Interview with Dr. Maryam Mahmood, State Dental Director

June 2023

Dr. Maryam Mahmood started with the state of Colorado as the state Dental Director in April and is excited to bring her experience and knowledge in health equity, inclusion, diversity, and accessibility to improve oral health outcomes for all Coloradans.

Dr. Mahmood has significant experience partnering with schools to promote school-based oral health programs, working on collaboratives addressing health issues such as diabetes in connection with oral health, and partnering with stakeholders to support underserved populations in intervention and prevention efforts.

In Dr. Mahmood’s role, she will collaborate with other state agencies and partner organizations to lead the implementation of the Framework to Advance Oral Health Equity in Colorado and work in the Oral Health Unit (OHU) in the Health Access Branch to advance evidence-based oral health strategies.

We sent Dr. Mahmood a series of questions to get to know her. Find out more about Dr. Mahmood and what’s coming up for the Oral Health Unit in this Q & A:

1. Can you tell us a little bit about your background and what projects you’re excited about that are coming up for the OHU?
   
   I started in public health as a pre-dental student at Arizona State University where I helped to start a dental program for CARE Partnership, a community center in an underserved urban area in Mesa, Arizona. I received my DMD and MPH from A.T. Still University, then worked as a general dentist and Federally Qualified Health Center dental director in rural Arizona for seven years. My work included school-based sealant programs, mobile dentistry programs, telehealth projects, and several modes of medical-dental integration, including behavioral health integration and diabetes programs
   
   There is so much exciting work happening within the OHU. It’s a pivotal time to be joining the OHU, with the launching of several efforts. The Framework to Advance Oral Health Equity in Colorado brings together a shared vision for the promotion of optimal oral health in the state through collective action. The Framework outlines several goals and strategies to promote oral health equity and eliminate existing inequities. This work, along with the formation of a statewide coalition, will help to coordinate efforts that can address all populations across the state. The new Colorado Oral Health website will bring this work together by offering shared data, resources, and updated information on current activities via an accessible platform that can be used by local partners as they plan their individual efforts within the Framework.

2. What are some approaches to oral health equity that you think are important for Colorado to either expand or develop?
   
   We heard directly from communities about the different ways in which they experience barriers to oral healthcare. These barriers are disproportionately distributed across the state, leading to inequitable oral health outcomes. Barriers may include geographic region, cost of care, insurance status, language barriers, and cultural variation. Social determinants of health have been outlined as a direct influence on oral health by the National Institutes of Medicine’s Oral Health in America report and are also outlined in Healthy People 2030 objectives. These factors are not all the same for all populations, so our approach to oral public health must address the unique barriers and systems in different communities. The OHU’s community engagement process to develop the Framework outlined the health equity issues most important to Coloradans, such as culturally and linguistically relevant care. Our work continues to be guided by the principles of health equity to ensure that our efforts are relevant to communities and effective for their needs.
   
3. What are some approaches to oral health equity that you think are important for Colorado to either expand or develop? 
   
   The integration of oral health into the provision of overall healthcare is an important approach to addressing oral health inequities. Oral health is inextricably linked to overall health, and has been associated with diabetes, cardiovascular disease, and pregnancy outcomes. Underserved communities that face a higher burden of disease are also more likely to have several of these conditions at once, each influencing the other for a worsening health outcome. The separation of oral health from all other aspects of healthcare has impacted the provision of services, payer systems, health information technology, education, and policy, which creates many of the barriers that lead to inequities. Some of the current OHU efforts to promote integration include Diabetes Cardiovascular Disease Oral Health Integration (DCVDOHI), Cavity Free at Three, and Behavioral Oral Health Integration (BOHI) initiatives. The OHU is continuing to develop and expand these important modes of integration as key strategies to impact oral health equity.
   
4. How important is a well-trained oral health workforce to improving health inequity and access across the state?
   
   Workforce issues contribute to many of the inequities that we see across Colorado. The shortage of oral health professionals in many of our rural and frontier areas poses a barrier to access, especially for those who cannot travel long distances to pursue care. Workforce issues can also present in the form of lack of representation due to a lack of opportunities for all communities to pursue careers in oral health. Not all students have a readily accessible school offering oral health training programs, and many do not have access to mentorship or guidance from oral health professionals. An exciting project that is coming up soon within the OHU is the Colorado Health Service Corps Futures program, which hopes to provide budding oral health professionals funding for their education to make this career path more feasible for students of all backgrounds when it is launched.
   
5. How can school-based oral health programs help us overcome some of these challenges?
   
   School-based oral health programs are a proven, cost effective way to reduce cavities in children and can address many of the barriers faced by communities that experience a higher burden of oral disease. The need for transportation is diminished as the care is brought directly to children. Evidence-based prevention strategies such as fluoride varnish and dental sealants help to prevent decay, which in turn reduces the amount of missed school time due to oral health-related issues. Parental time away from work is also reduced, so parents won’t have to potentially lose income or use their limited sick time. School-based oral health programs increase opportunities for children from all types of communities to access preventive oral health services, which will save costs and improve oral health and overall health outcomes.

We look forward to working with Dr. Mahmood on oral health and oral health equity.