A California dentist has taken a different path than most. He's now on the first wave of advocates for new technology, like tele-dentistry.
Paul Glassman, DDS, MA, MBA, says he went into dentistry for the usual reasons. Among them: wanting to do something that involved working with people.
But Glassman acknowledges, “I’m not sure if the career I ended up in has any resemblance to what I was envisioning when I went down this path.”
That’s probably a good thing.
Glassman, professor of dental practice at
, says that from the time he entered dental school he had the sense that he wanted to do something different than work on normal, healthy people.
“I always had some kind of a calling to want to work on people with more challenges to getting dental care,” says Glassman, who has more than answered the call.
During Glassman’s residency and early in his career he regularly worked with patients who were what he calls “medically complex.” That includes a young woman with severe multiple sclerosis. She wasn’t able to raise a toothbrush to her mouth, and her teeth reflected the neglect.
“I worked for almost 20 years in a hospital where the focus was on people with lots of complicated medical problems and disabilities,” Glassman explains. “That was what I had set out to do when I finished dental school.”
That exposure fostered a desire to move into public health.
“I initially saw people who ended up being taken to the hospital emergency room for treatment, and then four or five years later they’d be back with a whole new mouth full of problems,” Glassman says. “They weren’t getting any preventive care in between.”
But moving into public health required adjustments, mostly involving timeline and mindset.
“When I used to be a real dentist and was doing clinical care, there was much more opportunity for what I refer to as instant gratification,” Glassman says. “You do a filling, you can look at it, touch it, the patients say ‘thank you’ and you’re done.”
The public health arena presented a much longer time horizon. It could take years, sometimes decades before seeing that you’ve made some kind of difference. But, Glassman points out, there was also an opportunity to do things on a much larger scale.
Tipping the Scale
Glassman has been working for nearly 40 years to figure out how to deliver oral healthcare to the most vulnerable and needy populations, and is now reaching the tipping point where everything is coming together. Sometimes referred to as the father of tele-dentistry, he’s helping to trigger an historic disruption in the way dental care is delivered in California.
“I think [tele-dentistry] was an idea ahead of its time,” Glassman says. “We were trying to do something that had never really been done before—at least not the way we were doing it.”
That prompted a variety of reactions, he says, ranging from “That’s great. I can really see the potential for doing something important here,” to “Over my dead body you’re going to go in that direction.”
It started by winning a waiver from the state of California to train a handful of hygienists in inclusive tooth replacement without a dentist on site; gained passage of a state law expanding hygienists’ scope of practice to include ITR replacement; and has grown to the point where the Arthur Dugoni School is now the first dental school in the country to train dental students in tele-dentistry.
“Some of that initial resistance I think was based on fear that this would maybe somehow be bad for dentists in particular,” Glassman says. “But the reality is it’s not only really good for dentists, it’s important for the profession. It’s taken a while for that to sink in.”
Glassman says the premise has always been to get out into the community. A lot of the principles that are being following today are the same from back in the early 1990s, only without the aspect of tele-dentistry.
“But about 10 or 12 years ago, we began to think that technology had evolved to the point where it was possible to think about doing things differently and using the technology tools to connect dentists in their offices with both dental teams in the community, and then community members who were not part of the dental team,” Glassman explains. “So it’s been a gradual evolution.”
Outside Public Health
Travel is Glassman’s other passion. He and his wife frequently travel from San Francisco to Los Angeles to visit family and grandchildren. But there’s also an impressive list of “wonderful countries” he’s visited.
“We’ve been to China and Tibet, which was wonderful,” he says. “And then there’s Myanmar, a country that is just opening its borders to outsiders. We were among the first wave of tourists coming in, so it was great to see a country at that level of development.”
What Glassman finds particularly interesting in his travels is the variety of ways people live throughout the world. He wishes everyone could experience at least some aspect of that.
“We all tend to get sort of mired down in what we see in front of our faces on a day to day basis and can lose track of the wider world in a variety of ways, and people that exist on this planet.”
Making a Difference
Glassman says it’s particularly gratifying to see how much has been accomplished in oral and public healthcare, and acknowledges that many people have helped make that possible.
“It’s great to see that there are systems emerging now that can actually do a much better job of reaching the population that’s not getting dental care, and getting services to them early on so they don't develop dental problems,” he says. “I feel more hopeful now than I did maybe 20 years ago that this is something that could really make a big difference in the way the oral health system works in the United States.”