Reducing Disparities: An Urban Clinic Model

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Diverse patients and backgrounds

For the last nine years, Havva Zeynep Ertugrul, DMD, has brought oral care to the pediatric patients at Community University Health Care Center (CUHCC) in the urban, ethnically diverse Phillips Neighborhood of Minneapolis. Dr. Ertugrul provides restorative and preventive oral health care, including fluoride varnish, for multicultural children. Many of the children she treats are of Latino/Hispanic, Asian/Pacific Islander, East African, Native American, European American, and other backgrounds. The majority of her patients are on federal and state public programs.  Others pay a percent of costs on a sliding fee scale. Still others have commercially insured payers or are uninsured. Forty-six percent of the children she sees prefer a language other than English, implying at least that many patients she sees live in families that speak a language other than English in their home.

Multicultural barriers toward oral health and fluoride varnish

Many of Dr. Ertugrul’s patients have never seen a dentist. As a pediatric practitioner, Dr. Ertugrul understands many children are extremely fearful of invasive, unknown preventive care. Dr. Ertugrul is intent on establishing trust with the children and their parents from the first visit onward. 

“Being aware of their cultural and social differences, I approach my patients with utmost flexibility and sensitivity. I always use professional, bilingual interpreters when needed as an integral part of my team. I use properly chosen educational materials and communications, taking my time to inform and train what cavities are and how to prevent caries. Many of my patients and their parents initially have no knowledge of oral health and oral diseases, and their impact. The most common chronic childhood disease is caries, and I give information about the process of caries and the consequences of having caries. I teach how brushing, flossing, and ongoing fluoride varnishes prevent oral health disease. I also see the majority of my patients at least every three months.”

With carefully designed multicultural oral health and fluoride varnish education, parents and children begin to understand the importance of prevention and early oral care. Dr. Ertugrul explains:

“Families are anxious to learn. I talk about food and healthy diet because the food patients eat in their homes varies according to cultural considerations and preferences. I take this into consideration. From the beginning, I try to form a consistent oral health “team” with the children, parents, onsite interpreters, and our dental staff.”

Treating the individual’s oral health

Dr. Ertugrul shared a recent experience involving a patient we will call Erica, a young girl of Ecuadorian descent. Erica visited the dentist at age seven for the first time. Because Erica’s parents are recent immigrants, language and cultural changes are critical barriers they are currently experiencing. However, as recent arrivals, they are eligible for a sliding fee scale at CUHCC and they appreciate this adjustment in affordable care. When Erica arrived at CUHCC’s dental clinic with her parents, her mother and father explained the key reason for their visit was bad breath or halitosis.

Upon examination, Dr. Ertugrul discovered large, deep caries in all quadrants of Erica’s mouth. Her parents had no understanding of infection or what caused it. After ongoing team work with the patient, her parents, clinical staff including front desk and finance departments, and Spanish-language interpreters during all clinic visits, Erica gradually became familiarized and desensitized towards the dental procedures that she needed. Over time, her caries and abscess were eliminated with improving compliance to treatments. Throughout this whole process, Erica’s parents established new patterns for brushing and flossing that included changing after-meal practices. These successes were the result of a fully dedicated team working patiently in unison. Today, her parents continue to bring her to the dental clinic every three months for ongoing preventive care and maintenance.

“Erica’s parents are so grateful and appreciative of what they learned and the care provided. They put all the practiced preventive actions into their daily home care routine. This not only helped Erica and her parents but also became a great inspiration for our clinic. CUHCC learned what we can do and achieve as a team and how we can help our patients improve their lives for the better!”