by Sara Peebles
volunteer writer for Angels in Medicine
Copyright © 2024 Sara Peebles
Dr. Jessica Dubek grew up in eastern Washington state and was the first person in her family to attend college, which was quite an achievement.
During her undergraduate studies, she was at first unsure which professional field she wanted to enter. After getting to know a dentist, she thought that dentistry might be a fit for her. She was inspired to take the dental school exam and apply to dental schools almost blindly. After being admitted, despite not fully knowing what to expect, she leapt into the demands of professional school and stuck with it.
Following graduation, Jessica began work in private practice, where she soon realized that something was missing. She wanted to use her skills for a larger purpose— to provide dental care to underserved populations.
Lummi Dental Health Clinic
When a friend reached out to her about an open position, Jessica began work at the Dental Health Clinic on the Lummi Nation reservation in northwest Washington. The clinic needed a dentist with experience in pediatrics, which Jessica had focused on in her dental school training.
It was at Lummi that Jessica found her professional calling in public health dentistry. She loved the work, and after her first few years as a dentist, she was promoted to Dental Director. Her mentor, Dr. Justin Iwasaki, who was Medical Director at the time, gave Jessica a level of autonomy so that the team was able to build a dental home and a dental program for the Lummi nation.
“What I was able to accomplish for the community along with my team was really rewarding,” Jessica said. Because there was a lot of historical and current trauma that had occurred to patients, she explained, it took a decade to build trust, to build a safe place, and to have dental professionals in a place where they felt trusted. The time, energy, and love that the team put into the clinic was felt by the community.
The clinic was able to bring all dental specialties in-house, and they also incorporated dental therapists (mid-level providers similar to physician assistants in medicine) in 2019. Jessica noted, “That was a huge steppingstone for…the dental clinic, to have these two Lummi women go out and do training and really serve their family and their community.”
A State-of-the-Art Community Dental Home
After 10 years, Jessica left the Lummi Tribal Health Center. But not before the changes she worked on became a reality. This June, a brand new 16-operatory dental clinic was opened. The clinic had just a handful of staff when Jessica arrived; they were up to over 30 members when she left. The new building allowed them to quadruple both the staff and the number of patients seen. It has been expanded into a state of the art, community-focused, patient-focused dental clinic.
Bringing all dental specialties into the clinic — braces, dentures, implants, root canals, and oral surgery — was a crucial step forward. When Jessica first started, she would have to refer patients to an outside provider for many services. When a patient had a bad experience or was treated poorly at an outside office, they often wouldn’t return. They would miss their appointment, putting them back at square one.
“It really took a lot of work to get these services incorporated at the dental clinic, but treatment was getting completed. Having this dental home where you really are respected and listened to really made patients want to come to their appointment, and I think that’s important for any community.”
The clinic saw many, many cavities, including early childhood caries, which is common at community clinics. Diet and nutrition play an important role in dental health. The closest grocery store is far from the reservation, so most residents usually go the local food mart, which has few healthy options.
“Education was a strong point to bring in,” noted Jessica, “and the dental therapists did such a great job with that. Having someone who looks like you tell you something means more than someone who doesn’t look like you. And that’s why it’s so important to have a diverse workforce.”
The team also incorporated a holistic cultural approach within the clinic design for families. Jessica was adamant about having a bench in operatory, where families can sit comfortably while a patient is being treated. She wanted the clinic to be sure to offer that level of compassion, knowing how important family relationships are for even a simple dental procedure, and for building trust.
Founding DentALL to Expand Dental Care Access for All
Jessica credits her experiences at the Lummi clinic with inspiring a new venture. “That really helped launch DentALL,” she said. “Knowing what was potentially possible for other communities, and what really gave me the courage to start.”
In 2023, Jessica founded DentALL with the mission of finding innovative solutions to bridge the oral health care gap in the US. She hopes it will address these disparities locally in Washington state, and also serve as a model for other areas. “I am passionate about ensuring folks have access to dental care…there has been so much research behind the connection between oral health and overall wellbeing of you as an individual. Ensuring you have that option of seeing a dentist is crucial.”
Starting a new organization is never easy, and Jessica has been very busy working to reach out and secure partnerships and funding. Having a team is an important part of the process, even with a small startup. She began with two dental assistants, but it has grown. “I do have a great team helping me, so I’m not doing it by myself anymore. I have an amazing team, [including] an operations manager who has really been fruitful in allowing me to be a little bit more present at home.”
Currently, DentALL serves two locations, the Whatcom County Jail clinic and the Orcas Island clinic.
Whatcom County Jail Clinic
DentALL serves the Whatcom County jail weekly, with the team consisting of Jessica and a dental assistant. Every Thursday they perform exams, emergency exams, extractions, and fillings. “It’s very humbling being at the jail. I really truly enjoy it,” Jessica said.
She has found the conversations with patients to be very educational for her. She feels fortunate that they have shared their childhood stories, and their stories in general, about drug use, and how hard it is living on the street and to stop using fentanyl.
“I don’t think I grasped what drug use does to you… when someone is consistently taking fentanyl, [they] are not feeling anything, and so when they get booked at jail, they are going through withdrawals two to three days later. Everything hurts, they are sick, and they are having extreme pain due to tooth decay.”
Most of these patients would not get dental care if they were not in jail. Luckily, the jail has been good about making sure that patients receive care while they are there.
There are a lot of emergencies that need to be handled, and so the DentALL staff sees as many patients as they can in six hours. Dental procedures take time, like a mini surgery. A sterile field and sterile instruments must be prepared, then numbing is administered, then the surgery, and then disinfections and sterilizing. It takes 45-60 minutes, and the team goes as fast as they can, but they can still only fit so many patients into one day.
Jessica has spent more time at the jail in August to try to get through the waiting list. She feels lucky to be able to provide dental services to patients who are truly in need of pain relief.
Orcas Island Portable Clinic
DentALL’s first portable clinic works on Orcas Island, which is located off the coast of northwest Washington in the San Juan Islands. It is only accessible by boat or plane. The main local industry is tourism, and the island has many restaurants, rental homes and hotels. Many residents work in the hospitality industry, and many are professional artists. Due to its geographic isolation, the population has limited access to dental care.
Jessica, along with a dental assistant and a hygienist, established a portable community clinic at the Fire Hall. (They will be moving to a permanent location in September.) They pack in all the equipment once a week to see 20 patients.
All the equipment is kept in storage, and Friday morning or Thursday night, a volunteer crew sets it up. It takes a lot of energy to set up and break down the clinic, because it includes all the necessary dental supplies and equipment—sterilization tools, chair, unit for suction, saliva ejector, drilling tools, as well as cases of materials.
The DentALL team is flown in 35-40 minutes before the clinic opens (the flight takes only 12 minutes), and after they set up the equipment, they see patients for six hours. They then fly out, and fly back Saturday morning and see patients again, before packing all the equipment back up in storage until they do it all over again the next time the team is onsite.
Many organizations, including the San Juan County Health Department, Orcas Island Community Foundation, Orcas Community Resource Center, and the Hospital District, have come to the table to make the portable clinic possible and to make sure residents get care. Otherwise, it would take all day to leave and return to the island.
Mercy Flights, a nonprofit that typically flies patients out for emergency care, is also a critical partner, as they fly the DentALL team out and back. Jessica notes that Bob Waunch, Mercy Flights pilot, along with his wife Marsha Waunch, are an amazing support. They have made a great case for bringing care providers in and allowing the team to see 20 patients on a weekend.
It Takes A Dedicated Team of Volunteers and Staff
When asked who inspires her, Jessica explained that it is not one single individual, but rather the dedicated collective of people she works with. “To work alongside…for example, people at Lummi who have inspired me, just seeing their compassion or even the small things, bringing in baby toys for a patient who is about to have a baby.”
She explained that it’s not one big thing that has made a difference. Rather, it’s “just little, small things that have made me want to do better, be better, and seeing humanity at its best has inspired me just to continue doing what I’m doing. Even this journey with DentALL, a lot of this wouldn’t have happened if I didn’t have people who stepped up… and that has inspired me, and I hope to pass that on.”
Jessica also continues to be motivated by the patients and communities she serves. “I love hearing stories and asking questions, and it’s been interesting hearing their journey[s], and the hardships… Knowing that what I am doing is making their life just a little bit easier has been really rewarding for me in doing what I’m doing.” She summarized it this way: “Starting DentALL and having this level of community engagement, and knowing that it is actually making an impact, has made this all worth it.”
DentALL plans to continue expanding its services by adding mobile clinics in the coming months, and Jessica hopes this will allow her team to serve more people living in dental deserts.