The Oral Health Program at the Carroll County Health Department has a new manager in David Williams, a dentist with extensive experiences ranging from private practice, to Army special forces deployments, to forensic science research.
Most recently a member of the full-time faculty at the University of Maryland Dental School, Williams is now splitting his time between doing research at the school and working in the Carroll County Health Department's dental clinic three days a week, and is exploring possible areas of cooperation between the school and the Health Department.
The Times caught up with Williams to discuss his more than 30 years experience doing dentistry under a wide variety of conditions and how his experience will translate to the clinic here in Carroll.
Q: You're the new Oral Health Program Manager at the Carroll County Health Department, but some people may not be familiar with the program. What is the oral health program and who does it serve?
A: The most obvious program we have is the pediatric dental clinic. The clinic was started about 15 years ago and up until I came here saw patients up to the age of 12. In looking at our schedule and the need in the community I increased the eligible age to 18, which is usually the age one is considered an adult. We service over 800 children each year providing care to those who have Medical Assistance insurance, are citizens of Carroll County, and are between the ages of 1 and 18.
Another oral health program supported by the Health Department is the fluoride rinse program that is provided, at no charge to elementary and middle school students that attend schools that do not have fluoridated municipal water. This is about half the elementary/middle schools in the county.
We also have a program to help older citizens called "Dental Access," not to be confused with "Access Carroll." This provides those over the age of 60 who meet specific income limits access to local dentists at a reduced fee.
It is also my job to reach out into the community to help to determine gaps in the oral health of the community and help to mitigate any deficiencies. In the past few weeks I've spoken with the school nurses and provided oral cancer screening at an event focused on the homeless. I will be attending a number of "health fairs" in the future to promote the pediatric clinic, provide information and in some cases provide services to the community.
Q: What does your role as manager entail in this program? You have been a dentist in private practice before, is this a similar job? And you get to do any actually dentistry?
A: My position is less direct patient care and more population based public health. This is a major pivot from private practice. In most cases in direct patient care, the patient comes in, there is treatment, and the patient leave at the end of the appointment in a better health condition that when they come in. In public health the interventions are for a much larger population with the idea that the results will be seen years, even decades later. The position also involves policy making/providing expert advice to policy makers. There are periodically issues that come up at the local, state, or federal level that involve oral health policy. I have to be knowledgeable on a variety of subjects to provide information that will guide policy making.
I do have the opportunity to treat the children in our clinic, which I like because it gives me the chance to get back to what I've been doing for the past 30 plus years.
Q: As a dentist, and now the manager of this oral health program, is there anything about dentistry or oral health that you think people should understand, but they often do not?
A: Oral health literacy is a very large part of public health and here it is no exception. Dental decay is the most common chronic disease, affecting over 90 percent of the population and it is completely preventable. We have the means to eliminate or at reduce this disease dramatically, but it continues to affect our citizens.
The effect of oral disease goes way beyond the mouth. There are studies linking oral diseases to a variety of systemic diseases including diabetes and heart disease. Consider the diabetic who cannot chew properly because of missing/damaged teeth. They cannot maintain a healthful diet and therefore would have more difficulty maintaining their blood glucose levels. In addition, the inflammatory process of diabetes increases diseases of the structures supporting the teeth and therefore reduces chewing efficiency, so it is a vicious cycle.
A person's appearance is critical to getting a good job and a nice smile is a big part of that. People with good teeth are more likely to get jobs and they are found to be more attractive, so there are social impacts to oral health as well.
Q: Prior to your recent dental career in private practice and teaching at the University of Maryland School of Dentistry, you served in the Army with the 10th Special Forces Group and the 3298th Dental Service Detachment. Were you doing dentistry during all of your time in the army, or did you serve in other roles?
A: I was on Active Duty in the Army for about 12 years and in the Reserve for 14 years. Following Officer Basic Training in San Antonio Texas, I went to Germany for three and a half years. That was a time when the Cold War was still in full swing. While there I supported the First Infantry division — The Big Red One — during field operations simulating the invasion of Germany by the Russians. My primary job though was to treat the family members of soldiers. I was treating mostly children for my time there, which came into use during private practice and here at the Health Department.
From Germany I went back to San Antonio for [the] six-month Officer Advanced Course and then to Fort Devens, and the 10th Special Forces Group Airborne as a Special Staff Officer. Here I treated members of the Group, also acted as the subject matter expert in dental and in some cases medical matters. Historically dental problems have accounted for up 30 percent of disease-non-combat injuries and can devastate the fighting strength of a military organization. While assigned to the Group, I attended Army Airborne School and eventually had 25 military jumps. I also completed the Special Forces Qualification course where we started with 214 soldiers and ended with about 60 at the end of the five months of training. The 10th's Area of Operation was Europe and the Middle-East and yearly we deployed there for training. When I left the Group, I transferred to the hospital at Devens where I assisted the oral surgeon and treated soldiers assigned to the hospital. During this time I graduated from the Army Command and General Staff Course.
My next assignment was at the Pentagon where I treated those Army personnel assigned to the Pentagon. I earned a Masters of Science in Systems Management during my time at the Pentagon
I left Active duty and went into private practice, but continued in the Reserves, initially in a number of units, until I was selected to Command the 3298th Dental Service Detachment in Brooklyn, New York, I had a unit of about 80 soldiers, both dentists and support staff, responsible for their general well-being and promotion.
I was then selected to be the Command Dental Surgeon of the 77th Regional Support Command, responsible for the oral health of about 20,000 Reservists in New York and New Jersey. I retired from there as a Colonel.
Q: Are there any experiences or skills from that in the army, beyond the specific dental practice experience, that you find our useful or applicable in this new position at the health department?
A: My overall time in the Army helped me to understand how large, governmental agencies work. My time in the special forces impressed on me the absolute need to work as a team. There if someone made a mistake, there was a potential for death. Overall it was a chance to hone my leadership skills by having outstanding mentors. The Army was a large bureaucratic organization, so it helped me to understand the pace at which governmental agencies make decisions.
Q: You've also served as an expert witness in court and have been involved in forensic dentistry. Can you speak a little to what is involved in that sort of work? Is it a body of knowledge and skill available to most dentists or does it sit apart from regular dentistry?
A: During my time in the Army, I attended a week-long forensic dentistry course at the Armed Forces Institute of Pathology. I learned a lot about how the dental and the legal fields intersect. I later took quite a few more courses in a variety of forensic-related topics. I am a Fellow in the American Academy of Forensic Sciences which requires training, experience and providing presentations on forensic topics.
I was asked by a local child advocacy center to consult on a case of suspected child abuse. I reviewed the available materials, and determined that the child had numerous injuries consistent with child abuse and I testified in court.
Q: Can you speak a little about your involvement with United Flight 93?
A: My wife and I were members of the Disaster Mortuary Operations Team in 2001. Following the downing of the four aircraft, the federal government assigned different organizations to each of the sites to aid in the identification of the victims.
We were deployed Sept. 13 to Shanksville [Pennsylvania] to aid in the identification of those victims. We were there for about 12 days, working in the morgue in a variety of positions. We were able to identify about a dozen victims through dental records and about the same number with fingerprints. In the end DNA was used to identify all 40 victims and the four hijackers.
Q: What about your other work, teaching at the dental school and your work on disaster management and child abuse: Are there any projects you are involved in that you are excited about?
A: My wife and I are working on research involving the oral collection of DNA that could provide the scientific basis for the future collection of DNA in the oral cavity.
I also have an interest in the prevention of musculo-skeletal injuries in dental professionals, and have conducted research and given presentations on this subject.
Q: What made you decide to bring your skills to bear here at the Carroll County Health Department? Are there projects or initiatives you are excited about undertaking here in your new role?
A: I heard about the position through a colleague. With my Masters in Public Health and my interest in population health, it seemed like a natural fit.
Currently I am interested in expanding our current programs with a view to perhaps to add programs as needs are identified and funding is available.
More dental providers willing to take Medicaid patients are needed
In general, the Carroll County Health Department is moving away providing clinical care directly, which is why County Health Officer Ed Singer was initially puzzled by the department's on-site pediatric dental clinic when he started on the job in July.
"It was one of the programs I was scratching my head about, as to why we were doing a dental clinic here at the Health Department, but as I have gotten into the job as health officer and looked at things more closely, I certainly have an understanding of why this one is really important," he said. "The service just isn't available out there."
By service, Singer is referring to dentists willing to see the roughly 8,000 Medicaid eligible patients ages 1 to 21 who need dental care.
"I found that seven private dentists will take Medicaid patients in Carroll County, however most of those dentists will not take many Medicaid patients," he said.
In 2013, the most recent year for which Singer had statistics available, 52.5 percent of Medicaid eligible children had been able to see a dentist within the 12 months prior to being surveyed, having been treated by a combination of private dentists and the Health Department clinic. That still leaves some 4,000 children in the lurch, but it's a vast improvement over what it used to be.
"In 2001, we had no Medicaid providers in Carroll County, and we didn't have a dental clinic here at the Health Department," Singer said. "At that point in time, there were 23 percent of the Medicaid population that were able to see a dentist within the last year."
Despite the increase, Carroll still ranks next to last among Maryland counties — just ahead of Charles County at 50.7 percent — attempting to reach a statewide goal of 64.6 percent of Medicaid eligible children seeing a dentist each year by 2017. Singer said he would like to improve upon that number.
"Our goal is to try to encourage private providers to take the kids that are on Medicaid or medical assistance as much as we can and get them into the private sector," he said. "That said, our other goal is as long as we can't get them all to private dentists is to try to make our clinics as efficient and see as many patients as we possibly can."
David Williams, the new manager of the Health Department's Oral Health Program will play a significant role here, according to Singer, both in terms of revamping the dental clinic to be more efficient, but in reaching out to local dentists to help and encourage them to take on at least some number of Medicaid patients.
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"A lot of it is now that we have a dentist here, just being able to have a conversation with people and say, 'Hey, this is the right thing to do for giving back a little bit,' " Singer said. "To try to get to where we really want to be it's not just going to take what were doing here at the Health Department, its going to take getting some other people in the community to chip in."