This profile is one in a series highlighting School of Dentistry alumni, donors and students.
Ann Arbor, Mich., Oct. 30, 2018 -– It was an interesting idea that started small 21 years ago and easily could have failed. Today, its astounding success proves it was a great idea and Marcy Borofsky is still working at making it bigger and better.
Last year, Smile America Partners took its mobile dental clinics into 8,000 mostly elementary schools in 19 states from California to New York and treated more than half a million young patients. To confirm: That’s 500,000 children in one year. The vast majority would have gone without dental care if not for this program that is designed to reach the children of low-income families.
Borofsky, a 1984 graduate of the University of Michigan School of Dentistry, is more business leader than dentist these days as Executive Vice Chair and Board Member of the company. Yet her passion is still based on the lessons she learned in dental school about the importance of oral health in a person’s overall health. That, in turn, is connected to countless life issues, like how successful a person with dental or other health problems will be at finding jobs, earning a living and providing for their families.
It all starts with children. Dental decay is one of the most chronic conditions for children in this country -– and is largely preventable. Low-income families often view dental care as a luxury they can’t afford, Borofsky said, and many don’t realize their children qualify for treatment under federal Medicaid regulations that have been in place since the 1960s. Even if their children qualify, it may be difficult for families to find or travel to a dentist who treats Medicaid patients. That means many underserved children have never seen a dentist by the time they are in elementary school.
Smile America Partners works with school districts from coast to coast to provide in-school dental clinics. Billing itself as the nation’s largest mobile Dental Service Organization, the company contracts with dentists, dental hygienists and dental assistants to go into elementary, middle and high schools and, with the permission of parents, provide preventative care, simple restorative care and referrals for more serious problems. More than a thousand employees, based around the country, coordinate the myriad details necessary to schedule the dental teams into the schools. The company purchases, maintains and transports the equipment and supplies used by the dental providers. There is no charge to the schools. Smile America Partners bills insurance providers, with 85 percent of the company’s revenue coming from Medicaid.
The origins of this success story are, like Borofsky’s dentistry path, a bit non-traditional. A native of suburban Detroit, she earned a degree in physical therapy from Wayne State University and worked in that field for three years before deciding to pursue dentistry at U-M. She gave birth to her first child between her third and fourth years of dental school, yet still graduated in four years. One year out of school, she had her second child, which influenced her career path for several years. She used her new DDS degree part-time while continuing to work in physical therapy. She founded a multi-site physical therapy and rehabilitation company and, later, a healthcare staffing organization.
Her work with physical therapy patients gave her insight into the surprisingly large number of people who have physical limitations that don’t allow them to travel easily to places that most people take for granted -– like doctor or dentist offices, among others. Borofsky began to brainstorm with a dentist friend, Margo (Yellin) Woll, a fellow U-M dental school grad (DDS 1978), about starting some sort of mobile dental clinic for patients who can’t easily access the traditional brick-and-mortar dentist office. As they researched and thought through their options, they considered several groups – senior citizens, people in the military, those confined to prisons and children who need dental care, particularly those of low-income families. It was the latter group that seemed to be the largest and, they reasoned, the easiest if they could somehow introduce dental clinics into schools since children are already there every day.
Working at their kitchen tables, the pair created a plan that they called “a private practice in a school” that would act as a dental safety net for children. In March 1997, they held their first in- school clinic, at a charter school, Great Lakes Academy, in Pontiac. They contracted with a dentist and hired an administrative assistant to help with the paperwork, assuming, correctly as it turned out, that they would need more than their own dentistry skills to meet the demand.
They quickly learned that poor oral health among underprivileged children was a bigger problem than they realized. Borofsky said she coined a phrase to describe why their program was immediately in demand: “We were sucked into a vacuum of need.” Most of the children had never been to a dentist and about half had significant dental decay. “We saw decay like they described in dental school about the pre-fluoridation days,” Borofsky said. A national health report, published three years after they started, documented the national epidemic for children in low-income, racial- and ethnic-minority families.
“Even with all the dentists we educate at dental schools in this country, you are never going to drill your way out of this issue,” Borofsky said. “There is just way too much decay to do that.” The answer was prevention and early intervention, and the school model seemed a good place to start. With the help of school administrators, the pair of dentists began steadily spreading their program into more schools. School officials were almost universally enthusiastic about in-school dental clinics because they understand that healthy kids are absent less often and are better students. Borofsky and Woll called their program “Mobile Dentists” and it soon expanded into the schools of Detroit, its suburbs and throughout Michigan.
Within a few years the Mobile Dentists program was in 10 states. They moved to successively larger offices until they arrived at their current location in Farmington Hills, in a large office building where they have regularly added square footage as the organization has grown. Over the years they occasionally received grants, from the Michigan Department of Community Health to build infrastructure; the Robert Wood Johnson Foundation; Annenberg Foundation Schools of the 21st Century; The Jewish Fund; and Home Depot. In 2008, Mobile Dentists took on a financial partner, Sentinel Capital Partners, and in 2011 became part of Morgan Stanley Private Equity. In the process of upgrading their financial resources and infrastructure, they merged with two similar in-school dental programs in Arizona and Georgia, becoming Smile America Partners. They now have offices in those two states as well as in New York, where they have a strong presence in the massive New York public school system.
The company contracts with about 350 dentists nationwide, as well as about 500 hygienists and assistants. The dentists range from recent grads to veteran dentists, including some who are retired. Some work nearly full-time at it; others mix it in with their private practice. Yet others like the limited school-day hours and summer months off. “You have to have a heart for this kind of work,” Borofsky said. “Because every day when they go into their own offices, they are used to having everything there – their equipment there, their supplies there, their assistant next to them. It’s organized. Going into schools is a less-organized environment, so they need to be flexible.” The mobile clinic may end up in a classroom, at the end of a hallway or at the back of a stage in an auditorium. Some dentists and hygienists try the program and move on, but many have stayed for a decade or longer. “The ones who stay, feel very good about the work that they do when they go home at the end of the school day,” she said.
As she looks back on the extraordinary story of how the program has grown from one school to 8,000, Borofsky has occasionally tried to analyze why she decided to take this route with her dentistry education and why it worked so well. For starters, she says, she grew up with parents who were Holocaust survivors, her mother from Lithuania and her father from Poland. “I think the idea of social justice was woven through the fiber of my being,” she said. “I didn’t grow up with a lot of relatives because most did not make it out of Eastern Europe.”
And then there were two moments at the dental school at U-M that left an early impression on her. She admits to being a student who sometimes sat in the back of class and didn’t engage professors much, but she recalls exactly where she was sitting one day when a professor was talking about a community dentistry case study. He said that a U-M dental hygiene student had attempted to start a prevention and sealant program in schools, but it hadn’t succeeded. “It was a light bulb moment for me,” she recalls. “I remember raising my hand, which was uncharacteristic of me, and saying, ‘Well, why didn’t it work?’ And I don’t remember the answer. But that was the moment when it was implanted in my brain that reaching out to people is something that you can and should do. That, coupled with my physical therapy experience, where people had limited mobility, really did form the foundations of what jelled into this idea.”
As Mobile Dentists was getting started, another bit of wisdom from dental school came back to her, from Professor Gerry Charbeneau. “He said, ‘If you keep your chair filled the entire time you are here at dental school, you will graduate on time.’ It was prescient and I remembered it as we came here to start this company, and it was very important for the success of this company. We were already getting low fees, they weren’t going to be higher, they were state-mandated fees. But if we could keep the chairs filled at the schools, we were going to have a financially sustainable model. So thank you, Dr. Charbeneau, for that advice, which lives on today.”
Borofsky has a new link back to the dental school, as an adjunct professor who is assisting Professor Margherita Fontana and her team with two major research grants into childhood caries. Borofsky is helping make connections with schools where researchers plan to follow the oral health of young children for several years. Some of the research involves Silver Diamine Flouride, which has shown promise in preventing caries and is being implemented into the mobile school clinics by Borofsky. As a result of that kind of commitment to the latest treatment trends, along with her national-level expertise in promoting childhood oral health and treatment efficiencies, Borofsky has been invited to serve on numerous state oral health coalitions and she speaks at conferences around the country. She currently serves on the Dean’s Advisory Committee of Harvard Dental School.
“I’m very proud of how this has evolved. It’s not the effort of one person, it’s the effort of lots of people,” Borofsky said. “Margo and I co-founded it and in the beginning it was difficult. Every day it was like, what problem’s next? Where’s the shield, where’s the armor? We created something out of thin air, something that didn’t exist.”
She credits the company’s school partners for identifying and working to meet student needs. “There is a huge group of unsung heroes in schools – teachers, principals, superintendents – who really know these kids need services. Over and over and over again, I am so overwhelmed in a positive way by how many caring people work in schools.
“It’s been an exciting career and an interesting career. But the down side is that however many children we reach, it doesn’t touch the need, because the need continues to be enormous. I hope, if anything, to be an inspiration to other dentists who want to work internationally or work in this country. There’s lots of work. You just have to be thoughtful about how you reach the populations and make that difference.”
Most of the time Borofsky is too busy to contemplate the incredible national impact of the mobile dental clinic model, but there are moments, though, when the success of the program washes over her. She was in a Detroit-area hospital earlier this year when she met a friendly and talkative employee who had just graduated from high school in Detroit. She asked him if he ever was treated by Mobile Dentists. He replied, “Are you kidding? My mom signed me up for that program twice a year, every time those Mobile Dentists were at school, for every year I was in school.” Before revealing her connection to the program, Borofsky asked if he has any problems with his teeth now. “No,” he said, “I have great teeth.” Borofsky smiled. “He could have done an advertisement for this type of program. It was pretty terrific.”
The University of Michigan School of Dentistry is one of the nation’s leading dental schools engaged in oral health care education, research, patient care and community service. General dental care clinics and specialty clinics providing advanced treatment enable the school to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction prepare future dentists, dental specialists and dental hygienists for practice in private offices, hospitals, academia and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide. For more information about the School of Dentistry, visit us on the Web at: www.dent.umich.edu. Contact: Lynn Monson, associate director of communications, at email@example.com, or (734) 615-1971.