Building a legacy: Dr. Natalia Chalmers on her work at CMS

Pediatric dentist is agency’s first chief dental officer in the Office of the Administrator

Years ago, Natalia I. Chalmers, D.D.S., Ph.D., encountered a grandmother and her three grandchildren who entered the dental clinic where she worked. The family had taken a two-hour bus ride to reach the clinic, and Dr. Chalmers soon learned that not only did all three kids share one toothbrush, they only brushed their teeth when they visited their grandmother. 

“Since then, I have never assumed that people have access to a toothbrush and toothpaste,” Dr. Chalmers said of the experience. 

Many people in the U.S. do not have access to high-quality dental care, Dr. Chalmers said, adding that this ongoing challenge of solving the disparities in disease prevalence and access to care is what keeps her up at night. It’s also part of the reason she decided to pursue a career in dentistry.

Dr. Chalmers is a pediatric dentist, oral health policy expert and public health advocate with more than 20 years of experience and the first-ever chief dental officer for the Centers for Medicare and Medicaid Services in the Office of the Administrator. She said through her role she hopes to, among other things, improve oral health care and policy.  

Dr. Chalmers’ position at CMS is to be the lead subject matter expert for the agency and improve oral health across Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace.

“CMS is committed to strengthening access to care and advancing health equity, and in my role, I can support this goal by focusing on improving oral health as a crucial part of overall health,” she said. 

The ADA has long advocated for CMS to install a chief dental officer and sent a letter congratulating Dr. Chalmers in 2021 when she was first announced. 

“Leveraging your leadership in the dental profession and past experience as a dental officer at the U.S. Food and Drug Administration, the Centers for Medicare and Medicaid Services is well-positioned to tackle the most serious issues in oral health care today,” wrote then ADA President Daniel J. Klemmedson, D.D.S., M.D., and then Executive Director Kathleen T. O’Loughlin, D.M.D.

Dr. Chalmers, who began at CMS in August 2021, talked with ADA News about how her role has been going so far and what she hopes to accomplish in the future. She said her top priorities as a chief dental officer are health equity, improved access, partnerships and collaborations. 

“One of dentistry's most pressing concerns is the high prevalence of oral diseases and the need for improved access to dental care, especially for underserved populations. To effectively tackle these challenges, a multifaceted approach that includes collaboration between health care organizations, policymakers and patients will be necessary,” Dr. Chalmers said. 

Since starting at CMS several years ago, Dr. Chalmers has demonstrated a commitment to her priorities in several ways. CMS launched the Oral Health Cross-Cutting Initiative, which addresses oral health needs by aligning programs and policies, collaborating with stakeholders and leveraging the expertise of various CMS centers and offices. 

Last month, the agency released the Oral Health Cross Cutting Initiative fact sheet that provides an overview of the initiative’s objectives such as improving access to dental services, promoting preventive care and cultivating partnerships. The fact sheet also includes key accomplishments and data analyses illustrating how CMS has worked across programs to improve oral health outcomes.  

Additionally, CMS announced in July that it can now accept, process and pay dental claims electronically, which Dr. Chalmers called a “significant milestone” for modernizing the Medicare payment system and promoting access to oral health services that promote wellness for all beneficiaries across Medicare and Medicaid. 

Looking back

Dr. Chalmers brings to CMS a wealth of experience. The decision to become a pediatric dentist-scientist was not just a career for her but a calling. She completed dental degree at the Faculty of Dental Medicine of the Medical University of Sofia in Bulgaria, and a residency in pediatric dentistry and Ph.D. in oral microbiology at the University of Maryland School of Dentistry.

"I chose this path because I witnessed first-hand the impact of poor oral health among elderly patients. Very early on, I decided to focus my attention on understanding the oral disease process and the most effective and efficient prevention strategies,” Dr. Chalmers said. 

Her specialty in pediatric dentistry led to her focus on promoting disease prevention through data-driven strategies. Dr. Chalmers’ clinical residency experience placed an emphasis on evidence-based clinical practice as well as on advancing public health and advocacy. 

This passion for advocacy carried her past school. She participated in the American Academy of Pediatric Dentistry Lobby Day in 2012, which Dr. Chalmers said taught her she can not only treat patients but also advocate for system improvements in oral health care. 

“It is a responsibility I embrace wholeheartedly, knowing that each step forward improves the lives of children and families in our community,” she said. 

Dr. Chalmers also served as a dental officer at the U.S. Food and Drug Administration and the National Institute for Dental and Craniofacial Research. While she was a Ph.D. doctoral candidate at the University of Maryland, Dr. Chalmers established a graduate partnerships program between the university and the National Institute of Dental and Craniofacial Research at the National Institutes of Health and completed her doctoral dissertation research in the NIDCR intramural research program. During her time at the FDA, Dr. Chalmers obtained a certificate in drug development and regulatory science from the University of California San Francisco School of Pharmacy. 

Then, after completing her pediatric dentistry advanced clinical training, Dr. Chalmers earned the NIDCR dental clinical research fellowship, during which she completed the NIH-Duke master’s program in Clinical Research. Through the Duke University School of Medicine, she received her master’s degree in clinical research. 

“This experience was transformational because of its deep immersion in big data and regulatory science, both invaluable during my time as a dental officer at the Food and Drug Administration,” she said. 

Looking ahead

During the course of her storied career, Dr. Chalmers has seen the importance of mental health to overall health become more widely appreciated through various policies and initiatives. She expressed hope that the importance of oral health will also receive more acknowledgment in the coming years.  

“I am hopeful that the conversation surrounding oral health will shift from being underrecognized and isolated to being recognized as an essential element of health for everyone,” she said. “People’s well-being, learning, employment and longevity are all dependent upon oral health.”

There are many stories similar to the family who shared a toothbrush that have stuck with Dr Chalmers. She recalled an instance where a young mom came into the clinic with an 18-month-old baby who had severe dental disease and required root canal therapy. The woman genuinely did not know that nursing without proper oral hygiene could cause such serious health issues for her child, she said. 

It’s instance like this, Dr. Chalmers said, that reinforce her enduring commitment to solving the disparities in disease prevalence and increasing access to first-rate dental care. 

“With broader awareness and policy implementation, I anticipate a higher focus on prevention and a decline in people dying from poor oral health and its complications in the U.S. Once oral health disparities are recognized, we must implement policy changes and improve access to care,” she said. 

There is still work to be done in terms of addressing oral health equity, improving care and promoting sound policymaking, and in her role as CMS’ chief dental officer, Dr. Chalmers will continue to tackle these issues and more. She also had a few words for the dental professionals who are already doing their part to provide world-class care to their patients. 

“I want to express my profound gratitude and appreciation to all the providers who open their doors to people who need oral health care,” she said. “Despite numerous obstacles, they still open their clinics and provide the necessary care for them.”