bowen: So, I think it's gonna look different for every office, but some of the things to consider would be, are you running one column or two columns? Like, you might be able to strategically start planning your patients where you have a simple restorative and then a more complex case. So, while you're working on that, that straightforward restorative composite or whatever, then once you've got that tooth prepped, the dentist can return to this other patient who's maybe getting an implant or something. And so, we've talked to some dentists that say, it frees me up a little bit more to work on those cases that I really love. Like, I wanna do very cosmetic, high-end, whatever, restorative cases. And so, the DA II gives me some flexibility to still treat these other cases while I get to focus a little bit more on implants some days.

And that is something that, that we've heard from our practitioners who've utilized DA IIs. Another thing that I had someone point out too, this is open for a hygienist. They still have to have a CDA, but a hygienist can do it. And one of the doctors that I was talking to about this program, she said, I would love to get my hygienist trained in this because she said, a lot of times on recall, patients will see something that's very simple, very straightforward, and rather than reschedule that patient, we might be able to just go ahead and do that class one while they're here. And so that's something to consider too. It can look different in a lot of different ways. That's kind of the beauty of this treatment model, too, is that you can really tailor it to what fits your office, your style, and your patient population.

[00:14:47] Paul Logan: And back to dentists in rural areas. Being able to see that patient without rescheduling them is so important. If they're driving 20, 30 more miles to... 

[00:14:59] Dr. Emily Bowen: Absolutely. 

[00:14:59] Paul Logan: ...get to the visit, it's not convenient. 

[00:15:02] Dr. Emily Bowen: I think that some of the challenges that our patients face, like you said, not only travel, but that's time off of work. That's time to secure childcare and all of those other things that go into it. And if you're working also with a Medicaid population, we know that return rates and sometimes visits aren't the best. And so, if you've got 'em there, let's make the most of this appointment and get as much done as we can. 

[00:15:24] Paul Logan: Are there any common misconceptions about DA IIs, the role they can play in patient care that you hear as you're talking to dentists in the area? 

[00:15:34] Dr. Emily Bowen: Absolutely. I think dentists and patients, I've had some conversations with patients. I actually had a conversation recently with someone who said, why would you let someone else do that? Why would you not just go to the dentist? And my response is. If you have a sinus infection and you call your primary care physician and they say, doctor is full, but we can get you in with a nurse practitioner tomorrow, would you take that? I would! Like, I wanna go ahead, get that antibiotic, get whatever I needed to get done. Those are mid-level providers. We have become accustomed to seeing nurse practitioners, physician's assistance in medicine. Dentistry doesn't have that, but DA II is as close as we have in Virginia, and so if we're accepting it in other forms. I don't know why people are so hesitant to accept it in this form.

And then with practitioners, again, I think that there's just a lot of confusion. A lot of them don't know that it exists. It's been available in Virginia for more than a decade now, but actually just at one of y all's recent, meetings. I think the last one that you all had in Norfolk we had someone stop by our booth 'cause we had it set up for DA II recruitment there and they were like, oh, are y'all out in North Carolina?

We're like, Nope, this is a Virginia thing. Like it, it happens in our state. So, I think a lot of people just don't know it exists. And then there's the confusion of the dental therapy versus DA II and there are so many differences. This is not dental therapy. And I think that is probably the biggest misconception that I see amongst practitioners. 

[00:17:05] Paul Logan: Talking specifically, you said that you have the three certificates you can get, as part of the DA II program. What does that timing look like for the education? And can you share a little about what the application cycle is? 

[00:17:17] Dr. Emily Bowen: Absolutely. The students will take an online oral anatomy and operative dentistry course first. They can opt out of it. We've seen several foreign-trained dentists who may not want to go back to school, may not have been accepted. That might be for finances, for family reasons, time, all of those things. But they've obviously been trained. They have a skillset, and they'd like to use it here, and if there is that, if they have gone through a CODA-approved program, such as a dental hygiene program, they can take an exemption exam and potentially place out of that. But if you have an assistant who's been chairside trained or gone through a non-CODA-approved program, we require them to take an online oral anatomy and operative dentistry course. So, we're really hitting the hard parts of all of the tooth anatomy because they're gonna be restoring that. So, we want them to know the official terminology for that. We want them to learn, again, about more materials. A lot of us get in the pattern of this is what our office uses, and this is what we know, but we want to introduce them to some other alternatives so that if they're working in a new clinic or if they want to use a new material, that they're at least familiar with it.

So, we have that. That runs about every semester. So, we'll have it. And it's not the full length of the semester as a seven-week course, but we'll offer it in the next one in the summer. We had one this Spring that's wrapping up right now, and we'll have another one in the Fall. So, students have to have their CDA first. They can email me or Dr. Mesmer at Germanna with a copy of their CDA and we'll help them get enrolled in that. And then after they successfully complete that course, or they've placed out of it on their placement test, they can enroll in any one of those three. Currently, we only offer crown and bridge in the Summer. But we offer restorative, both amalgam and composite in Fall and Spring. Those can run consecutively together. The hours will vary a little bit based on board requirements. So, amalgam has the least number of hours. But you have to think about amalgam. We're not gonna be doing any sort of interiors. Um, we’re only really doing posterior teeth there. Composites, we'll be doing both anterior, posterior. All the different classes and stuff. So, it was just a little bit more in-depth. And there's a few more hours required for that. The good thing about this program, it's been designed really for the working student in mind. So, we know that a lot of our students are working assistants or hygienists. And so, we try to be respectful of that. So, we offer labs and classes on either Fridays, typically, or sometimes Fridays, Saturdays. And that way, we're minimizing their time out of the office. Most offices are either closed on Friday or have limited hours on Friday. And so, we're trying again to be respectful of that and work with them in their schedule. Each of those three units are a semester-long. If you wanted to take it in theory, if you have your CDA, you could enroll in, in the operative course this summer, and you could be placing composites or amalgams by Christmas time.

[00:20:34] Paul Logan: And you mentioned that, there also is the DA II program at Germanna and the Fredericksburg area. 

[00:20:39] Dr. Emily Bowen: Correct. 

[00:20:40] Paul Logan: And those are the two programs we have in the state right now. Where would you recommend if a dentist wants to learn more, to just get more information, and to get someone in their office in the queue?

[00:20:53] Dr. Emily Bowen: Like I said, they can absolutely reach out directly to either myself or Dr. Messer. But also, just go on either Mountain Empire or Germanna's websites and search for DA II expanded functions. There's a link to it through our Dental Assistant Pathways, and that will have a lot of information there. 

Right now, also Delta Dental of Virginia Foundation has sponsored a scholarship. So that Oral Anatomy and Operative Dentistry course is normally $750. And we have a few remaining scholarships that will cover that cost. The labs, the Composite Amalgam and Crown and Bridge are covered by financial aid. And so, this is also a really good professional development investment. If you're looking at, the cost of this versus some other CE courses and things like that. I feel like that this is a really good investment in your practice if you're considering that. And this is a great time to take advantage of that scholarship while it's still available as well.

[00:21:51] Paul Logan: You have the financial support to be able to do that, can continue to work and have a steady income as you go through this course. And then on the other side, you have an expanded scope of practice and an ability to bring more value to the practice, and I think in talking to our members who have incorporated these into their practice, they also are rewarding those assistants who go through that.

[00:22:17] Dr. Emily Bowen: Absolutely. And like we talked about earlier, job security for the dental assistant but also job satisfaction that's a really big component of it. So yeah, it's, there are just so many advantages to this this treatment modality and utilizing this type of professional in your office. And the fact that you can tailor it to your office is super important as well.

[00:22:43] Paul Logan: Dr. Bowen, thank you so much for joining us today. Is there anything else you'd like our members to know about the program, about what you're building, and how they can help as you're making plans for the future? 

[00:22:57] Dr. Emily Bowen: Yeah, first of all, thank you for giving us this platform to, to promote it, to talk about this program. We certainly appreciate that. I think for our members a lot of them ask how can we support this or what can we do? We also see that there's a really big problem. We know that there's a provider shortage, and I think a lot of people are very quick to say we just need more dental students, right?

Working in education. I realize how that's easier said than done. It's a very expensive program. We have limited resources. Just like there's a provider shortage. We have a faculty shortage. And so, if you're in the position. If you're near one of these schools, whether it be an allied program like ours, or whether you're near the dental school at VCU or ODU in the hygiene program, really take advantage of that and go to those institutions, be willing to be an adjunct or something. You, you can do it, one day a month or something like it, it doesn't have to ruin your schedule. But we're always looking for adjunct faculty. 

And one that's just a no-cost, at all is if you ever have expired materials, give us a call. Our budgets are tight and you, we all know how expensive materials can be. So, if you have an expired Optibond or something like that. If you have a sleeve of lidocaine carpules that have gotten pushed back to the drawer, and you didn't realize that they went expired. We can practice with those. Our mannequins don't mind. And I would much rather have my students practice loading an injection in a syringe, in a safe, controlled environment, rather than with your patient in an office, if they're gonna get stuck, I'd rather them get stuck with us. Knock on wood, we've never had that. But those are the types of things that we look for all the time and it's a really big asset for us. If you'll just give us a call, we'll come take it off your hands. You don't have to do anything. 

[00:24:50] Paul Logan: And just to reiterate the point on the adjunct faculty need in talking to our members who've either taught at the dental school or at an allied program the rewards flow both ways, I think. Yeah. When they come to the dental school they're getting information on the latest treatments. The latest things that they don't have and are able to keep up with everything that's happening in dentistry, and it's just giving back. Everyone who has become a dentist, become a hygienist, become an assistant, has had so many people in their life who have donated that time to get them to that place. And... 

[00:25:30] Dr. Emily Bowen: Absolutely. 

[00:25:30] Paul Logan: ...it's wonderful to see that, especially for our dentists who are later in their careers and have additional time that they can.

[00:25:37] Dr. Emily Bowen: I tell my students that every semester they're always super nervous going into clinic and I say, guys, we weren't born dentist. We weren't born hygienists or assistants. Like you have to learn. And so, whether they tell you that or not, these dentists have gone through the ringer, they've gone through the program. And so, it is nice, like you said, to come and give back. It's also great if you're not late in your career, you can start identifying potential employees if you have a relationship. You can get an associate; you can recruit a hygienist to your practice. I can't tell you how many offices in our area have hired assistants who have come through and worked in their practice through our program, and they'll offer them a spot or something. It is a win-win for everybody. Yeah. It just takes a little bit of time and effort, and it's something that a lot of people just don't really think about. 'Cause once you get out of school, most of us kind of forget that mode. So, it's just kind of thinking back to, like you said, where you started.

[00:26:35] Paul Logan: Dr. Bowen, thank you again so much for joining us today and we will put all of the information for Mountain Empire's programs in the show notes. 

Thank you for joining us for this episode of The Fulcrum Podcast. The Fulcrum is a podcast of the Virginia Dental Association. Please send your comments and ideas for future topics to thefulcrumpodcast@vadental.org.