The MATTER Health Podcast

Transforming Oral Healthcare: Innovating accessible, equitable and integrated solutions

April 14, 2022 MATTER Season 2 Episode 3
Transforming Oral Healthcare: Innovating accessible, equitable and integrated solutions
The MATTER Health Podcast
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The MATTER Health Podcast
Transforming Oral Healthcare: Innovating accessible, equitable and integrated solutions
Apr 14, 2022 Season 2 Episode 3

One in five Americans do not have adequate access to oral healthcare. And for many who do, the cost of care is insurmountable. Dental expenses account for a quarter of all healthcare out-of-pocket spending — that means, in aggregate, patients are personally paying $55 billion annually for dental care. Whether due to a lack of providers, high cost, social barriers or infrastructure challenges, getting to and paying for dental care is difficult for too many people.

To address the broken oral health system, CareQuest Innovation Partners, in partnership with MATTER, has launched SMILE Health — a program designed to identify and accelerate early-stage startups at the intersection of oral health improvement and health equity advancement. SMILE is an acronym that underscores the innovations the program seeks: Simple, Minimally Invasive, Integrated, Low-barrier and Equitable.

MATTER and CareQuest Innovation Partners welcomed  former Dean of Harvard School of Dental Medicine Dr. Bruce Donoff and **Executive Director of National Collaborative for Health Equity Dr. Gail Christopher, **for a conversation with Chief Innovation Officer of CareQuest Innovation Partners Mariya Filipova discussing our current oral health system, bridging the gap between oral and overall health, ways to make oral health more accessible and equitable and the launch of SMILE Health.

For more information, visit and follow us on social:

LinkedIn @MATTER
Twitter @MATTERhealth
Instagram @matterhealth

Show Notes Transcript

One in five Americans do not have adequate access to oral healthcare. And for many who do, the cost of care is insurmountable. Dental expenses account for a quarter of all healthcare out-of-pocket spending — that means, in aggregate, patients are personally paying $55 billion annually for dental care. Whether due to a lack of providers, high cost, social barriers or infrastructure challenges, getting to and paying for dental care is difficult for too many people.

To address the broken oral health system, CareQuest Innovation Partners, in partnership with MATTER, has launched SMILE Health — a program designed to identify and accelerate early-stage startups at the intersection of oral health improvement and health equity advancement. SMILE is an acronym that underscores the innovations the program seeks: Simple, Minimally Invasive, Integrated, Low-barrier and Equitable.

MATTER and CareQuest Innovation Partners welcomed  former Dean of Harvard School of Dental Medicine Dr. Bruce Donoff and **Executive Director of National Collaborative for Health Equity Dr. Gail Christopher, **for a conversation with Chief Innovation Officer of CareQuest Innovation Partners Mariya Filipova discussing our current oral health system, bridging the gap between oral and overall health, ways to make oral health more accessible and equitable and the launch of SMILE Health.

For more information, visit and follow us on social:

LinkedIn @MATTER
Twitter @MATTERhealth
Instagram @matterhealth

Speaker 1: (00:11)
Well, hello, everyone. Welcome to our program on transforming oral healthcare, which we are hosting together with care quest, innovation partners, uh, I'm Steven Collins. I'm the CEO of matter. We are a healthcare technology incubator and an innovation hub with the mission to accelerate the pace of change of healthcare. Uh, for the past decade, we have seen rapid increases in investment and entrepreneurial activity focused on improving health and healthcare. There has however been comp comparatively little activity focused on dentistry, and it's time to change that. So oral health is a critical component of overall health and wellbeing, and there are enormous opportunities for entrepreneurs to help address issues of access and equity and capitalize on new technologies to improve oral health for all care quest innovation partners. In matter recently launched smile health program, designed to identify and accelerate early stage startups at the intersection of oral health improvement and health equity advancement.

Speaker 1: (01:14)
Our goal is to foster identify and advance solutions that can make oral health more accessible and equitable and integrated into our overall health. Um, and it is my pleasure to introduce Maria Phillip PVA, who will be the moderator of today's program. Maria is a serial entrepreneur, an activated patient, and a health cor healthcare transformation catalyst. Uh, she's the chief innovation officer at the care quest Institute for oral health and care quest innovation partners, where she leads initiatives and integrated care and manages in impact investing fund for solutions that make oral care more integrated, equitable, and accessible, uh, previously. And when I got to know her Maria served as the vice president of innovation at Anthem, where she led the development and launch of multiple breakthrough solutions and programs that made the news recently, including, uh, the first of its kind blockchain coalition for interoperable solutions in healthcare called avenue, uh, Anthem sensor portfolio, developing solutions to diagnose and manage chronic disease remotely, uh, Anthem's digital data sandbox, which is the largest, uh, de-identified commercial data set available for researchers and startups and a $5 million XPRISE rapid COVID testing competition, uh, to identify and validate fast, frequent, cheap, and easy to use testing solutions for COVID 19.

Speaker 1: (02:41)
Um, Maria's personal journey as a patient fuels her passion for blasting change in healthcare. She's been recognized by a number of publications and organizations, including a business insider and the Harvard business school associations of Boston for her leadership. Um, I'm delighted to be able to work with her, to build what is, what we believe a transformational approach to oral health innovation, uh, welcome Maria, and I'll turn it over to you.

Speaker 2: (03:10)
Great to be here and a pleasure to be reconnected Steven, and to be working on this, um, really transformational initiative together. I am, um, very pleased and honored to be part of the conversation today and the conversation partners that I have the pleasure of, um, sharing the stage with are two dis distinguished leaders and change agents in their own, right in health and oral healthcare. And I'd like to begin by introducing my two conversation partners today. Um, I'll start with Dr. Gail Christopher, Dr. Christopher is the executive director of national collaborative for health equity. She's an award winning social change agent with expertise in the social determinants of health and wellbeing. And in related public policies previously, Dr. Christopher served as a senior advisor and vice president at the WK Kellogg foundation where she was the driving force behind the America healing initiative and the truth, racial healing and transformation effort. She's currently sharing the board of the trust for America's health. She's been a fellow of the national academy of power administration, as well as the recipient of the Terrence Keenan award from grant in health. In 2021, Dr. Christopher was elected by the a PHA that's the American public health association to be the honorary vice president for the United States. Dr. Christopher, I'm so pleased to welcome you to this discussion. Welcome.

Speaker 1: (04:46)
Thank you. It's my pleasure.

Speaker 2: (04:49)
It's really a pleasure and really looking forward to our discussion. I'd like to introduce our second panelist today. Dr. He's the distinguished professor of oral and Mafa surgery at Harvard university. He served as the Dean of Harvard school of dental medicine for almost two decades from 19 91, 20 19. I promise we won't try to date each other in terms of the, the ears we've been in healthcare. Um, very importantly, uh, Dr. Dono grew up in Brooklyn. He received his degree in dental medicine, uh, from the Harvard school of dental medicine and his degree in medicine from Harvard, from the Harvard medical school, Dr. Don's professional career has centered on Harvard's faculty of medicine in the Massachusetts general hospital department of oral max facial surgery. He's been, he's made major contributions in research to the specialty of oral and max facial surgery with interest in wound healing, bone graft, survival, censoring, nerve repair, and oral cancer. He recently launched an initiative for car school of dental medicine, integrating oral health and medicine. I can't wait to ask him about that. He's also received numerous awards throughout his professional career and continues to see patients today. Dr. Dono, we're so honored to have you with us today. Welcome.

Speaker 3: (06:10)
Thank you.

Speaker 2: (06:12)
So, um, what, what we have in common, um, is our, um, passion for transforming health and, uh, oral healthcare. What we also have in common that I discovered is that we're all of us are storytellers who take on change in, in healthcare somewhat personally from our own personal experience. And, and we've dedicated a lot of our careers to that passion. So as storytellers, I'll start with a fairly broad question to all of us, which is how do you see the current gaps in healthcare in the healthcare system? And what do you think innovators could do to help, um, with some of those guests, I'll, I'll start with Dr. Bruce dun of who is a self-proclaimed, uh, storyteller as well. So maybe Dr. Don, if you start us off,

Speaker 3: (07:10)
I am a storyteller. I like to tell a story, but an answer to your question. I think that the two gaps that I would highlight are the gaps in medical treatments for dental diseases and secondly, uh, a gap in integrated care. And I would highlight to use your transformational analogy, the work of both the former professor clay Christensen, who coined the term disruptive innovation, um, for non-consumers for under consumers. And I think we're dealing with some of that here. And I would also highlight the work of, uh, Heitz and Linsky, who talked about transformational change versus technical change. And that brings up a very important point. Uh, and that is that there is always someone who's gonna lose something in transformational change. And I think that's what we've seen recently with, with the American dental association, not supporting dental benefits in Medicare, et cetera, et cetera. So I think, um, there are some bright lights, you know, I think that, uh, silver diamine fluoride just got breakthrough drug, um, status for the FDA. The world health organization has recognized fluoride as an important medication, getting oral and dental on the, uh, global map. Um, but I'll stop there.

Speaker 2: (08:47)
Yes. So I'm glad we're starting with the quote unquote easy gaps, the transformational gaps, the things you to do to really move the industry and the feel forward, um, Dr. Christopher, from your perspective, what is, what is the gap that communities and patients are feeling the, the most today?

Speaker 4: (09:07)
I, I think one of the biggest gaps or several of them were revealed by the pandemic, uh, the COVID pandemic, uh, and that is the social context in which people live, uh, that presents barriers both to access and care and to some measure barriers to informed self care. And so, as long as we are operating with a lack of understanding and knowledge about the social context and the way that context has been constructed historically on the basis of racial hierarchy, so that certain groups of people in our society are literally excluded from the primary more fluid systems of care and support. And so we saw tremendous disparities in exposure and death and disease rates in native American populations in African American populations, in rural populations because our, our systems of, of care and health and wellbeing are so much are so fueled by profit motives.

Speaker 4: (10:14)
You know, we just don't have a broad enough blanket if you will, a broad enough structure of care that will, that will reach everybody, particularly those who are in the greatest need. So I think that's one of the gaps. The other huge gap is the lack of understanding. I think both within the medical profession and within the broader public of the intimate relationship between oral health, oral health and the integrity, you know, of the oral health, the, or the, the dental health and general body health, you know, and we just don't understand how those connections are so important. Those who have a disproportionate burden of chronic disease usually have poor oral health. If you have poor oral health, you're more vulnerable to, to chronic disease, that's fueled by chronic inflammation and infection. So I guess I would say it's, there's a lot of work for us to do not only to provide interventions, but to transform the systems by which those interventions are delivered, uh, whether they're inside the medical system or in terms of two communities where self care and prevention can be emphasized.

Speaker 2: (11:30)
I'm glad that you went straight there, uh, Dr. Christopher around the connection between overall health and oral health. And let's unpack that for a little bit. Maybe Dr. Donna help us, um, call out some of those established connections from literature, where, where science has already told us that there are connections between the chronic diseases, health of the body oral health. And of course, we're all talking about not only clinical outcomes, but we're also talking about total cost of care and how understanding that connection between oral health and overall health could actually equip us to make better decisions about clinical outcomes and cost of care.

Speaker 3: (12:14)
Well, I'll stop with, start

Speaker 2: (12:15)
On that. Yes,

Speaker 3: (12:17)
I'll, I'll, I'll go back to storytelling when I was a resident residents used to see every pre cardiac surgical patient before their surgery to make sure they didn't have any suspicious teeth, inflamed, gums, et cetera, because of the possibility of subacute bacterial endocarditis, especially for valve patients. Um, I think that has, uh, extended itself. And although there is no hard proof about the association of inflammation and cardiovascular disease or diabetes, I think there's a lot of associative, um, evidence that they're involved. Um, Richard wat has formed a, a program. That's now a commission from the Lancet that talks about the multi morbidity of chronic disease and the importance of oral health to all of that changes. And I think that, um, the most recent thing, although it, it seems way out the box is a paper that just appeared a second or third one on the possibility of credentialism being related to dementia and Alzheimer's, and that speaks to, to Dr. Christopher's concerned about the social determinants of disease, because if you can't pay for it, you don't get it paid. And I think the whole notion of bringing public health to bear on oral and dental disease is a critically important thing. But the truth of the matter is it's all about procedures,

Speaker 2: (14:01)
The current system, and I will do a follow up to you as well. And Chris, please, Dr. Christopher chime in, it seems that there is a consensus of, of the, uh, lack of general understanding of that connection, let alone putting that understanding in practice. And so the current construct of the system may pause additional limitations to even putting in action, even the limited knowledge that we may have mm-hmm , um, and limited is relatively speaking. Now, what do we, do you believe needs to change in order for that behavior to happen? Are we talking about more research and publications? Are we talking about changing incentive structures and value based payment models? Where do you see the real opportunity to make a dent in the way we practice medicine and dentistry

Speaker 3: (14:50)
Today? Well, I think, uh, I can make a list starting with teaching medical students a bit more about the mouth. My favorite story is when I used to teach physical diagnosis to medical students and they'd look at the patient and then they'd examine the patient, take the history and present the patient they'd spurt back the history and under H E E N T head his eyes, nose, and throat. They talk about the eyes, Pearl, all of that, and, uh, go faring benign. They look right past the mouth because they really don't learn about it. And there's been good evidence in papers written by, by Hughes silk and others, that there is no real, um, um, experience in that. It's why there's so such expense for dental pain and emergency ward visits. They come in with facial pain, they get a CT scan, a brief exam, and, uh, they could be gone with a bill of about $2,000. So I think one of the things is education. Um, my own personal bent is we need champions who are both medical and dentally qualified. And my, my thought would be that it doesn't always have to come from the dental side. Believe it or not. There may be some medical students who are interested in primary care with an emphasis on oral health. Um, I'll, I'll remind everybody about, about the interventional cardiology and how that grew up. Well, maybe we need interventional oral and dental health as part of primary care,

Speaker 4: (16:35)
You know, in terms of stories. I was so glad that you brought up the issue of, or, and the association with some sort of chronic condition. You mentioned Alzheimer's, but I'll tell a story. I, I had a cousin who, who had been in an accident and he had lost teeth and he was in the, in the communications industry. And, you know, I said, you can't succeed unless you get that fixed. Right. And so I wrote him a check for a few thousand dollars so that he could go and, and get the care that he needed. And he came back and he suddenly had no teeth and was being fitted for dentures. And I said, but that wasn't SU you didn't, why did you lose all your teeth? And he said, well, the dentist said he could extract all of my teeth for a few hundred dollars versus several thousand, you know, to do the restorative work.

Speaker 4: (17:29)
And here was an example of a, a challenge that many African American now he's deceased now, but I think he was in his fifties when that happened. And it's just a illustration of the type of intervention we need in terms of, we have to be able to have access to quality care. We also have to have education of those who are delivering care, so that the biases or the preconceived notions that might drive their decisions, you know, uh, that there's more of a partnership and a respectful relationship between the providers. We're still looking at single digit levels of diversity within the medical system, within the dental delivery care delivery system. We have got to diversify our healthcare delivery system, and we've got to accelerate that work, and we haven't done a very good job of that. So that's one of the ways that we change the system. The other thing that we really have to do, and I concur with Dr. Duno in terms of education of the providers, but in the public health space, we really have to do a better job of educating the consumers so that they can drive the quality and have different expectations when they interact with the medical and dental care systems.

Speaker 3: (18:50)
I think I said in, uh, before that, um, I think it's Susan Brody used to write the health column for the, um, New York times in her last column saying goodbye. She talked about the, the, the progress that has been made the importance of inflammation, and guess what didn't get mentioned once.

Speaker 4: (19:12)

Speaker 3: (19:14)
That's part of a problem too. Mm-hmm

Speaker 2: (19:17)
That's right.

Speaker 3: (19:18)
Nothing personal

Speaker 2: (19:21)
And no. And, um, those are those of our audience who know me. I typically for them, I don't have to give the disclaimer, but probably were saying that typically the conversations I tend to be part of are, uh, straight talk. And, um, as you call it, Dr. Donoff, um, trouble making in the best possible sense of the word. So we are past the, I think the, in order for us to do a service to our, uh, patients and to the community and to the innovators and ability for us to solve these problems, we really have to be very direct and we have to acknowledge what's in front of us. Um, that's the only way we could start thinking about solutioning for those problems. So I appreciate you taking that, um, that invitation, that implied invitation , um, by being part of that conversation. So you both touched on something around patient empowerment and, and educating patients to be better advocates for them, for themselves, Dr.

Speaker 2: (20:24)
Christopher, your, your story with your own family member was very, very visceral palpable example of that. Um, and yet when we look at solutions that have been designed in healthcare from me, electronic medical records to digital you name it, digital apps, most of them are designed, um, in an expert centric way. Uh, patient center design came much later in healthcare, um, maybe even still is, is arriving in dental care. So could you talk a little bit about what you're seeing as unmet needs in, in terms of the solutions that are currently being positioned in, in dental care or in overall healthcare and, and the ability of patients to engage and understand them in a very intuitive way, the way they would be able to understand, you know, being a consumer on Amazon or consumer for financial services or consumer in their everyday life, in any other sphere of their life, patient centered design in oral health? Yes. One reaction,

Speaker 3: (21:35)
Go ahead, Dr.

Speaker 4: (21:35)
Christopher. No, I was gonna certainly encourage you to go ahead Dr. Duno, but, but my response to that would be that we, we don't establish a clear enough case in the minds of the consumer slash patient, that they have power to make choices and decisions that they can have access to preventive. You know, we, we spend less than 3% of our national healthcare budget on prevention and public health. And I don't know what that specific prevent what that investment is in terms of the oral healthcare, but, but we don't encourage the healthcare consumer that they have a central role to play in terms of being, you know, part of a continuum of wellbeing throughout the life cycle. So we have to deliver, you know, we talk about health literacy, but that literacy, I think, is woefully lacking. As you pointed out in the article, uh, it's woefully lacking in terms of the central issues of, of maintaining optimal oral health.

Speaker 4: (22:49)
You know, so to a large degree, the literacy piece is part of what needs to be folded into the innovations, particularly the technology based innovations, uh, but you know, health ultimately is a relational conversation and the quality of the relationships within the community and between the providers within the public health community and the, and the clinical community, we have to do more to make sure that those relationships put the people, the patient, the consumer at the center. And, and we have to be more honest about who's most vulnerable. Who's been most marginalized historically by those systems so that we can build relationships that are really grounded in the fundamental principles of do no harm and, and optimize access to quality.

Speaker 3: (23:40)
Well, I think, you know, you hit, uh, access and is, is a critical issue. And, um, also the perception of the providers is important. Um, I'm always reminded, as I said, there, there are no medical treatments for oral disease that there are fluoride water, flu fluoridation, but, you know, even a city like Wooster doesn't have it. Uh, recently the silver diamine fluoride that's that Dr. Milgram at the university of Washington has made his life's work really is a changing situation. And it reminds me of the, uh, the story that a tool Gandi once wrote in the new Yorker, where he talked about the acceptance of ether anesthesia, when it was introduced, which went like wildfire fast spread faster than if there was an internet back in 1846 versus the acceptance and implementation of ASEP aseptic technique by surgeons, which was very slow. And the reason for that is one was very good for the doctor.

Speaker 3: (24:52)
The other wasn't so good for the doctor was a lot of work. And so there's another issue. And I think sometimes payment mechanisms can, can even that playing field. Uh, but I think the most important thing is to create champions for oral health who are acceptable to all healthcare communities. Mm-hmm , I mean, why don't we have more dental therapists? There's a classic example. You know, they've been shown to be very effective in Alaska, but I always remember the first time I went to a meeting about that, um, uh, someone objected to, uh, the fact that these poor Alaskan Eskimos didn't have cosmetic dentistry done. And I remember someone getting up and saying, you know, they're out there hunting whales and seals. They don't care about a veneer on their teeth now, true. That has changed. In some cases, I used to take care of our local hockey team. And there was the pride in missing teeth from some, from, uh, some, uh, activity on the ice, but even now veneers and bridges and all sorts of things, but they can afford it. So I think there are lots of things we need to do to continue to break down the silos and care

Speaker 4: (26:20)
I would just like to

Speaker 3: (26:21)

Speaker 4: (26:22)
Yeah, I would just like to pick up on that, uh, workforce issue, there are many innovations that can be delivered by dental therapists and, you know, we funded that work at the WK Kellogg foundation. Yep. And we, we fought the battles that had to be fought in terms of resistance, but there's a lot more that hygienist can do in terms of instructing and, and helping to deliver these preventive products that are going to strengthen, uh, the Enam and strengthen and help to prevent the, the carries or at least even early detection innovations are out there. Uh, so there's so many tools and resources that could be made available. We need a much more diverse and well funded delivery system in terms of the, the deliverers of care. And we also need to, to put an emphasis on, on prevention.

Speaker 3: (27:15)
You know, this is not a, this is not something that just happened. I have a book in my bookshelf called the foresight experiment. It's from the early 1970s. And it was experiment carried out at the foresight dental infirmary where hygienist did restorative dentistry under the auspices of practicing dentists. And you know what, they did it as well as any dentist mm-hmm . And you know, what else the state decided that it violated the practice act. So, you know, we have a lot of things to go up against mm-hmm  and that was well before dental therapists.

Speaker 4: (27:54)

Speaker 2: (27:55)
That's right. And the risk of going down the path of a, not so optimistic  for what we need to get done. Right. So all we need to do is redesign incentive system in the, and, and we're, and we, we solve for prevent preventative care. We solve for minimally basic care. We solve for access and equity. Right. Um, and I'm being, uh, I'm a little bit, a little bit playful here, but there are two things that I want to absolutely highlight, um, something Dr. Dun that you said as good as the innovation is, it won't go anywhere unless it understands. And more importantly anticipates the impact you would have on all the players in the system. If it's not good for the dentist, they won't adopt it. If it's not good for the insurance companies, they're not going to pay for it. And so that's the reason why innovation tends to lag health in the healthcare field, or even the dental field by decades, because innovating requires being very thoughtful and disciplined about the impact of that innovation on each and every member of ecosystem.

Speaker 2: (29:04)
That, that, that system has survived so long because it's very good at creating what I call innovation antibodies. Right.  you see something, you see something that threatens the existing status quo and you very quickly go after it and say, there's a law against this it's never been done before. Yep. And so if we understand the, the reality of what we are operating in, right? The, the limitations of that system, um, I was reminding by a, a book called, um, the digital doctor, uh, by you doctor Donna flask. Yeah. We talked about the unanticipated consequences of, um, digitizing care and technology. And so the question I have for you is where do you see the promise of technology in being able to democratize access to knowledge training, deliver some of those cutting edge insights at scale, and yet, what are some of the limitations that we need to be cognizant of when it comes to those new innovative technologies? Um, so that we're not, so they're not falling flat and they're not getting, um, a back wrap for shining new toys or just, um, innovation sparkle, if you will. So let's talk a little bit about that.

Speaker 3: (30:27)
Well, I think, you know, there's a lot of, a lot of emphasis and, and hope for the electronic health record, combining medical and dental and oral health, uh, portions, you know, there's even the largest company. If I may mention epic, you know, now has, uh, a piece that's deal deals with oral health, but that doesn't answer the cultural problems that exist when someone goes to dental school and there's a 47% reduction in total patient care. And basic science that's taught at dental school at the expense of more and more procedures like implants, which are important, but like implants have created their own problems like per implantitis. Um, someone has to draw the line. And I think part of this that, uh, can help do this is for the dental education system to finally say, Hey, for people who don't go into a specialty of which there are too many, maybe they need a general practice residency, you know, medical school doesn't prepare someone ready to practice dental school does.

Speaker 3: (31:50)
And there's a great book written by a Leroy Johnson, who is the Dean of the Harvard dental school when it became the Harvard school of dental medicine. And he said, dentistry is the only profession where the degree is awarded before competency is achieved. Um, and I don't mean in, in the most damaging manner, but I think if you speak, and I have spoken to people who have run state dental associations when we were promoting a year of general practice residency, that, that, um, who, who said that, oh, no, I don't think it's necessary. I said, what did you do after dental school? And they said, oh, I was in the army for two years. It was the best two years of my life. I was in the Navy for two years, et cetera, et cetera. So they did have that. And, um, people forget, but I think that's an important part of the dental profession becoming part of overall health,

Speaker 4: (32:57)
Um, the, um, the payment structures and the costs of dental education. They can become barriers to addressing the inequities, uh, in terms of being able to, to work within communities or with, for that matter within community health centers where their primary payment is through federal programs like Medicaid or, or Medicare. So we do have that continued challenge. You know, when a person graduates from dental school, they have usually tremendous debt and they need to have a form of, of practice that allows them to, to pay that debt, but also to prosper. So that's one of the considerations, the promise of, of technology and electronic health records and, and artificial intelligence. It it's balanced, it has to be balanced by the concerns about privacy, uh, and also the, the concerns about literacy and access in terms of the general population. I also think we need to understand and not be afraid of it.

Speaker 4: (34:04)
You know, there was an article this morning or a discussion about how inflation in one sector drives inflation in another sector. Well, I think innovation drives further innovation. I used to run the Institute for government innovation at the Harvard Kennedy school. And we understood that if we did effective innovation, we would pro someone like you said, so well, someone may suffer, but it may also drive them to create other innovations as a result of the transformation that the innovation, uh, creates. And so understanding that innovation is how we progress. And as you do incentivizing innovation, I think is such an important part of the answer to what has been a longstanding dilemma of the absence of, of universal access to oral healthcare and the absence of a continuum in terms of every stage of life perspective about the need for, uh, oral health in general.

Speaker 3: (35:09)
No, I'm looking through some of the questions in the chat. It's quite amazing. I think there's a fair amount of evidence that, um, good oral health improves general health in a number of areas. Uh, um, I would, uh, I would, I would suggest you go to the website of the initiative for integration of oral health and medicine on the Harvard school of dental medicine webpage there's, there are so many papers that really can pinpoint this with, with statistically significant results. I think that that relationship is being shown.

Speaker 4: (35:50)
Yeah. And even the relationship between nutrition and, um, and oral health, if you just do a PubMed search on that, you're gonna come up with over 12,000, uh, articles that are relatively recent, uh, that document, that relationship. And, and it's not communicated very well. You know, the, uh, the, the exposure that children have to excess, uh, sugar sweetened beverages. Um, the, and we see that often in indigenous, particularly like up in Alaska, where the water systems were inadequate and therefore beverages that were commercially available and marketed were substituted, uh, good water, good high quality protein beverages, rather than heavily sugared beverages. They make a difference in terms of vulnerability to carries at an early stage in childhood and throughout the life cycle. So there's a lot of evidence about, you know, the social factors, the environmental factors, the nutritional factors, the relationship holistically speaking between optimal health and wellbeing, uh, throughout the life course. And of course, oral health is part of that.

Speaker 2: (37:04)
Yeah, I can't, uh, like we can't underscore that, that point enough that, um, you treating the overall health requires us to look at lifestyle nutrition, chronic disease, oral, uh, dental, uh, care. And that's, um, the, the kind of the balance balancing act between science technology, humanism in this art form that we call healthcare. Um, we, and, and again, I, I started this as, um, appealing to our own, uh, sense as patients. We, yes, we are decision makers and in, uh, chain in leaders in healthcare, but first and foremost, we feel that visceral frustration with our system as patients as well. And I know that for me, that's, that's what keeps me grounded and, and motivated to keep asking those same questions day in and day out. And so the, um, one of the key takeaways that I would like our audience to hear is yes, we are looking for innovative solutions to advance the field of oral health.

Speaker 2: (38:15)
However, these solutions don't necessarily have to come from the oral health field. Uh, only there may be solutions that are currently in the medical field. There may be nutrition. There may be in other industries, not even in healthcare. And we want to be able to, uh, still adopt, borrow all of these solutions to apply to any of the problem statements that we touched on today. This is really, um, the opportunity that we we see in front of us. And, uh, perhaps in the next couple of minutes that we have together before we, uh, transition to a little bit more of an overview of the smile health program, I'd like to take a step back. And, um, if we could go back into that, uh, positive state of mind or art of the possible, um, if we think about truly finding those, those disruptive innovations, applying them before they get killed at scale, um, what do you see the future state of our healthcare system look like, um, in let's say, 20 years? And what would it take for us to be able to realize that vision in five?

Speaker 3: (39:32)
Well, I, I used to be very optimistic about this, but I recently reread a paper I wrote in 2004. Okay.  2004

Speaker 2: (39:42)
After. Dunno if it's no, we're not allowed to end on a negative note. Okay.

Speaker 3: (39:47)
So if, you know, I'll tell you what I do

Speaker 2: (39:50)
Realistically. Okay. Okay.

Speaker 3: (39:52)
Realistically, I don't know if there's realistic, but, you know, I think, uh, um, there are lots of examples of solutions that are outside of oral health, like the iPhone, like, uh, um, just the Telegraph to the phone for crying out loud was disruptive. I think Western union called the telephone a toy when it came out and they passed up taking up the patent on it. Um, so I think I'd like to see some programs that integrate education in both medicine and dentistry, it can come from the dental side. It can come from the medical side, um, to create champions who really understand oral health, because they've done it. I'm not saying that they're gonna do it as, as part of their primary care practice, but they'll understand it. And I think to address the issues of inequity and access, I would certainly create incentives for underrepresented minorities to enter into these programs and be the caregivers and the spreaders of that kind of information to their communities.

Speaker 4: (41:10)
You know, I, I'm an optimist at heart and much of the work I do begins with inviting people to share a vision for a future that is no longer defined by our legacy of racial hierarchy and our permission to devalue people based on physical characteristics. So my vision of a future healthcare and dental care system is one that has acknowledged that legacy and committed to redressing it with very specific, specific and proactive efforts to incentivize change both in the workforce and in the various, um, subtle structures within the workforce to expand access. We talked about the dental therapist. We talked about the role of the hygienist. You know, there are so many things that could be done to expand the connections between those who truly need care. And those who are in a position in relationship within communities to provide care. COVID 19 made us create, uh, you know, trackers and, and, and vaccines being distributed.

Speaker 4: (42:19)
We did all sorts of things in an innovative way, rapidly in response to the crisis. So a big part of it is that our nation has not really paid enough attention to the primacy of this discussion and how important oral health is to total health. And so my vision of a future is how we've used social media and technology to raise and change the narrative, to raise the conversation to where people see this as an important part of their wellbeing. So workforce communication, narrative change, and an enhancing of the quality of our understanding, all of those things are a part of what I think will go into a holistic system that drives us to a very different set of outcomes.

Speaker 3: (43:07)

Speaker 2: (43:08)
That's right. That's that's

Speaker 3: (43:10)
Remember, we didn't wear gloves before the HIV epidemic.

Speaker 4: (43:14)

Speaker 3: (43:15)
You think we could do a little better after two and a half years of COVID?

Speaker 4: (43:19)

Speaker 2: (43:20)
That's right. We, uh, we have shown that we could mobilize resources think across disciplines and move fast. That's what the pandemic has shown us when the stakes are high enough. Right. Um, and I I've seen that unfortunately firsthand in my medical insurance side, they, that the problems need to be so large, so painful for so many parties in the system. So that transaction cost of collaborating could be worth it.

Speaker 4: (43:52)

Speaker 2: (43:53)
Our systems are not designed unfortunately at a system level to collaborate. Right.

Speaker 3: (43:58)
That's an example. People are asking about Canberra, which was the carries management by risk assessment program. It's taught in all dental schools and probably less than 3% of dentists apply it.

Speaker 4: (44:10)

Speaker 3: (44:11)
Classic example of ether, anesthesia and aseptic technique.

Speaker 4: (44:17)

Speaker 2: (44:18)
That's right. Well, I invite our audience to continue the discussion. I am so impressed by the engagement and the thoughtfulness of the comments in our chat. So please continue that discussion. We will share, please take advantage of the resources we called out today. The resources on integrating oral, um, dental and medical care at the Harvard school of, uh, dental medicine. Some of the other resources we called out that Dr. Christopher listed will share, um, as part of the, uh, replay link. Um, we are so grateful to you, Dr. Christopher and Dr. Dono for spending, um, an hour with us this afternoon and starting to peel the layers of what could we do? Uh, what can we do today to accelerate the, um, the, the new vision, the transformed vision for oral health that we all have, um, grateful for your comments and your thoughtfulness? I would, uh, now like to, um, invite, uh, Carol Zenman, who is the vice president of innovation at care quest innovation partners, and who is also the driving force behind smile health to share a little bit more detail about what smile health is and how the design of the program is intended to address some of the systemic issues that we, we called out during the last 40 minutes or so Carol, take it away.

Speaker 5: (45:46)
Thank you, Maria. Thank you, Dr. Christopher, and thank you, Dr. Donoff for this fascinating discussion and, uh, good afternoon to, um, our attendees. It's my pleasure to spend a few minutes to speak about smile health, uh, a program that, uh, we at care quest innovation partners together with, uh, partnership and with Matt have, uh, really designed to address many of the gaps and opportunities, which you have just heard about from our incredible panelists. Smile stands for simple, minimally invasive integrated, low barrier and equitable health. And the program aims to identify and accelerate early stage startups that deliver transformative and disruptive changes to improve health. Our challenge statement to global inventors and entrepreneurs is how can we provide equitable, accessible and integrated oral health to improve health outcomes? Smile health is distinct from other corporate and private incubators and accelerators because of its focus on outcomes and on impact aligned early stage startups, quote the potential to make transformative change.

Speaker 5: (47:02)
Therefore, um, submitted solutions should address one or a combination of our three priority areas. Those being, how can we make oral health more equitable by progressing towards racial socioeconomic and geographical equity? How can we make oral health more accessible by innovating preventive or minimally invasive solutions to be delivered both in and importantly, outside of dental offices? And how can we make patient care more integrated by bridging the gap between overall health and oral health that you've heard so much about today? Smile health kicked off with an application process on March 9th, and it will run for six months culminating in the demonstration day, the week of September 12th, the program has four phases represented by the different colors in the squiggly line that you see in this image. We are in phase one right now with, uh, sourcing global entrepreneur inventor applications to the program in response to our call to action.

Speaker 5: (48:12)
Please note that all applications must be in by April 22nd. I'll speak more about, uh, phase three in the following slide, which is really the meat and potatoes of smile, health programming. And finally, the program will wrap up, uh, with an, uh, demo day, uh, in September during which potential investors, partners, customers, and the public will come together, hopefully in person should the conditions allow it, um, to listen, to smile health graduates and consider them for collaboration and partnership. Most of the activity, as I said in smile, health will occur during a three month period between May 16th and August 12th, and will focus on helping to do risk the startups, helping them focus their solution to the unmet market needs and giving them access to robust market validation platform. Startup participants will experience three parallel and contemporaneous use tracks, which include first participating in organized and tailored online curriculum to help them close industry market, business, model funding, and other knowledge gaps to prepare them to present, to potential investors, partners, and clients during demo day second, by building a relationship with me with experts from matter, as well as a specifically designated mentor, who will typically be an industry functional leader in the startups area of need or interest, and will have a week over week understanding of how the startup is progressing to help guide them.

Speaker 5: (49:45)
And finally, startups will participate in a bespoke market validation study, working directly with a matched corporate impact partner to gain data required, to validate their solution and progress it towards market readiness. This mechanism will provide startups appropriate access to clinical settings to validate patient outcomes in clinical utility, access to data, intelligence, and insights to strengthen their business case for investment and scale access to the corporate partner who will have you specific needs and expertise and access to end users and decision makers to test for product market fit, anticipate and address product, um, uh, barriers to adoption and validate technical requirements. Smile health is very startup friendly. It does not require the start to give up equity in the company in order to participate in the program. In fact, selected startups will each receive a $10,000 stipend. Other benefits include becoming a, uh, part of a community of O other forward looking companies, learning from carefully selected faculty mentors and partners, and having access to best in class training tools, insights, and resources to help validate their solution in our attempt to leave no stone and turn we've made a global call to action.

Speaker 5: (51:11)
As I said, I've been pleased, uh, at the expressed interest from across the globe, including countries such as Brazil, South Korea, Australia, and others. Um, while we are focused on early stage companies, which will be typically at the precede funding stage level, we do need the applications to have a solution that is ready to be tested such as having a good understanding of the market need having a working product, having a team and a business model. Finally, we're also explicitly open to non-oral health startups who see a potential use for oral health. If you are an entrepreneur that fits our profile, we urge you to apply by April 22nd. We've been very pleased with the reception that smile health is receiving from the oral health ecosystem. We are proud to share curated and growing list of our distinguished corporate partners across insurance care delivery, consumer products, venture capital, and other verticals in the coming days.

Speaker 5: (52:13)
We'll be announced in additional partnerships within medical insurance, within academia and across the information categories for mentioned categories, our partners fit into one or a combination of the following. Two types. An impact partner has a specific business problem and deep industry expertise. They will be matched with a startup that has a potential solution to that problem by working together, the impact partner and the startup will test and refine the solution, the associated business model and product market fit help by smile health. The impact partner will provide resources, access to insights, expertise, and support a four to six week market validation study with the startup in return. They'll get early access to the smile health cohort, have the opportunities to select and go deep with the match startup and to potentially deploy the ed solution within their business. The other type is a scale partner. These are entities who can provide access to potential customers can be go to market partners for graduating startups and can provide capital to startups who meet their investment criteria. If you are an organization that would like to get involved in this way. We welcome speaking with you to wrap up. If you are interested in learning more about smile health, you can find more information and care quest, or you can contact us directly by emailing care quest Thank you

Speaker 1: (53:54)
Real, thank you so much for that overview. Um, Maria, thank you so much for facilitating the conversation, uh, today and, and as well for the partnership, uh, with you and Caril, um, Bruce scale, thank you so much for your insights and for sharing your time with our community. And thanks of course, to everyone who joined us today, um, we look forward to working with you working together to encourage more oral health entrepreneurship, and developing great solutions that will make oral health more accessible and equitable. Uh, thank you again. I hope you all enjoy the rest of your day.