Where Dental Care Isn’t Reaching, They Go

Professor Teresa O'Daniel (far left) and Dr. Waletha Wasson (far right) visit the Tiptonville Senior Center with UT Health Sciences dental hygiene students, just one rural location where they increase access to dental care.

Teresa O'Daniel was killing time.

It was a stretch of downtime between visits to Margaret Newton Elementary School and a Lake County middle school, and she found herself scrolling through what health services might exist in the area surrounding Tiptonville, Tenn. A name she didn't recognize popped up, a rural ministry. She called. The woman who answered asked if she was really from UT.

She was. And the rural resource's dentist had just retired.

"One thing just leads to another," says O'Daniel, a dental hygienist and assistant professor at the University of Tennessee Health Sciences College of Dentistry. "I like people, so I like going and meeting and talking."

That instinct has built something significant. What began as a single educational visit has grown into a multi-site community outreach program embedded in the curriculum of the College of Dentistry's Dental Hygiene department. O'Daniel runs it alongside Kiesha Werlitz, EdD, assistant professor and interim department chair, and Waletha Wasson, DDS, professor and program director of A 21st Century Initiative - Oral-Systemic and Population-Based Health For All.

A Map, a Need, and an Ask

It started with a map. When O'Daniel and Dr. Werlitz were working together in 2022, O'Daniel pulled up a map of Tennessee counties using 2021 data. Dozens of counties across the state had no dental clinic at all. Lake County, a rural community in the northwest corner of Tennessee, had gone without a dentist for more than a decade.

O'Daniel arrived at UT Health Sciences after 10 years in public health, determined to put that knowledge to use. When nursing faculty asked her to lead a health education session at Margaret Newton Elementary, she saw more than a one-time visit. The school's principal asked if the team could do anything more, and O'Daniel said she would see what she could do.

They went back to do more, with more. She soon called the senior center in Tiptonville too. Then found the rural ministry with the unused dental chair.

"You need somebody who's willing to commit to come back," she says. "Rural communities are used to people blowing through and it looks good on camera. What we're trying to show is we're invested."

The program now serves multiple sites in Lake County. Hygiene students have screened 172 patients, administered 147 fluoride varnishes, and provided 21 silver diamine fluoride treatments. When screenings turn up cases that need follow-up care, O'Daniel arranges for referrals to Willis Reese, DDS, assistant professor and clinic director at the university's rotation site in nearby Union City. The senior center in Tiptonville, which previously had no way to transport patients to Union City, now has a van.

Dr. Wasson is direct about why the follow-through coordination matters.

"Screenings are OK, they're good, but that should not be the end," she says. "You have to follow all the way through to get the work done, then follow up to see if they did it, and then see if they continue. That's the part that's often missing."

What the Students Carry Out

The dental hygiene program at UT Health Sciences trains two cohorts every year, previously 20 students per group, now 24 each term, spring and winter. Getting those students to drive two hours each way for Lake County visits takes some convincing at first. O'Daniel runs pre- and post-surveys tracking shifts in attitudes toward public health work and rural practice, and the reflections students write after outreach visits reveal what numbers alone can't capture.

"A lot of times they'll add more than you really expected," she says. "Some of them make me teary."

For Lakiyah Walker, a dental hygiene student who traveled to both Lake County and Encompass Rehabilitation Hospital in Memphis, the experience changed how she understood her role. Some of the children at Margaret Newton Elementary had never been to a dentist. One child raised her hand to ask if she was supposed to brush her tongue.

"If even one child left feeling more confident about taking care of their teeth, or less afraid of going to the dentist," Walker says, "then the outreach really made a positive impact."

Student Ann Young reflected on a similar shift after visiting Encompass, where UT Health Sciences hygiene students deliver oral health education to stroke survivors. The patients' questions about brushing and flossing after losing mobility gave Young a clearer picture of what prevention specialists do.

"Our role as hygienists is to not just clean teeth, but to prevent every patient we see from developing oral infections that impact the rest of the body," she says. "The mouth is the gateway to the body."

The Interprofessional Thread

Encompass Rehabilitation Hospital sits in the heart of Memphis, serving stroke survivors and others navigating recovery from serious neurological events. Many of its patients face barriers to dental care that have nothing to do with geography. Mobility limitations, insurance gaps, and the sheer difficulty of managing multiple appointments during rehabilitation put oral health low on the priority list, even as research increasingly ties oral disease to stroke recovery, heart health, and Alzheimer's disease.

This is where the university's hygiene students show up in a different way. They don't come to screen teeth. They come to teach, working alongside physical therapists, occupational therapists, and speech therapists, to help patients understand why oral health belongs in the recovery conversation.

"When you see a person who has a mouth issue, you've got to start checking to see the inflammation in the rest of the body."

Waletha Wasson, DDS

Caillouet Hurst, a speech pathologist and team lead at Encompass, says the students have become part of the rhythm of patient care at the hospital.

"They do all the work," she says. "They come here, they make the presentation, they provide the education, and it's extra, hearing it from the actual professionals themselves."

Sessions cover everything from choosing an alcohol-free mouth rinse to selecting toothbrush handle adapters for patients with limited hand movement. Therapists from Encompass sit alongside the students, and Hurst says patients who might tune out familiar advice often respond when it comes from a new voice. Even the reminder to brush without teeth in the mouth, to clean gum tissue and remove bacteria, feels different coming from a dental hygiene student than from a therapist.

Dr. Wasson, who accompanies O'Daniel on many visits, sees the Encompass partnership as evidence of something health care can be slow to acknowledge.

"When you see a person who has a mouth issue, you've got to start checking to see the inflammation in the rest of the body," she says.

The Infrastructure Behind It

This semester, O'Daniel restructured the outreach to give every student group a range of experiences. Two larger groups make the Lake County trips. Four smaller groups rotate through other sites, including Encompass for the interprofessional experience as well as additional placements at schools and senior care facilities. Every group delivers multiple presentations throughout the semester.

The logistics are considerable. O'Daniel has students build and rehearse presentations in front of each other before going out. She reviews them, makes sure clinical terms get swapped for plain ones. Xerostomia becomes dry mouth. She manages consent forms, cancellations, and makes the drive. She and Dr. Wasson cover their own gas and vehicle wear-and-tear.

Dr. Werlitz grew up in a small Illinois town, with fewer than 500 people, and went without regular dental care as a child.

"I was one of those kids in those school systems who didn't go to the dentist regularly," she says. "If somebody doesn't come into your school, give you fluoride, or put sealants on, or check your teeth, then you just don't ever have that access."

Briana Mann, principal at Margaret Newton Elementary, has watched the program serve the county's students since 2023. Lake County has no local dentist. Families drive 30 minutes or more to reach care. The school, she says, is a place children trust.

"This program has allowed our students to receive quality care in a safe, familiar environment, which is especially important for our youngest learners," Mann says.

Healthy Smiles and What Comes Next

The outreach work connects to a broader structure. The Healthy Smiles program offers a pathway for hygiene graduates to commit to rural service in exchange for loan repayment support, a natural pipeline from what students experience during outreach rotations. When O'Daniel mentioned the rural ministry near Tiptonville might open a hygiene position, one of her students said she would go. She lives in Dyersburg.

Dr. Wasson draws the line from individual visits to long-term community health. Dental disease missed in childhood affects school attendance, concentration, and employability. Longitudinal data on fluoride and sealant programs shows measurable downstream effects on communities that start early.

"If you just have more educated people coming from that community," O'Daniel says, "then they bring in jobs and industry, and all of a sudden you've got a thriving community."

The team is small. Funding started at $10,000 and has grown modestly with outside donor support. O'Daniel, Dr. Werlitz, and Dr. Wasson are still working to publish the pre- and post-survey data and student reflections they have collected. Word has spread anyway. Lauderdale County reached out after hearing the team was in Lake County. The rural resource near Tiptonville is in conversations with the college about a formal partnership.

"What she's doing in her course is taking in-house learning and taking it outside to the actual environment," Dr. Wasson says of O'Daniel. "These students have an opportunity to be both participatory and observant at the same time. Not everybody gets that."

O'Daniel doesn't wait for a formal invitation. She picks up the phone. She shows up between appointments. She calls strangers.

"If you hadn't had the perfect storm of alignment," she says of getting all the pieces moving, "I'd still be sitting in my office staring at that map."