Pennsylvania Is In The Midst Of A Rural Dental Crisis. Pitt Is Ready To Help.

Marnie Oakley's path to becoming dean of the University of Pittsburgh School of Dental Medicine began in the small town of Mountain Top, in northeastern Pennsylvania. As she split wood to help heat the family home, she learned the value of hard work, perseverance and the power of connection from her father, a Sears accountant, and her stay-at-home mother. She loved arts like sketching and painting as much as she loved science. Dentistry, she realized later, was a perfect balance of both.

As a teenager, Oakley (A&S '89, DEN '92) followed her brother, Matt LaVigna (CGS '87), to Pitt, where he'd been recruited to play football. She studied biology as an undergraduate and completed her dental studies in 1992 before joining the U.S. Navy. Her first assignment as a naval dental officer was at Naval Station Great Lakes, where she saw a health need she hadn't imagined: Recruits, barely out of high school, would tell her they had never seen a dentist. Many arrived with severe decay.

"I have never seen more need and dental disease in my entire life," she says.

That early exposure to health disparities instilled in Oakley a deep sense of compassion and a conviction that good health care - oral or otherwise - should never depend on where you live or what you earn. After leaving the Navy in 1996, she returned to Pittsburgh, and, while working in private practice, she joined the Pitt Dental Medicine faculty and rose through the ranks, heading programs in leadership, culture and mentoring. She became known for her collaborative style and belief that efforts to serve the most vulnerable must be driven by purpose, not personal gain.

Dean of Pitt Dental Medicine since October 2023, Oakley now is channeling that same compassion into one of Pennsylvania's most pressing public health challenges: the growing shortage of dental care in rural communities. In Pennsylvania, nearly 2 million residents live in areas facing a dental shortage. A rural practice losing even a single dental hygienist or dental assistant could create enough of a hardship to result in a practice closing its doors.

Working with colleagues and key stakeholders, Oakley and the School of Dental Medicine are preparing to launch several Regional Training Centers, or RTCs, to address the workforce shortage. These centers will provide clinical training for dental residents, hygienists and assistants, while also bringing affordable, accessible care to communities that need it most. That's all in addition to graduating more than 80 DMDs, nearly 30 dental hygienists and nearly 25 residents across nine specialty programs in Pittsburgh every year.

"We're enhancing each region's overall health and economic development through creating new workforce opportunities in the health care field for the now healthier individuals who live there," says Oakley.

The first RTCs will be located in Titusville and Bradford, where patient care is scheduled to begin in July. Others, including Johnstown, will follow soon thereafter.

Pitt Magazine spoke with Oakley about the origins, structure and impact of the RTCs, as well as her vision for the future of Pitt Dental Medicine. This interview has been edited for clarity and length.

Pitt Magazine: Pennsylvania has one of the nation's largest rural populations. What was the moment you knew Pitt Dental Medicine had an opportunity to step in with a new model for rural oral health?

Marnie Oakley: After 2020, the dental profession struggled to maintain appropriate levels of qualified dental auxiliaries - dental hygienists, dental assistants and dental laboratory technicians. The aftermath of COVID alongside other factors led to a decrease in those who served in these roles.

As the only school on campus that runs its own ambulatory clinic, we were feeling the same pain. In 2021, I regularly gathered our school leaders to ask how we could help each other. Seemingly, all my clinical chairs had the same request, "Please find me a dental assistant - in fact, while you are looking, I need more than one."

Like dental offices across the profession, we rely on our auxiliaries to function. They essentially run the office, from cleaning teeth, taking X-rays and sterilizing instruments to assisting the dentist chairside. Without them, the efficiency in a dental office is severely limited.

At the same time, the American Dental Association has reported that one-third of the dental practices across the country could not fill their patient schedules, in part due to staffing shortages, leading to fewer procedures performed and fewer patients served. In the end, as a former private practice provider, I knew that also meant fewer office expenses would be covered, and a financial crunch would follow in many dental offices.

I also knew this meant our rural dental offices would be hit the hardest. We needed to do something to help our alumni, our profession and our communities. That's why we built the Pitt Dental Medicine Regional Training Centers.

Why was Titusville chosen as the first site?

Oakley: Pitt-Titusville President Rick Esch (UPB '81, '83; BUS '98G) has been a wonderful partner. He saw the win-win for the University and the community immediately. President Esch also brought key partners to the table, like Titusville Area Hospital, which had open space to use as our dental clinic.

What sets this initiative apart from other approaches to addressing rural health care shortages?

Oakley:Each RTC supports three educational programs: a yearlong General Practice Residency (GPR) program, a dental assistant training program and a dental hygiene program.

For decades, dental schools, legislators and organized dentistry have examined how to solve the access to care issues across the United States - noting only 6% of Pennsylvania's dental school graduates decided to practice in a rural area. These data are supported by a range of contributing factors, including a preference for proximity to urban amenities, feelings of professional isolation, challenges in staff recruitment and retention and reduced Medicaid reimbursement rates - all of which compromise ideals and undermine financial sustainability.

Pitt's new training opportunities not only increase the number of skilled professionals within the rural community but also attract new talent from within, driving economic growth through increased employment, local spending and improved access to essential dental care services. The enhanced oral health of the population further supports overall health, productivity and well-being, contributing to long-term community sustainability.