Office Visit: Dr. Jessica Bremerman by Kyle Patton, associate editor

Office Visit: Dr. Jessica Bremerman

by Kyle Patton, associate editor
photography by Chad Bremerman

Dentists spend most of their working hours inside their own practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of how they practice.

From homelessness to the head of dentistry of a 10-chair public health clinic, Dr. Jessica Bremerman’s path to dentistry is a remarkable tale of resilience. “Once my patients saw I wasn’t just another dentist trying to pay off my student loans and I truly cared about their well-being, I could see the change,” she says. “When I look at my patients, I see myself. I was them.”

Bremerman is a Jill-of-all-trades general dentist at the Yakima Valley Farm Workers Clinic, a nonprofit community health center that operates 43 clinics throughout Washington and Oregon. This remarkable Townie is also the vice president of the Society of American Indian Dentists and a mentoring doctor for the Northwest Dental Residency.

In this month’s Office Visit Q&A, Bremerman gives us a unique look into a federally funded public health practice, her involvement and history with serving the American Indian and Alaska Native populations, and shares some of the pearls she has picked up over the years of mentoring.

Office Highlights

Dr. Jessica Bremerman

Graduated from:
University of Washington School of Dentistry

Yakima Valley FarmWorkers Clinic

Practice size:
10 chairs

Team size:
2 general dentists, 2 AEGD residents, 3.5 hygienists, 9 assistants

You’ve described periods of your life as nomadic. Before we get into your professional career, tell us about your personal path.

I was raised by the community around me. Saying I grew up “nomadic” is just a way to glamorize my crappy childhood. My parents struggled with addiction and their own demons. I changed primary schools 11 times before I graduated from high school. My family went through rough times of being homeless; relatives or family friends would take us in. I spent a season of my life living in a pull–behind trailer behind a Chevron station. There were five of us and two cats.

My saving graces have been my passion for doing well, my competitive nature and my resilience. I always did well in school and sports. My competitiveness always put me at the top of my class, wherever I was. I didn’t have a whole lot of life guidance and it wasn’t until my freshman year at the local junior college that someone really paid any close attention to me and gave me some advice. My professor for an elective class—the history of jazz—saw my potential in a paper I’d written about Miles Davis. He encouraged me to apply to go to a university, to think big. From there, I became a biochemistry major with the hope of becoming a dentist.

Why public health instead of your own private practice?

From early on, I knew that I wanted to make a huge impact in the dental care given at a public health level. I graduated dental school naively wanting to change the world; it didn’t take long for me to realize that my impact would take time and I needed to focus on the dental provider relationship with my patients. There is this level of mistrust between patients and public health dentists. I wanted to break through that wall.

Once my patients saw that I wasn’t just another dentist trying to pay off my student loans and I truly cared about their well-being, I could see the change. When I look at my patients, I see myself. I was them. I hope that when my patients look at me, they can also see themselves. I love that my patients need me and are grateful for the care I give. The dentistry is hard but so rewarding.

Have you considered switching to private practice?

There are days that I question my future as a public health dentist and wonder how I would do in private practice. Sometimes the bureaucracy of public health can be frustrating. There are days I wish I could do more for our patients but am limited by the financial barriers and even the patient’s accountability for his or her own oral health. I wish for more flexibility and full control over practice management, and even the stigma of being a public health dentist gets to me. I hate the perception that I am “less than” my equivalent private practice dentists.

Give us an overview of the community at large and the patient pool you treat.

Yakima Valley Farm Workers Clinic (YVFWC) is a nonprofit community health center with 43 clinics throughout Washington and Oregon. Our clinics provide services to patients of all ages and provides them with medical, dental, behavioral, pharmacy and outreach services. YVFWC predominately sees the low-income and underserved communities of the Yakima Valley. At my site, the patient demographics include primarily children (50%), pregnant women and agricultural/ seasonal workers of our community, and the majority are Spanish-speaking. About 50% of the patients have dental coverage through the state Medicaid and the other half have no dental coverage.

All of our dental assistants are bilingual and are required to pass a standardized exam in English/Spanish verbal translation for our organization. At first it was hard to transition to communicating with my patients through another person, because dentistry is already a foreign language, but I’ve learned to speak, pause and listen so that I can establish rapport with my patients. I use a lot of models to explain to patients their treatment options. Their input is always addressed, and they know that we value their voice in their dental care.

Tell us about your involvement with the Society of American Indian Dentists (SAID).

As an underrepresented minority in the dentistry field, I am very proud of my American Indian heritage and how I can encourage minority students to pursue a dental career. I think that minorities pursuing health care professions have to deal with not only personal challenges but also academic and stereotype barriers. I remember during my undergraduate studies, a friend who was also working toward applying to dental school implied that because I was a minority, it would be easier for me to get accepted into dental school. I felt completely disrespected by his behavior, but it also encouraged me to embrace and speak for members of my Native community who are aspiring to be a part of the health care field.

I am currently a board member, and the vice president, of SAID. The organization’s mission is to promote and improve the oral health of the American Indian/Alaskan Native (AI/AN) community and to provide advocacy for AI/AN dental professionals across the United States.

I believe that underrepresented minorities in the health care professions have a huge impact on the community when they voice the health care disparities that minorities suffer when accessing medical and dental services. It’s well known that AI/AN suffer disproportionately to oral health disparities and Native children are the highest group to have untreated early childhood caries. I believe that if we can encourage more of the AI/AN youth to pursue careers in the dental profession, we will be better suited to solve these disparities in our community.

What’s an upside of being in a federally funded practice?

I think that there is a misconception about public health dentistry being federally or state funded. Being a community health center means that we receive funds from the federal government. The expectation is that we deliver care to the community and provide services without denying patients medically necessary dental treatment. Through federal funding, we’re able to see patients for dental care without rejecting patients because of their inability to pay for that dental service. We’re also able to provide sliding fees, which helps patients receive routine dental care and preventive care.

Receiving funds from the government does not mean that patients receive free dental services that are not medically necessary. Public health dentistry provides dental care to so many in our community who otherwise would not have accessible urgent dental care or afford routine dental care.

How does your average day look?

I work either 7 a.m.–6 p.m. or 7 a.m.–5 p.m. four days per week, and these are all hours doing direct patient care. Two days per week I am expanded with a hygienist, when I do a lot of restorative. I have a lefthanded hygienist (I am also left-handed) who shares my strong work ethic, so we make a great team and those days are my favorites because I feel like we work like a well-oiled machine. I typically see 20–30 patients per day, and the resident who works under me sees about 8–12. We have an emergency hour for same-day dental emergencies who aren’t patients of record.

Tell us about the Northwest Dental Residency program.

I am a mentoring dentist for the NDR, which is an AEGD residency program. We typically have 8–9 residents per year who are spread out between multiple sites, most being federally qualified health centers (FQHCs) in rural communities in Washington state. With budget cuts, our incoming 2021–22 class will be five residents.

The program is structured slightly differently from other residencies because it’s within a community dental clinic setting, and also our residents get selected to work under one particular dentist for the full year, rather than working under multiple mentoring faculty.

Initially, I wasn’t super excited about teaching but have grown to love it! The first years out of dental school are so critical, and there’s a lot still to be learned. I take the responsibility of preparing these dentists for real life very seriously.

How are the new dentists you mentor?

I find it interesting that young dentists want to jump right into doing aesthetic dentistry and placing implants when really, they need to focus on getting their speed and efficiency up—the bread-and-butter part of dentistry. They need to build their confidence in their treatment-planning skills and come to the realization that dentistry is not black-and-white. It has lots of gray areas and there are always multiple ways to address a patient’s dental needs.

The residents are required to get a certain number of higher-end procedures. In a normal community health setting, some of these procedures would not be an option or would get referred out. This includes crowns and bridges, molar endodontics, dentures, implant restorations, periodontal surgery, etc. There is a financial allowance that the residents can allocate to patients to help them move forward with these procedures that aren’t covered by their insurance.

How is the business side of the practice handled?

Being a public health dentist really allows me to focus on patient care. My colleagues in private practice constantly complain of their stresses of dealing with the practice management issues, staff issues, hiring and dealing with private insurance companies. I don’t have any of that.

Our leadership team takes care of the day-to-day practice management. I do have some input when it comes to hiring new staff and I have a great relationship with our clinic supervisor and director. That’s part of the reason I’ve stayed with my current position: We work very well as a team and I feel my input is valued.

Any issues in not having a hand in the business management?

There are challenges that I have to deal with. Many of the leadership team do not have a dental background and make recommendations with a medical perspective. Their understanding of what happens on a daily basis in our dental clinic is very minimal, yet they are the people who develop procedures and policies for our department.

An example would be the infection control group wanting to dictate the dental sterilization workflow. A current frustration of mine: Because of a credentialing issue with the use of our diode soft-tissue laser, all procedures where the laser would be used are now on hold. In a private practice setting, this issue could be expedited. Here, it’s now been well over a month of waiting to get credentialed.

Top Products

Vitallium Clasp Adjuster. My “boomerang.” I have a ton of patients with partials and they need their clasps tightened/adjusted occasionally. I am not the best at bending wires and struggle using the three prongs. The boomerang is way more user-friendly when adjusting clasps.

Luxator 3S 3mm Straight. This is in every OS cassette.

Garrison Composi–Tight 3DXR Sectional Matrix System. I almost never have issues with getting proximal contacts with my Class II resin restorations when I use this system.

Zyris Isovac and HenrySchein Isolite. Isolation is key to predictable resin restorations.

SOL Portable Diode SoftTissue Laser. I love using this for crown preps with deep margins and angry tissue, as well as for mild gingivectomies after orthodontic treatment. It can even be used for simple frenectomies.

Clinically, you love oral surgery. Why?

There’s something so gratifying about taking a tooth out effortlessly on a patient who has no confidence in me because I am a female dentist. I have had patients directly ask, “Are you strong enough to take my tooth out?” or say, “You are too pretty to be able to take my tooth out.”

As a dentist with Indian Health Services, you are exposed to a lot of oral surgery. I remember taking out 300–500 teeth per year! Lots of wisdom teeth, full-mouth extractions and dental emergencies. My favorite instruments are the Luxator and the Periotome. When extracting teeth, I like to “feel” the progression of movement; it’s definitely a more tactile than visual approach.

Got any tips?

When working with the AEGD residents, the biggest mistake I see is them getting stuck and doing the same thing without any progression. They’re hesitant to go surgical. If elevating against the adjacent tooth wasn’t working in the beginning, it’s not going to work 20 minutes later—if anything, the situation is worse now that the patient has been open forever and is experiencing jaw pain.

Another tip during those times of frustration when that last root tip is just not coming out is to take a break and step away for a few minutes. You would be surprised how many times I’ve done this, and a fresh set of eyes is just what I needed to get a new perspective and to pop that sucker out.

Share one of your favorite cases with us.

Although our dental office has served and made a positive impact on many patients, a case that I speak of with joy is my patient of many years, Juan Tellez (photos below). Juan’s case stands out to me because I was able to help him achieve his oral health goals despite his financial and literacy barriers.

It also reminds me of the impact that a community health dental clinic can have, bridging the gap for dental care for the underserved and collaborating with other dental professionals in achieving good oral health one patient at a time.

Juan, then 34, was seen as an emergency because of dental pain in 2014. He had no underlying medical conditions but his oral health condition was severe, and he had chronic periodontitis with an overall poor to hopeless prognosis for all of his dentition. The dentist before me had recommended full-mouth extractions and complete dentures. Juan was adamant about saving his teeth and declined the dentist’s treatment plan recommendations.

Once I became his dental provider, our dental care team was able to stabilize his gum disease and complete his restorative needs, and he ultimately followed up on my recommendations of seeing the local periodontist, Dr. John Iasella. Because of Juan’s excellent oral health compliance, in 2017, we were able to pursue a more feasible treatment plan that involved multiple implants instead of a removable prosthesis. His smile reflects my values as a public health dental professional and the rewarding patient–dentist relationship in working together to achieve a common goal.

Office Visit: Dr. Jessica Bremerman
Fig. 1
Office Visit: Dr. Jessica Bremerman
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What aspects of it would you miss most if you were to ever transition into private practice?

At this point in my career, I would miss my patients. I’ve been with YVFWC for almost seven years now and I have an established practice. My patients have shown their appreciation for my work by bringing me goodies, trusting me with their children’s and family’s dental needs. I’ve seen their children grow over the years and the provider–patient relationship has grown. I have staff and co-workers I love to work with and trust.

Unlike many public health dental clinics, we don’t have a ton of turnover. Many of the assistants have been here for 15-plus years. The other dentist—who was actually one of my mentors in dental school—has also given his life to public health dentistry and has been with YVFWC for 16 years. Work environment is super important to me; I’ve been in offices where you can feel the negative energy. We don’t have that.

How did you and your office handle the pandemic?

It was rough and stressful, as I know many other dentists felt too.

Our clinic did stay open during the pandemic with a limited staff. Most of our staff were put on standby and we rotated through the staff dentists—I would have two weeks on, then two weeks off. We saw only dental emergencies; no aerosol procedures. We followed the guidelines as they came out, and were constantly changing our workflows to adapt to the ever-changing information from the CDC. Essentially, we’re practicing dentistry in a plastic bubble now, but I’m getting used to it.

Many of the private offices in our valley completely closed or took calls only during those initial months of the pandemic, so I was honored that we could provide an option for the community to seek emergency dental care.

You did have one tool that some private docs would be jealous of during all this ...

Yes, one of the greatest benefits of working in a community health clinic during this pandemic was our connected health care software that links our patients’ medical and dental records. We have access to their full medical records—their medication lists, their emergency visit encounters and labs, including their COVID-19 test results. We have been using Wisdom software for almost two years now.

We did all the COVID-19 screening over the phone the day before a patient’s appointment and screened them again from their car before they entered the clinic. Then we’d check their temperatures at the door. You’d be surprised how many patients would still try to come in, even if they were symptomatic or waiting on their test results. This goes to show how essential dental care is to a patient’s overall health.

What do you think is the biggest challenge dentistry as a profession faces or will face in the near future? What’s a potential solution?

I don’t think we have seen the true COVID-19 impact on our profession yet.

I know there is talk about adult dental Medicaid coverage being on the chopping block for Washington state. Because the financial impact of COVID-19, dental access could be severely hindered. As unemployment rates go up and businesses close, fewer people will be able to afford routine dental care. FQHCs are a safety net for the underserved and low-income, but we are already unable to provide for the current needs of this socioeconomic group.

Give us a snapshot of your life outside of dentistry.

I married my high school sweetheart and have three growing boys, ages 11, 9 and 6. I was destined to be a “boy mom.”

Our life revolves around basketball and other sports. I am currently coaching my littlest one’s soccer team and have coached the others as well. My husband coaches the boys’ basketball teams. It has been so fun to share our passion for sports with them! My husband played professional basketball in Australia while I was in dental school. The boys love to compete at a high level. We travel all over to compete for basketball: Reno, Salt Lake City, Phoenix, Boise.

In my first 10 years out of dental school, I was super involved with organized dentistry. Now that my boys are older and have goals for themselves, I feel compelled to focus on them. Looking at my childhood, that’s something I wish I had. I also never want my children to look back and wish I had been around more.

One of the biggest pieces of advice I give the residents is that you’ll never be on your deathbed and wish you had worked more. You will wish that you’d spent more time with the ones you love; you will wish you had traveled more; you will wish you had lived life more fully.

Being a public health dentist has really given me the best balance for life as a mother. Eventually, I plan to get back involved with organized dentistry, once my children are older and don’t want to hang out with me anymore.

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