The Oregon Health Authority has named Bruce W. Austin as its first statewide dental director after a nine-month search that struggled last summer to find candidates with adequate policy and public health experience.
Austin, whose first day on the job is Feb. 23, has a diverse resume that includes 20 years of private practice with Permanente Dental Associates, service overseas as an Army dentist, teaching positions at Lane and Chemeketa community colleges and experience treating underserved patients in Linn County.
An Oregon-licensed dentist since his graduation from Oregon Health & Sciences University in 1985, Austin, 54, holds a doctorate of dental medicine and is a licensed massage therapist. He grew up in Roseburg.
The lack of a state dental director has cost Oregon millions of dollars in missed federal grants in recent years, according to the Strategic Plan for Oral Health in Oregon, a six-year plan published last October by the Oregon Oral Health Coalition, the Oral Health Funders Collaborative and the Oregon Health Authority.
One of its top recommendations was to hire a dental director to establish clinical, fiscal and policy priorities for oral disease prevention and care. The group also recommended basic preventive services, such as fluoride varnish at all local facilities serving children and their parents, and incentives for oral health providers to work in underserved areas of the state. The percentage of practicing dentists in Oregon declined 9 percent from 2010 to 2012.
Austin has his work cut out for him in his new role. The Strategic Plan for Oral Health in Oregon found that 58 percent of third-graders have experienced tooth decay, and that nearly one in five adults 65 and over have lost all their teeth. In addition, Oregon Health Plan enrollees are four times more likely than those with commercial insurance to visit an emergency room for dental problems, and emergency room visits for nontraumatic dental problems cost the state as much as $8 million annually.
“Dr. Austin will align oral health policy across the agency to support dental health care integration throughout the state. He will work closely with Public Health Division and the Division of Medical Assistance Programs to ensure oral health – for people of all ages – is an important component of our triple aim of better health, better care and lower costs,” Dr. Jeanene Smith, the authority’s chief medical officer, said in a statement announcing the appointment.
The biggest task facing Austin will be to find ways to fit oral health into the larger healthcare transformation under way in the state, particularly with the coordinated care organizations, which are now responsible for managing dental care for Medicaid patients.
As an example of the limited access to dental care in some areas, AllCare Health Plan discovered last year that there was just one semi-retired dentist serving Medicaid patients in all of Curry County. Last fall, Advantage Dental opened a three-provider practice there.
Austin said his introduction to the coordinated care model began last year as the community director for Capital Dental Care, the largest dental contractor in the state. Every Tuesday, he would board a mobile dental unit and travel to Sweet Home, a small community of less than 10,000 people outside of Lebanon that does not have a dental clinic for Oregon Health Plan enrollees.
His main goal was to treat diabetics, pre-surgery patients and pregnant women – all populations targeted as deriving the greatest benefit from a dental checkup. The service in Sweet Home was paired with a hygienist, placed in a local medical clinic, who performed dental screenings five days week.
“There’s such a connection between decreasing oral inflammation and overall health. It greatly improves overall health,” Austin said. “That’s something that the new state dental director can help encourage.”
Capital also received a $135,000 grant recently through the Oregon Office of Rural Health to provide teledentistry services to approximately 1,500 children in a school district in Polk County. Capital plans to set up a community clinic in Independence, staffed with a dental assistant, to transmit radiographs to a dentist at another location.
The link between oral health and overall well-being will get more attention this year when the percentage of children with a protective sealant on their permanent molars is introduced as one of the performance metrics for coordinated care organizations. “This is dental-medical integration,” Austin said.
He believes there is a link between Oregon’s high rates of tooth decay and the state’s ranking near the bottom nationwide in rates of community water fluoridation. Portland is the largest city in the country without fluoridated water, and less than 25 percent of the state lives in optimally fluoridated communities.
“I believe in the safety and efficacy of community water fluoridation,” he said.
Austin’s first experience in what he describes as “public health dentistry” was five years ago, at the Boys & Girls Club of Albany, treating both adults and children who had nowhere to turn other than a hospital for their dental care.
“There’s such a need for basic emergency services. A lot of these people end up going to the emergency room. There’s not a lot of options for people who don’t have coverage.”
“I always wanted to go into dentistry,” said Austin, whose mother was a dental assistant. “As I worked in different aspects of dentistry the last 30 years, I developed more of a passion for the public health side, providing bread and butter dentistry for people who needed it.”
In his free time, Austin is an avid runner who has completed 42 marathons around the world – everywhere from Antarctica to Athens, in 2010, when he ran with a friend from Salem and the pair crossed the Olympic Stadium finish line holding hands.
“I was carrying an olive branch that an old Greek lady gave me in Marathon,” where the race started, he said. “It was just a little twig, but yeah, I carried it the whole way.”
One wrinkle to Austin’s appointment is that the dental director position appears to be a job few dentists actually wanted. The state received just six applications between May and October of last year.
Last fall, Leslie Clement, chief of policy at the Oregon Health Authority, provided an update to Sen. Peter Courtney and Rep. Tina Kotek, the co-chairs of the State Emergency Board, on the dearth of candidates for the position.
The agency began advertising the position last May and had received just four applications by July. After interviewing three of the candidates in August, OHA reopened the position the following month “to find candidates with more policy and public health experience,” Clement wrote in a letter dated October 27, 2014.
By last October, after mailing “3,350 recruitment letters to all Oregon dentists in good standing” with the state board of dentistry, the agency received just two new applications.
Although the dental director position is new at the Oregon Health Authority, the state did have a part-time dental director in 2009. The Lund Report previously reported on the search for a dental director last October.
The dental director position is classified as a “Principal Executive Manager H” with a salary range of $92,412 to $136,344.
For now, Austin does not have a contract, just a letter of appointment. A bill in the Legislature this session would establish the dental director as a permanent, funded position.