Shenam Ticku, BDS, MPH, is currently an instructor in Oral Health Policy and Epidemiology at Harvard School of Dental Medicine. Ticku conducts research on behalf of the Office of Global and Community Health at the Harvard School of Dental Medicine, HSDM’s Initiative to Integrate Oral Health and Medicine, and the Center for Integration of Primary Care and Oral Health (CIPCOH). Born in the northern Indian state of Jammu and Kashmir, Ticku grew up all over the world and attended school in New Delhi, India, and Gaborone, Botswana. After graduating from high school, Ticku trained in dentistry at the J.S.S Dental College in Mysore, Karnataka, India. Before joining HSDM as a Health Policy Fellow in 2016, she received her Master of Public Health at the Harvard T.H Chan School of Public Health.
How long have you been collaborating with the Initiative to Integrate Oral Health and Medicine and the Center for Integration of Primary Care and Oral Health (CIPCOH)?
I joined both the Initiative and CIPCOH in 2016. I have been involved with CIPCOH since its inception both programmatically and as an investigator. In year one, I helped create entrustable professional activities (EPAs) in oral health for primary care providers. Subsequently, in year three, I co-led a mixed methods study with Dr. Tien Jiang to understand the integration of chronic medical conditions, behavioral health, and social determinants of health into postgraduate dental programs. Currently, I am working with Drs. Hugh Silk and Christine Riedy and Ms. Judith Savageau on the 100 Million Mouths Project. I will also help Drs. Robin Harvan and Christine Riedy in the evaluation of CIPCOH.
You have been involved in a variety of projects that prioritize integration of oral health and primary care. What attracted you to this work specifically?
As a dental trainee in India, I was not overtly conscious about the separation of medicine and dentistry. Most of my first, second, and third year courses were in the medical school or hospital, taught by the same faculty that taught medical students. Of course, it’s only later that I realized that while I was taking courses in General Medicine and Surgery, my medical colleagues weren’t being taught about oral health.
My time at the Chan School was transformative; it is there I started thinking about population health and systems-based issues. Toward the end of my MPH, I learned about the Initiative to Integrate Oral Health and Medicine and met with Associate Dean Jane Barrow. I knew immediately that this is what I wanted to do!
You recently helped launch the 100 Million Mouths Project. Can you discuss what this project aims to achieve, and how it connects to the integration of oral health, primary care, and patient care outcomes?
One of the main things we learned through our research at CIPCOH is that oral health champions are one of the main predictors of oral health integration into primary care training. Therefore, we decided that the best next step for us would be to cultivate these education champions across the 50 states in the U.S. These champions will engage health profession schools in their states to increase oral health teaching. Each champion will hopefully create other champions and help us reach millions of mouths. Currently, we are piloting the project with six states: Alabama, Delaware, Hawaii, Iowa, Missouri, and Tennessee.
You recently moderated a webinar titled, “Access to Dental Care: How is COVID-19 Increasing Existing Disparities?” From your perspective, how has the pandemic impacted disparities in care, and are there opportunities for primary care and oral health professionals to alleviate some of these disparities?
Persistent barriers and disparities in access to dental care existed among the vulnerable communities that have been most affected by the COVID-19 pandemic and the related economic downturn. While we need more research, we can hypothesize that potential loss of employer sponsored dental insurance, financial strain on millions of families, and added burden on dental safety net settings may increase disparities. The pandemic also provides a window of opportunity to foster integration. For example, 20 states have allowed dentists to administer the vaccine for COVID-19. This is an excellent time to pilot new models of care and simulate integration of electronic health records.
You were involved in a project to identify stakeholders in oral health reform. Can you tell us more?
Dr. John McDonough, Associate Dean Jane Barrow, Mr. Ralph Fuccillo, and I recently authored a paper on national stakeholders in oral health reform. We looked at three different areas: expanding coverage for oral health services, integration of medicine and dentistry, and workforce improvement and development. Some areas have received greater traction than others. For example, multiple groups are involved in the inclusion of a dental benefit in Medicare. Similarly, there are many national organizations working to legislate dental therapists across the U.S. However, we believe that to have comprehensive oral health reform we need stakeholders representing organized dentistry to not only be at the table but also lead the way.
You are working on a study of oral health literacy of primary care patients. In what ways does this support the mission of integrating oral health and medicine?
One of the main goals for this study was to identify the characteristics of people who regularly access primary care services, and are otherwise engaged in their healthcare but forgo dental care. We are collaborating with ProHealth Dental and ProHealth Primary Care Associates on this research.
In your opinion, what does the future of integrated primary care and oral health look like?
I hope that we continue to integrate oral health in primary care training programs. Simultaneously, we need heightened focus regarding inclusion of behavioral health and social determinants of health in dental education. To achieve that we will need accrediting bodies, discipline-specific association and other stakeholders in health profession education to necessitate change in these programs. On the larger policy front, as we gather more data regarding value-based care, we will see changes in the delivery and payment of oral health services. From a patient’s point of view, I hope we can provide care that integrates not only medical, dental, and behavioral health, but also accounts for the social needs of the population. Integration in itself, without health equity, is meaningless.