Preserving Oral Health for a Lifetime

Susan Hyde, DDS, MPH, PhD, an award-winning teacher and population scientist, knows firsthand how seemingly small health issues can become disabling over time, threatening life quality. “I have a passion for quality of life,” says Hyde, DDS, MPH, PhD, an associate professor at the UCSF School of Dentistry. In all her career endeavors, she promotes practices that preserve oral health and quality of life, not only for patients, but for practitioners as well. Hyde has a special interest in working with populations that are underserved, including minority children and the homebound elderly. Her research on health practices that prevent cavities confirm that these groups fare poorly and probes reasons and remedies. When Hyde, born and raised in Canada, first came to the United States as a recent college graduate, she found satisfying employment in cancer research. Yet she always wanted to be a dentist. Her father was a professor of dentistry at the University of British Columbia, and Hyde got a taste for private dental practice working as his office assistant. When she decided to stay in the US, she enrolled in dental school at UCSF. Upon graduation she made a smooth and happy transition into private practice. Then she hit a roadblock. “My body ergonomics were not well suited to it, and I became disabled after only four years.” Hyde soon came to see this setback as an opportunity to return to research, this time from a public health perspective, while remaining connected to dentistry.

Addressing Health Disparities

She earned a doctoral degree in epidemiology at UC Berkeley, completing original research as part of a US Department of Health and Human Services program. Hyde worked with welfare recipients, who often have oral health problems that affect appearance and quality of life, as well as limited resources for obtaining dental care. Hyde developed new survey and clinical data and found that oral health and use of dental care services was positively associated with the likelihood that study participants would obtain employment. People who actually used the dental services provided through the program were more successful in obtaining work, she found. Hyde then completed a fellowship in geriatric dentistry at the UCSF-affiliated San Francisco VA Medical Center, and joined the Department of Preventive and Restorative Dental Sciences in the UCSF School of Dentistry in 2005. She soon signed on with the CAN DO (Center to Address Disparities in Children’s Oral Health) project aimed at preventing early childhood tooth decay, which is on the rise and is worst among minority and low income populations. In 2008, the School of Dentistry received the largest grant in its history -- $24.4 million from the National Institutes of Health -- to enable CAN DO to launch a second round of programs to address socio-economic and cultural disparities in oral health and prevent early childhood tooth decay. In a study she co-led with UCSF School of Medicine researcher Sally Adams, RN, PhD, Hyde informed and surveyed Hispanic and African American mothers in San Francisco about preventive treatments. The treatments included three targeted to children: brushing with fluoride toothpaste, application of fluoride varnish, and having a child eat foods that contain caries-fighting xylitol sugar. However, the bacteria that colonize the mouth and cause caries are frequently transmitted from parent to offspring, so two additional treatments are targeted to mothers: antimicrobial chlorhexidine rinse and xylitol gum. “For the Hispanic population, fluoride varnish and brushing with fluoridated toothpaste ranked highest,” Hyde reports. “They perceived fluoride varnish to be very effective and perceived brushing to positively promote lifelong healthy habits.” African Americans in the study similarly valued toothbrushing, but were more likely to express concerns about other treatments. “If we were to stage an intervention with African Americans at the community level, we would want to target respected elders and spokespeople who could vouch for the safety and efficacy of these treatments.” In another CAN DO-related project, Hyde, working with School of Dentistry colleague Jane Weintraub, DDS, MPH, has been evaluating oral-health-related quality of life among agricultural workers and their families in Mendota, California, a Hispanic community. The researchers found that workers who were the least acculturated and those with the lowest wages had the worst oral health, and that oral health problems that arise in early childhood continue to have an impact later in life. Public health measures to improve oral health might include making dental treatment available at federally qualified health centers, or improving the acceptance and availability of fluoridated water, Hyde suggests.

Advocating Interprofessional Education

“I love the CAN DO Center because it is so interdisciplinary,” Hyde says. At UCSF, she advocates the same interdisciplinary collaborations that mark her own research. She is an active organizer of interprofessional education initiatives, including classes open to students and faculty from all four of UCSF’s professional schools. For example, Hyde, who remains committed to research on oral health and quality of life across the lifespan, organized an interdisciplinary “training of trainers” program called “Oral Health and Aging; Focus on Long Term Care.” She recently developed online training modules for the UCSF Academic Geriatric Resource Center, as well as for a UCSF fellowship program, Pathways to Careers in Clinical and Translational Research. “No matter what your practice is, patients – especially older patients – don’t usually have health issues pertaining only to one organ system,” Hyde says. “We’re not just mechanics for the mouth. Oral health is intimately tied to systemic health.” A dentist might be the first to observe that a middle-aged patient has diabetes symptoms, for instance and in the first years of life a pediatrician may be the first to observe early tooth decay. In recognition of her exceptional and innovative teaching, Hyde has received the Dugoni Faculty Award from the California Dental Association, an Excellence in Teaching Award from the School of Dentistry, a Junior Faculty Award from the American Dental Education Association, and most recently, the 2010 Outstanding Faculty Award from the American College of Dentists. Hyde mentors students at all levels, including students in the combined DDS/PhD program, and directs the fourth-year course on patient-centered care, a keystone of the curriculum. She’s also a dedicated preceptor and coach in the clinic. Hyde wants to prepare dentists for the long haul. As students work with patients in the examination chair, she wants them to avoid habits that might cause them harm. “Ergonomics is a big issue in dentistry. Dentists are perfectionists by training or personality. But you have to use the mirrors and develop your indirect vision, because it will serve you in the long run. Dentists also must learn to take breaks, and to work effectively with assistants.” Photo by Elisabeth Fall/fallfoto.com

Related Links:

UCSF School of Dentistry UCSF Academic Geriatric Resource Center Pathways to Careers in Clinical and Translational Research UCSF receives $24.4 million to fight early childhood cavities UCSF News Release, December 18, 2008