The life course perspective was used as an organizing framework for a series of value-based care interventions to improve oral health service delivery conducted over 5 years by New York University (NYU) Langone Dental Medicine Postdoctoral Residency Programs (hereafter NYU Langone Dental Medicine). For nearly 4 decades, NYU Langone Dental Medicine program leaders, dental faculty, and staff built a network of more than 110 CHCs originating at Family Health Centers at NYU Langone, a Federally Qualified Health Center (FQHC) network in southwest Brooklyn, NY, and encompassing community-based, ambulatory care training sites located in 30 US states, Puerto Rico, and the US Virgin Islands. The mission of the 5 programs, namely, Advanced Education in General Dentistry (AEGD), Advanced Education in Pediatric Dentistry (AEPD), General Practice Residency (GPR), Dental Anesthesiology, and Endodontics, is to serve, teach, and discover (10). The 3 largest programs (AEGD, AEPD, and GPR) are considered primary care dentistry programs and are the focus of this report.

While CHCs are uniquely positioned to provide integrated, patient-centered care, they experience challenges related to both personal and organizational oral health literacy (18) and the building of sufficient capacity to meet the high demand for oral health care services (19). As per Bates et al., the decision of a dental school graduate to pursue postgraduate dental training is heavily influenced by having a residency requirement in the US state where the dentist elects to practice, as is currently mandated in New York, as well as the amount of federal graduate medical education (GME) investment in resident support (20). In addition, community-based vs. dental school-based postgraduate training increases the likelihood that dentists will participate in the Medicaid program (21) and work at CHCs (22). Even as there are other determining factors, foreign-trained dentists are more likely to participate in the Medicaid program than are US-trained dental school graduates and Black women who are dentists are more likely to work at CHCs than their peers, leading Mertz et al. to conclude that dentist workforce diversity is critical to closing the gaps in oral health care access and delivery for underserved populations (22). Finally, younger dentists are more likely to be female, members of underrepresented racial/ethnic minorities, practice in groups rather than solo, and be affiliated with dental support organizations vs. independent practices than late-career dentists, representing a major generational transition that is still underway in dentistry (23).

The specific, measurable learning objectives of the 5-year postdoctoral training project were to: A.

Train general and pediatric dental faculty and residents to use SDM (24–26) and MI (27–29) techniques to deliver age-appropriate oral, primary, and behavioral health care services

The following collection of 5 categories of interventions were conducted at various levels across targeted stages of the life course to enhance the IPE and training of NYU Langone Dental Medicine faculty and residents (please see Figure 1). Note that certain of these activities were briefly described in a recently published IPE use case (10). Since interventions that address factors at multiple levels may be more effective than those that involve a single level (30), whenever possible IPE and training activities targeted as many levels of influence as time and resources allowed. For instance, at the societal/policy level, Medicaid coverage of health services and GME funding of dental residents at CHCs are critical to implementing and sustaining each of the following types of interventions. To further illustrate the multi-level approach, at the community/neighborhood level, the screening and referral pilot projects sought to improve access to and coordination of care across services within CHCs, while screening dental patients/parents for the SDOH and referring them when indicated and desired to, e.g., food pantries and English as a second language classes, were designed to enhance linkages between CHCs and community resources (31). Interventions targeting the family/friends level were thought to be especially effective given how essential and influential the people we love and care for are in our lives, including by providing assistance with toothbrushing for young children and older adults with disabilities and cognitive impairment, actively listening to the concerns of parents/guardians regarding HPV vaccination for their children as trusted family members and confidants, and suggesting actionable strategies prioritized by young people themselves for limiting sugary drinks in their diets to promote both their oral and general health. Finally, identifying key oral health outcomes at the individual/population level for all age groups and suitable metrics that can be tracked over time and place is an urgent priority in moving dentistry from fee-for-service to value-based oral health care (32).

Of all the interventions, the SDM and MI training underwent the most radical upheaval of its workplan (33) yet ultimately proved to be the most transformative for NYU Langone Dental Medicine. The positive dental faculty experience with the ZOSCE learning format delivered by an accessible and responsive team of New York Simulation Center for the Health Sciences (NYSIM) hosts, staff, and SPs (patient actors) is summarized in the following participant quotation. “I'd like to reiterate how impressive the training session was yesterday. While the subject matter was top-notch [I always learn something new from (MI consultant)], I really do think that's the first [continuing education] course I've been a part of that has used the potential of Zoom effectively. The training was actively enhanced [using] the Zoom features. This really is the first time I've taken a virtual learning course where I felt that it did things that wouldn't have been possible with an in person learning experience. It was exciting to be a part of the future of learning”.

Moreover, AEPD program faculty and residents are tailoring and implementing QI projects regarding screening and referral of dental patients for the SDOH and HPV vaccination in their own CHCs based upon adaptations of the first and second patient scenarios for the ZOSCE sessions. Meanwhile, AEGD program faculty and residents conducted a group patient education project in the last academic year regarding sugary drink intake based on the third ZOSCE scenario and presented their results at the NYU Langone Dental Medicine Annual Research Fair held in June 2024. Finally, the AEGD program faculty and residents are finalizing a group patient education project on HPV vaccination in the current academic year inspired by the second ZOSCE scenario to be presented at the forthcoming Research Fair to be held in June 2025. All these extension initiatives of the project are intentionally scaling up the IPE and integrated practice priorities of NYU Langone Dental Medicine, fulfilling Commission on Dental Accreditation (CODA) standards for residents to engage in scholarly activity or clinical research (38), and providing structured research opportunities for faculty and residents that are team-based and geared toward improving patient experience and patient-reported outcomes as part of value-based oral health care (11).

While the referral process at Family Health Centers at NYU Langone is more seamless since the implementation of the integrated EHR on November 1, 2021, organizational changes, workflow refinements, and re-education of providers and staff across departments are also needed to fully realize the benefits of patient-centered care in an accessible location (30). As an illustrative example, SmartSet clinical decision support now alerts a medical provider at wellness visits when a patient has not visited a dentist in 18 months or longer, effectively doubling the number of referrals to dentistry and orthodontics from ∼500 referrals per month to ∼1,000 referrals per month (39). This notable success nonetheless required adjusting the staffing model to provide outreach to ∼1,000 patients per month and oral health care to markedly more patients, especially children (39). Thus, the scale-up of new workflows needs to be phased in.

In support of these integration efforts, the project team developed targeted ZOSCE training scenarios regarding interprofessional care toward fostering confidence in faculty and residents to build nonjudgmental dentist—patient partnerships (33). The collaboration between the Department of Dental Medicine and the Behavioral Health Program has been especially rewarding since the workflow is now fully institutionalized, with behavioral health providers screening all of their patients at intake (both in-person and virtual) for oral health and health care needs and the SDOH, with on-site referral for dental care upon patient request at the Sunset Terrace location. Since the behavioral health patients who present for oral health care are at elevated need of treatment services (35), this partnership helps to restore dignity, health, and well-being to an often stigmatized and marginalized patient population.

In terms of the culturally competent sugary beverage educational campaign, in Spring 2022 a short, written survey was developed by the GPR faculty and residents and completed by their patients at a dental clinic in Sunset Park, Brooklyn to help identify useful strategies to educate and modify the sugary drink intake of their culturally diverse, socioeconomically disadvantaged patient population. Results included that a large percentage of patient respondents did not believe that New York City tap water is safe to drink. This finding was then incorporated into one of the “Rethink Your Drink” educational posters displayed in the dental clinics (please see the Supplementary file for the presentation titled, “Rethink Your Drink”).

Finally, in Spring 2023 a focus group was conducted by the GPR faculty and residents with 11 adolescents from Project Reach Youth regarding oral health, visiting the dentist, and beverages that they and their friends and family drink. The focus group participants also provided valued feedback on the “Rethink Your Drink” campaign and helped select a more universally applicable poster to support dental faculty and residents in engaging with an obese adolescent dental patient regarding their sugary drink intake during the ZOSCE training sessions (33). The scenario used to train the SPs (patient actors) contains the excerpt provided below. Note that it includes a possible discussion aided by the aforementioned “Rethink Your Drink” poster (33) as part of the explore-ask-explore MI approach, wherein the dentist first asks the SP about their knowledge of sugary drinks before offering any unsolicited advice.

In partnership with the NYU School of Global Public Health and expert dental consultants, NYU Langone Dental Medicine developed the following 3 courses available to all faculty and residents on its Brightspace platform in the initial 2 years of the project, with ongoing review by staff and learners and further enhancements planned as resources and time allow. (1)

Public Health and Dentistry

Module 1: Mental and Oral Health: A Public Health Perspective

As of Spring 2025, 17 dental residents were graduates of the ACPH program, even as there are still scores of dental residents who were accepted by their program directors and may yet receive their certificates. The Vice President of Graduate Dental Education (M.L.) considers this number of graduates to be impressive, given the start-up administrative challenges exacerbated by the COVID-19 pandemic and the hectic clinical training environments at CHCs. If future opportunities present themselves to offer scholarships to earn an ACPH for dental residents, a more selective process will be used to ensure that applicants plan to manage oral health programs, evaluate systems of care, and design surveillance systems to measure oral health status upon graduation.

In the final analysis, this project was successful only if NYU Langone Dental Medicine was able to recruit and train dentists to lead patient-centered models of integrated care delivery at CHCs in underserved and rural areas of 30 US states, Puerto Rico, and the US Virgin Islands. Table 2 provides the numbers of graduates hired since 2018 among active dental faculty in Spring 2025, by program and overall.

Of 950 active dental faculty in Spring 2025, 114 (12%) were graduates hired since 2018. To place these numbers in context, HRSA estimates that of the more than 200,000 active dentists in the United States in 2023, only 5,167 were employed in CHCs (40). A total of 370 AEGD, AEPD, and GPR trainees each year provide oral health care to CHC patients, with 908 active dental faculty practicing and supervising them in these 3 programs alone (please see Table 2). This sums to 1,278 primary care dentists working at CHCs either employed by NYU Langone Dental Medicine or its CHC partners. In other words, 1,278/5,167 = 24.7% or nearly one-quarter of the US dentist workforce at CHCs is part of the NYU Langone Dental Medicine network. Note that this percentage does not include graduates who work at CHCs but are not active dental faculty of NYU Langone Dental Medicine.

In other data compiled by program staff for a competing continuation of the project (40), 32% of the total current AEGD, AEPD, and GPR residents are from a rural background, a disadvantaged background, or an underrepresented minority with no resident counted more than once, as per the program definitions in the notice of funding opportunity (40). Finally, 47% of AEGD, AEPD, and GPR program completers over the past 2 academic years currently practice in health professional shortage areas (41).