A career in health care was a no-brainer for Roaa Saadeh, 25. Growing up, she developed an innate belief that quality health care could shape a person's quality of life. It drove a desire in her to create healthy communities. So, she explored multiple clinical fields in medicine, psychiatry, and even optometry in college for the right fit.
In high school, while living and volunteering in Jordan, which is home to a large refugee population, Saadeh saw first-hand that dental care was overlooked in underserved communities unless the patient was in excruciating pain. Back in the U.S. months later, she noticed similar patterns, low-income communities with little-to-no access to dental care.
"Dental care is not a health priority in vulnerable communities," Saadeh said, pointing out they naturally prioritize paying for things like food and housing ahead of visiting the dentist. "But oral health is the key to preventing infections in the body and to identifying other possible medical conditions that need attention. I knew this is where I could make the biggest impact in the lives of patients, especially those who are marginalized."
How it started
Now in the final year of her Doctor of Dental Surgery (DDS) degree in UC San Francisco's School of Dentistry, Saadeh is juggling a full schedule of classes, labs, internships, and externships. She also volunteers at the Citywide Dental Clinic, a monthly free public pop-up dental clinic in San Francisco's Tenderloin District organized by UCSF's School of Dentistry. At Citywide Dental, UCSF dental students provide free care to patients under the watchful eye of UCSF dental faculty.
Dentistry allows me to be involved in research, advocacy, and community service, which is why it's the career for me.
Roaa Saadeh, uCSF DDS Candidate
The dental clinic is the brainchild of Gurrinder Atwal , DDS, MS, professor at the School of Dentistry and director of the School of Dentistry's Community Based Clinical Education program. He piloted the free dental clinic as part of the UCSF-run Citywide Case Management Program , a behavioral health and intensive case management program for low-income San Franciscans run by the UCSF Department of Psychiatry at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG).
The pop-up dental clinic is organized by three faculty in a room equipped with a portable dental chair and x-ray equipment and individually wrapped sterilized dental instruments. UCSF dental students assist in treating six to eight patients a day with faculty oversight.
Citywide's psychiatric case managers and social workers refer their patients to the dental clinic for teeth cleaning, filling cavities, tooth extractions, and adjusting dentures, or to answer questions regarding implants. After the initial evaluation and treatment for acute issues, patients needing longer-term care are referred to the UCSF Student General Dentistry Clinic at Parnassus, a permanent clinic open 8 a.m. to 5 p.m. weekdays, where dental students receive their clinical training and many students continue caring for the patents they treated at the dental pop-up.
"Bad dental hygiene impacts these patients' physical and mental health," Atwal said. "Gum disease can be a sign of cardiovascular disease and chronic inflammation in the heart, lungs, and even brain, causing dementia. In addition, unhealthy teeth and gums impedes their confidence in job interviews, socializing, and just getting back on their feet."
The patients in this marginalized community are fighting their mental health demons while struggling to survive on the city's streets. They face violence, hunger, and, sometimes, disdain, but also struggle with being treated as invisible by society. Atwal is adamant that student-patient relationships begin and end with trust.
"When patients walk into this clinic, we first make sure they know 'we see you.' We ask questions about their dental and medical health, take notes, and make sure they understand that they have been heard. We meet them where they are and work with what is in front of us," he said.
A life-changing decision
Patient Jeffrey Romey's first visit to Citywide Dental was out of desperation. For a month, the 44-year-old had lived with a burning, throbbing toothache that was so painful he could barely eat. Long lines at other public dental clinics gave him little hope of an appointment. As his pain worsened, he figured his only remaining option would be the emergency room.
A Citywide social worker told him about the center's monthly dental clinic. Within a week, Romey was in a dental chair with Atwal scrutinizing the worrisome tooth.
The verdict? Extraction.
"This is only one step in improving their overall health, but it can change their entire lives."
Gurrinder Atwal, DDS, MS
UCSF School of Dentistry
Atwal calmed Romey's fears by carefully explaining every step of the extraction - what he was doing, why he was doing it, and what to expect. The procedure was quick, the recovery easier than anticipated, and, most importantly, the pain that had dominated his life for weeks was gone.
"It was a game changer," Romey said.
However, he also found out that 25 years of drug addiction had taken a toll on his teeth, and he would soon need them all extracted due to gum disease. Although the diagnosis was frightening, the threat of it possibly contributing to other health issues down the road due to neglect - especially after three years of hard-earned sobriety - was more terrifying. Romey made an appointment at the UCSF Student General Dentistry Clinic at Parnassus.
"I would like permanent implants," he said, sheepishly grinning. "Taking out dentures is not a great look if you're dating."
This time Romey wasn't as leery about the dental visit. His experience at Citywide let him know what to expect: timely, compassionate care close to home from providers who treated him with dignity.
Patients like Romey often delay treatment or seek care only after a dental emergency becomes unbearable, Atwal said. Direct access to a dental clinic close to home can make all the difference to their overall health.
How to reach more people in need
For Saadeh, treating vulnerable patients at Citywide has fortified her passion for dentistry.
Many haven't visited a dentist in years and end up coming in for emergency dental work in unbearable pain. Resulting conversations often lead these patients to charting a long-team plan that includes meeting with dental specialists like periodontists, prosthodontists, and endodontists at the Parnassus campus.
"I just love the flexibility that dentists have as being advocates for their patients, as well as the ability to guide them toward overall health," Saadeh said. "Dentistry allows me to be involved in research, advocacy, and community service, which is why it's the career for me."
After graduation, Saadeh plans to pursue a residency in oral and maxillofacial surgery (OMS) "for its unique role at the intersection of medicine and dentistry"- where she'll learn to repair broken jaws, do complex wisdom teeth extractions, surgically repair cleft lips and palates, and more.
Meanwhile, her passion for the people at Citywide prompted her to submit a proposal to the UCSF Academic Senate to formalize the pop-up clinic as an elective course in the graduate program curriculum. She expects a decision by the end of 2026.
The program is currently voluntary, which students often find difficult to fit into their busy schedules of classwork, clinical hours, and internships. As an elective, students would receive credit and be able to prioritize the experience as a valued part of the dental program.
"The benefits of participating in the dental clinic are immense - you receive one-on-one training and mentorship from seasoned faculty, you work with the integrated psychiatry team to learn the patients' backgrounds, and you learn how to approach patients with compassion and sensitivity," Saadeh said. "Being an elective could incentivize students to take advantage of this valuable opportunity."
Feedback about Citywide Dental from social workers and community organizations has been positive, Atwal said, with often more patient referrals than the current volunteer staffing can support. But his vision is to increase the number of clinic days to biweekly or even weekly if possible, providing more students with the experience they need and more patients with dental care.
"This is only one step in improving their overall health, but it can change their entire lives," he said.
