When it comes to improving the oral health of underserved residents in Santa Clara County, Dr. Shakalpi Pendurkar felt there was more that could be done.

Working at a federally qualified health center, Dr. Pendurkar said she had started seeing more patients come with dental emergencies.

"Some of my patients couldn't afford preventive care, even the minimum amount charged at our community dental clinic," she said. "They had to choose between putting food on the table or gas in their car or going to the dentist."

While she noticed private dental practices, community clinics, and other organizations doing their part to help fill the access-to-care gap, barriers—such as lack of dental benefits, inability to pay for dental coverage, or lack of transportation—remain.

"I just always thought that there can be more of a concerted effort, at a county level, to address the oral needs of those who can't afford to regularly visit a dentist," said Dr. Pendurkar. "If we can have a group effort—that might make a bigger impact in our community."

In 2017, Dr. Pendurkar spearheaded that group effort in the form of the Collaborative for Oral Health in Santa Clara County, a group of stakeholders seeking to identify gaps in oral health care in the county and lead a concerted effort to address those gaps.

The collaborative involves about three dozen stakeholders, including the Santa Clara County Dental Society, the Santa Clara County Public Health Department, Kaiser Permanente, area hospitals and medical centers, FQHCs and community clinics, area state representatives, several nonprofits, and privately practicing dentists.

Today, the group's work is gaining momentum.

This spring, the collaborative will work with the firm selected to conduct an oral health needs assessment of the county, which they expect to complete before the end of the summer. They will put a strategic plan, based on the assessment, in place by the end of the year.

To think, Dr. Pendurkar said, it was just over a year ago when an instructor with the ADA Institute for Diversity in Leadership asked Dr. Pendurkar a simple question that led her to get to work.

She said, "The instructor asked me directly: 'If you don't take charge and make this collaborative happen, who will?'"

'Focus on the collaborative'

With the encouragement of mentors and colleagues, Dr. Pendurkar applied for the ADA Institute for Diversity in Leadership, a program designed to enhance the leadership skills of dentists who belong to racial, ethnic, and/or gender backgrounds that have been traditionally underrepresented in leadership roles within the profession and their communities.

As part of the ADA Institute for Diversity in Leadership, participants are tasked with developing and executing a personal leadership project that addresses an issue or challenge in his or her community, organization, or the profession. Institute participants receive help from ADA staff and work with leading educators from Northwestern University's Kellogg School of Management and Duke University's Fuqua School of Business.

In December 2016, during a group discussion, an instructor sat with Dr. Pendurkar and her colleagues to discuss their projects, including coming up with a general plan to accomplish their goals.

"I had all of these ideas in my head," Dr. Pendurkar said. "But she encouraged me to focus on the collaborative."

Making calls

The work began with a series of phone calls to dental offices, area clinics and hospitals, nonprofits, schools, and health-care organizations.

Because it's a collaborative, Dr. Pendurkar said she didn't only focus on the dental community. Integrating oral health with mainstream health care is one of her main areas of interest.

"I introduced myself and told them why I was calling and forming this group to every single person on my list," she said. "I spent a lot of my own time making these calls, but it was all worth it."

Dr. Pendurkar said most of the people and organizations she called weren't only willing to participate, but were excited to be a part of the collaborative.

The first stakeholders meeting was held in June 2017. Dr. Pendurkar also presented her project that same month to the California Dental Association. In September 2017, she shared her project with her Institute colleagues prior to graduating from the program.

Last summer, the California Dental Association executive director Peter DuBois, introduced Dr. Pendurkar to Dr. Jayanth V. Kumar, California's state dental director, via email.

Finding momentum

Dr. Pendurkar said that Dr. Kumar expressed interest in the collaborative's mission and how it aligns with the goals of the state's oral health plan. That plan, Dr. Pendurkar said, seeks to identify a group in every county to lead efforts in improving oral health. For Santa Clara County, that group is now the collaborative.

When California Prop. 56, a tobacco tax increase initiative, passed in 2016, about $30 million of the tax revenue goes to the state dental director's office every year. About $410,000 of that money is dedicated to help Santa Clara County improve its residents' oral health.

By working with the county's public health department, the collaborative has a voice on how those funds are utilized, such as the oral health needs assessment to begin this spring.

"Everyone in the collaborative was on board before we knew how we were going to fund projects to accomplish our goals," Dr. Pendurkar said. "It's a testament to our mission that the state recognized the value of the collaborative."

Dr. Pendurkar accepted the role of chief advisor of the group, which meets every month. Previously, it had planned to host quarterly meetings. However, Dr. Pendurkar said, the collaborative recognizes that there's a lot of work ahead. They're already looking at ways to improve oral health education, access to prevention services, and to better integrate oral health in residents' overall health.

"We have so much momentum in California," she said. "Now we need to make sure our work continues moving forward."