Dentistry for immigrants in the age of globalization

A decade of evidence on the disparities in dental need and access between groups defined by income, race and urban/rural residence in Kansas, has produced responses ranging from foundation support for innovative programs, a massive two-day charitable treatment event conducted annually by the dental community, passage of legislation enabling extended care permits for dental hygienists, and the appointment in 2006 of the state's first Director of Oral Health. However, little progress has been reported on access barriers faced by recent immigrants to the state. As elsewhere, Kansas public policies have been silent about or in some cases openly hostile to providing benefits for legal immigrants who speak little English, and even more so to the undocumented. We report on our work in Kansas' most ethnically diverse and impoverished neighborhood where after years of recording unmet need through scientific surveys, we added a 4-chair primary care dental clinic to our community based health education training center. Although modest in comparison to area private practices, response to the fee-based nonprofit program has been overwhelmingly favorable in year one. Patients vary widely in background and economic status with disproportionately high numbers of recent Asian and Hispanic immigrants. Most have been without dental care for years. Despite a well qualified, richly multicultural/multilingual staff, dentist recruitment in a state lacking a dental school, patient “no-shows”, and immigrant-adverse public policies challenge our sustainability. We describe implementation missteps and solutions and discuss the importance of ensuring a diverse dental workforce to care for our rapidly changing population.