Of the more than two million incarcerated Americans, many suffer from chronic health conditions, disease, and substance-use disorders, however some of their most urgent health concerns can be a throbbing tooth, or aching oral abscess.
Harvard School of Dental Medicine (HSDM) students are learning this firsthand by providing care to patients incarcerated at Suffolk County’s Nashua Street Jail. Several HSDM students and faculty operate a weekly clinic at the 640-bed facility in downtown Boston as part of the Crimson Care Collaborative (CCC)—a team of medical, dental, and mental health professionals from Harvard and other institutions.
“The waitlist for dental care is constantly overwhelmed, and many patients must wait in order to receive palliative treatment for highly progressed dental disease that can cause pain, sleep loss, or difficulty eating,” Mindy Truong, DMD 2019, director of education for CCC at the jail said.
Jails like Nashua Street traditionally offer limited short-term palliative dental care. The Suffolk County Sheriff ’s department welcomed the partnership with CCC to provide expanded health care options to inmates, along with the opportunity to train future health care providers in a correctional setting.
Understanding health disparities
“To our knowledge this is the first collaboration of its kind involving student-delivered medical, dental and, mental health care in the correctional setting,” Lisa Simon, DMD14, PD15 attending dentist for CCC said. “This benefits patients, who have expanded access to care, dental students, who learn about the unique correctional setting, and medical trainees, who can learn more about oral health.” Dr. Simon and colleagues recently wrote about the innovative model in an article for the American Journal of Public Health.
The collaboration, spearheaded by Simon, began in October 2015 and has become a popular volunteer opportunity for DMD students. A student leadership board and faculty mentors run the clinic. Before entering the correctional setting, all volunteers attend mandatory training sessions, receive an overview of the U.S. justice system, and are screened for security clearance. Students’ roles range from conducting patient interviews and providing educational programs, to assisting or performing clinical treatment. To date, more than 15 DMD students have participated in the program, and several alumni plan to work in a correctional setting or with formerly incarcerated people in the future.
Working with the incarcerated population, students gain awareness of the complex social determinants of health. They also work closely within interdisciplinary teams to collaborate on patient care and overall health.
“People in jail face various health disparities that predispose them to increased morbidity and mortality. Many of our dental patients have complex medical conditions and/or mental health issues.” Zhen Shen, DMD 2019, dental integrated clinician for CCC said.
“I’ve learned how to better communicate with incarcerated patients and address their special needs in addition to providing dental care. It is truly gratifying to see that our dental team at the jail values oral health as part of overall health, providing patients with interprofessional care,” he added.
The jail setting poses unique challenges as patients may only be present for a short time while awaiting trial or sentencing, making it difficult to settle into a dental home. Dental students and faculty often make appointments or connect patients to community-based programs that will provide a transition to care when inmates are released.
Compassion and Care
Many students speak with compassion about incarcerated patients they’ve come to know on a personal basis. Shen recalled a patient in his forties who came in with severe tooth pain and was diagnosed with irreversible pulpitis with an abscess.
“During our visit, he shared with us how saddened he was to miss his daughter’s birthday and hopes he could be in her life soon. His emotions were tangible. Many patients like him, as much as they need their acute problem resolved, are also in a vulnerable position emotionally,” Shen said.
Some student experiences in the clinic have been profound, and even influenced their outlook on their career in dentistry.
“I would advise anyone considering alternative practice settings not to rule out the correctional setting based on any preconceived idea of what the interactions with incarcerated patients may be like. I truly have had only positive experiences,” Lindsay D’Amato, DMD 2018, said. “I have developed a sincere interest in working in this type of setting in the future.”