Grassroots Dentistry

The last thing Corie Rowe, G05, D11, wanted was to become a dentist. His first experience in the chair, as a young boy in Jamaica, was so dreadful that he swore it would be his last.

After studying mathematics and environmental science at Bradford College in Massachusetts, Rowe test-drove some pretty diverse career paths, starting with grassroots community work with local and national environmental organizations in Boston (he holds a master’s degree in urban and environmental policy from Tufts). In the late 1990s, during the dot-com heyday, he worked as a network engineer. Then it was public health: he studied access-to-care issues as a research associate at the University of California, San Francisco.

A divergent path, for sure. Along the way, he went back to the dentist (his second experience was positive), and he started thinking that dentistry could be a powerful way to improve health in low-income African American communities.

Now, nearly two years after earning his D.M.D., Rowe has obtained a loan and expects to open a clinic this spring on Chicago’s South Side. He talked to Tufts Now about how his experiences helped shape his approach to dentistry.

Tufts Now: So your first experience with dentistry almost drove you away from the field permanently?

Corie Rowe: Yes! At the time, I was a kid in Kingston, Jamaica, with a typical Caribbean upbringing—kites, soccer from dusk till dawn, hurricanes, running around barefoot. I was really independent, so when I had a toothache one day, I was just told to go find this clinic around this corner all on my own. I wound up with an extraction of one of my molars—number 30, in the lower right. Knowing what I know now as a dentist, I’m sure it could have been saved with a root canal, but back in those days, they just did extractions. So I left the place with a lump of gauze stuck in my mouth, and when I went home, I fell asleep and woke up with blood all over the pillow. I was so freaked out that I wanted to kill the guy. That was it for dentistry, as far as I was concerned. I hated it for years.

That’s not an auspicious start. How did you end up in dentistry?

I took kind of a circuitous route. I knew I wanted to stick with science, but I didn’t want to do purely academic stuff. I wanted it to apply to something, and I felt the best way to do that was in environmental science, where I could have an impact at a grassroots level.

During undergrad, I started working for a program that the U.S. Environmental Protection Agency ran at the Franklin Park Zoo in Boston, helping expose urban youth to the environment around them, instead of just concrete, which is just about all you see in the city.

Later, I worked with Alternatives for Community and Environment, an outfit that gives legal assistance to low-income communities that are trying to prevent industrial waste facilities from being built in their neighborhoods. Most often you won’t find those sites in wealthy areas of a city. That experience drove home the idea that environmental issues are really social justice issues. That resonated with me and inspired me to start grad school at Tufts in environmental and natural resource management. I left school for a few years, though, because my experience with the EPA led to some disenchantment with the whole environmental process.

Disenchantment? How so?

Well, at the community level, you’re on the street, hearing people’s concerns in person. In order to do anything about them, though, you have to wade through the red tape of a government organization. You don’t always serve the community effectively. I got so frustrated that I eventually left the environmental movement and dropped out of grad school at Tufts for a while. I wound up switching gears entirely, thanks to some computer skills I picked up in high school and college. I was a network engineer at a telecom start-up called Snapdragon in the late 1990s, and later moved on to Wired Business and Alcatel, two other telecom companies. It was a real dot-com experience. We were all drunk on the idea of being millionaires overnight! But the dot-com boom went dot-bust pretty quickly, so things didn’t pan out the way we’d hoped.

That’s a big career change. Was it hard to make the switch?

Sort of. It was great to get that big paycheck every two weeks, but I always missed the satisfaction that I got when I worked with low-income communities. That was far more rewarding than any accolades I could get in the tech world. Luckily, after a couple years, I had an epiphany about dentistry.

How did that happen?

I finally had a truly great dental experience. It was around the time I left grad school temporarily in the late ’90s. I had a cavity, throbbing pain—something wasn’t quite right. I hadn’t been to the dentist since I was a kid, if you can believe it, so I was pretty lucky that I didn’t have any other problems. I was nervous, of course, but this guy was fantastic. He gave me local anesthetic, and I didn’t even feel the needle because he shook my jaw. That was totally new to me. My perception of the pain was much less than the horrible experience I had as a kid, so I left the appointment thinking very differently about dentistry.

Then, in 2000, the surgeon general’s report on oral health in America came out. It was pretty influential—it basically said that the state of oral health in low-income communities and communities of color was so bad, it was becoming a public-health nightmare. That’s when it hit me: Those are the same populations I was working with doing environmental stuff, so if I became a dentist, I’d have an opportunity to really make a difference in those communities. So I got back in touch with Tufts, finished the last few credits on my master’s degree and applied to dental school.

What was it like to be in dental school after years of doing environmental work?

It was like trying to drink water from a fire hydrant. That’s how fast and furious the information came at us. Ultimately, though, it was a blessing. I was talking with some of my classmates recently—we’ve only been out in the real world for a year and a half, yet we all feel that Tufts prepared us really well for any challenge. Drinking from the fire hydrant helped us define the boundaries of our own knowledge and gave us the confidence we needed to teach ourselves anything we didn’t already know.

How do you think all of your experiences have shaped your approach to dental care?

They’ve made me appreciate that dentistry isn’t just about white, straight teeth. It’s about total oral health, and systemic health. How you chew your food, for instance—that can affect your temporomandibular joint, which can cause headaches or pain from chewing. It can affect your whole life.

So how will that translate into your work at the new clinic in Chicago?

The clinic on the South Side is in a predominantly African American area. My goal will be to educate my patients on a one-on-one basis to help them understand how their oral health ties in to their overall health.

My negative experience with dentistry also informed my outlook, in that my practice will use a lot of technological advances to reduce a patient’s perception and apprehension of pain. I know what it’s like to be terrified when you’re in the chair. If you give the patient a couple of tablets of a benzodiazepine, for example, it relaxes them and reduces their anxiety so you can get the work done that’s needed. Those are the individuals who oftentimes fall through the cracks within dentistry—the ones who are afraid of the dentist.

As a new grad, however, one of the most important things we have to keep in mind is that a dental practice is a small business. The clinic will be in a storefront on West 95th Street, where there are a lot of other businesses that have been open for years, so I’m hoping that’ll help bring in patients. It’ll be a small practice at first—just me, an assistant and a front-desk person. But if things go well, I want to bring in an office manager, an insurance verifier and a hygienist. Right now, I’m just trying to promote the business the way other small businesses do—go out and make connections in the community, work with the local small business bureau, send out marketing pieces, the works.

Building Connections with Low-Income Patients

“Even if there’s a clinic around the corner, low-income communities just don’t have the same education about preventive dental care as you’d see in more affluent communities,” says Corie Rowe. Photo: David Johnson

In 2007, Corie Rowe ran into a riddle: More children in America’s low-income communities had access to state-provided dental insurance than ever before, yet according to the National Center for Health Statistics, they also had more cavities.

The problem wasn’t simply that they had no place to go for care. “Even if there’s a clinic around the corner, low-income communities just don’t have the same education about preventive dental care as you’d see in more affluent communities,” he says, and so their oral health may not be as good.

Perhaps something was getting lost in translation between the academic community and the patients and their parents. Rowe, who at the time was a research associate at the University of California, San Francisco (UCSF), had read dozens of studies that examined the effectiveness of treatments to prevent cavities.

“Yet very few of those studies examined which treatments community members actually preferred for their children,” he says. A better understanding of their preferences, he reasoned, could help dentists encourage more widespread use of the available treatments—and therefore lower the rates of decay in these communities.

Rowe decided to test his hypothesis in a formal study done through UCSF. Based on similar research other UCSF researchers conducted in nearby Hispanic communities, he helped design a 10-question survey examining three common cavity-prevention treatments for children: brushing, applying a fluoride varnish and using the proven cavity fighter xylitol, a dietary sugar substitute.

Because parents ultimately decide what sort of dental care their children receive, Rowe says, he included questions about two treatments for parents themselves (xylitol gum and chlorhexidine rinse). The questions directed toward the adults, he theorized, might tell researchers more about the parents’ own preferences, which could offer insight into how family habits affect children’s oral health.

Rowe administered the survey to 48 low-income African American adults who lived in Berkeley, Calif. They were asked if they felt any of the five treatments were appropriate for a toddler or young child, and then asked to rate their preferences for each treatment for their own kids.

The 48 parents and guardians said all five treatments were “acceptable,” but the vast majority chose tooth brushing as the preferred treatment for their children. The study results were published last year in the Journal of Public Health Dentistry.

Rowe attributes the overwhelming preference for brushing to existing cultural norms. “That’s what their Mom and Dad taught them to do,” he says. “That’s what people in their community did, and that’s what you see people most often on TV doing.”

A better understanding of these treatment preferences, he says, may give other dentists working in low-income African American communities an entry point to educate patients about a range of effective oral health practices.

“Existing treatment preferences, that’s your hook,” he says. “You say, ‘Well, I know you value using a toothbrush, and that’s great. But did you know about xylitol?’ And if someone isn’t already comfortable with these other preventative measures, you can use their knowledge about their existing treatment preference to get them interested in that conversation.”                                                               

This article first appeared in the Spring 2013 issue of Tufts Dental Medicine magazine.

David Levin is a freelance writer based in Boston.