DentalUM Fall 2007

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For more information about

these and other continuing

dental education courses

contact:

University o Michigan

School o Dentistry

Ofce o Continuing

Dental Education

1011 N. University Avenue

Room G508

Ann Arbor, MI 48109-1078

www.dent.umich.edu.

Mark Your Calendar:

Upcoming Continuing Dental Education Courses

December 7, 2007 (Friday)

Evidence-Based Dentistry and Dental Practice

This course will defne and critique the concept o evidence-based dentistry.

A protocol or practicing evidence-based dentistry (EBD) will be described and

how it can be used to provide inormation to patients. The course will ocus on

the process o conducting evidence-based practice, how to prevent the abuse o

EBD in a clinical practice, sources o critical inormation, the new ADA National

Library o Medicine project, and how practitioners can interact to provide

eedback and ask questions on best evidence or clinical care.

Location: U-M School o Dentistry, Ann Arbor

January 25, 2008 (Friday)Innovative Strategies for the Prevention, Early Detection, and

Treatment of Oral Cancer

In this course, Dean Peter Polverini will present the most current inormation

about the causes o oral cancer, describe new chairside methods to rapidly

detect premalignant oral lesions, and discuss some exciting new strategies

designed to prevent recurrent oral cancer. The development o some new

therapies or this disease will also be discussed.

Location: U-M School o Dentistry, Ann Arbor

March 28, 2008 (Friday)Dialogues in Orthodontics: Mini-Pins and Mini-Plates as Skeletal

Anchorage

Dr. Axel Bumann and Dr. Hugo De Clerck, who were well received at the

School o Dentistrys Moyers Symposium earlier this year and spoke about

microimplants as temporary anchorage in orthodontics, are returning to Ann

Arbor to present their material in greater detail.

Dr. Bumann will ocus on the undamentals o mini-pin anchorage in the

correction o a variety o malocclusion types, discussing site selection and

the use o sel-tapping vs. sel-drilling screws. Dr. De Clerck will ocus on the

use o modifed mini-plates or skeletal anchorage, including the details o

orthodontic and surgical management.

Location: The Michigan League, U-M Central Campus, Ann Arbor


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DentalUM Fall 2007

In recent years, more than 11,000 patients have annually been

to our Patient Admitting and Emergency Services (PAES) Clinic as

their irst step toward better oral health.

About 5,000 have received emergency care. In act, we oten

reer to the PAES Clinic as the dental schools version o a hospital

emergency room.

For another 6,000 patients, the PAES Clinic is their irst stop

to receiving longer-term comprehensive care and treatment in our

Schools clinics.As you will learn reading this issue oDentalUM, the Clinic

serves many patients who live within a 30- or 40-mile radius o

Ann Arbor.

However, others drive two, three, our, and sometimes ive

hours rom western Michigan, northern lower Michigan, and

even the Upper Peninsula to receive care here.

Dr. Stephen Steanac, our associate dean or patient services

who oversees the Clinics activities, says that with the state o

Michigans economy being what it is, we are now seeing more

patients than ever who have no where else to be treated or

their conditions. In many instances, were the providers o last

resort.The PAES Clinic, however, is not just a treatment acility. Since

it is an essential part o our School, it provides our dental students

with learning opportunities and gives them chances to educate

patients about proper oral health care.

The Clinics three sta dentists Drs. David Jacobson, Juan

Johnson, and Vernon Rie work with the dental students to help

them develop their skills, increase their comort level in dealing

with emergency situations and, ultimately, develop their own

style.

I think Dr. Jacobson summarizes what the Clinic means to all

o us when he says, For me, its incredibly gratiying when you

can both help a patient and teach a student something new about

the art and science o dentistry.

Sincerely,

Peter J. Polverini, Dean

DentalUM magazine is published twice a year by theUniversity o Michigan School o Dentistry, Oice o

Alumni Relations and Continuing Dental Education.

Mail letters and updates to: Jerry Mastey, Editor, School

o Dentistry, Room G532, 1011 N. University Ave., AnnArbor, MI 48109-1078. Or you may send your letters andupdates via email to: [email protected].

Dean . . . . . . . . . . . . . . . . . . . . . . . . Peter PolveriniDirector o External Relations and

Continuing Dental Education . . . . . . Richard FetchietWriter & Edit or . . . . . . . . . . . . . . . . . . Jerry MasteyDesign . . . . . . . . . . . . . . . . . . . . . . . . . Chris Jun gContributing Photographers . . . . . . . . . Per Kjeldsen,

Russell Taichman, Jerry Mastey, Wanda Snyder,Diane McFarland

Member publication o the American

Association o Dental Editors

The Regents o the University:

Julia Donovan Darlow, Laurence B. Deitch, Olivia P.Maynard, Rebecca McGowan, Andrea Fischer Newman,

Andrew C. Richner, S. Martin Taylor, Katherine E. White,Mary Sue Coleman, ex officio.

University o Michigan School o Dentistry

Alumni Society Board o Governors

Terms Expire 2007:

Samuel Bander, 81, Grand Rapids, MI

Richard L. Pascoe, 70, Traverse City, MISusan Pritzel, 67 DH, Ann Arbor, MI (chair)

Terry Timm, 71, Saline, MI

Josephine Weeden, 96, 99, Saline, MI

Terms Expire 2008:

William E. Brownscombe, 74, St. Clair Shores, MIJohn R. McMahon, 82, Grand Rapids, MI

George M. Yellich, 72, Los Gatos, CAHarold Zald, 79, West Bloomield, MIJemma Allor, 00, Dental Hygiene, Mt. Clemens, MI

Terms Expire 2009:

Charles Caldwell, 77, Grand Rapids, MIDaniel Edwards, 97, Ann Arbor, MI

Gary Hubbard, 78, Okemos, MIMetodi Pogonche, 76, Lansing, MIJanet Souder Wilson, 73, Dental Hygiene, Northville, MI

Student Representative: Jamie Luria (D4)

Ex Officio Members:

Peter Polverini, DeanJanet Souder Wilson, 73, DH, Northville, MI

Alumni Association LiaisonSteve C. Graton , Executive Director, Alumni Assoc.Richard R. Fetchiet, Director o External Relations and

Continuing Dental Education

The Universit y o Michigan , as an equal opportun ity/a irmati ve actionemployer, complies with all applicable ederal and state laws regardingnondiscrimination and airmative action, including Title IX o theEducation Amendments o 1972 and Section 504 o the RehabilitationAct o 1973. The University o Michigan is committed to a policy onondiscrimination and equal opportunity or all persons regardlesso race, sex, color, religion, creed, national origin or ancestry, age,marital status, sexual orientation, gender identity, gender expression,disability, or Vietnam-era veteran status in employment, educationalprograms and activities, and admissions. Inquiries or complaintsmay be addressed to the Senior Director or Institutional Equity and

Title IX/Sec tion 504 Coordina tor, O ice o Instit utional Equity, 2072Administrative Services Building, Ann Arbor, Michigan 48109-1432,734-763-0235, TTY 734-647-1388. For other University o Michiganinormation call 734-764-1817.

* Includes discrimination based on gender identity and gender expression.

DentalUM

Our Schools Gateway

to Better Oral Health

Fall 2007 Volume 23, Number 2


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DentalUM Fall 2007

COVER STORY

FEATURES

16 The PAES Clinicthe Gateway to Better Oral Health

The School o Dentistrys Patient Admitting and Emergency Services (PAES)Clinic is the gateway to better oral health that serves the public in two vitalways. One is providing emergency care. The other is screening patientswho will receive long-term comprehensive care. More than 11,000 patientshave been treated annually at the Clinic in recent years. Many live withina 30- or 40-mile radius o Ann Arbor. However, others drive two, three, andsometimes our hours to receive care.

Pictured are: Dr. Stephen Steanac (seated), associate dean or PatientServices, who oversees the Clinics activities; Dr. Vernon Rie (let), sta dentist;Dr. David Jacobson (center), Clinic director; and Dr. Juan Johnson, sta dentist.

22 Fourth-Year Dental Students Say Clinic A Very Valuable Experience26 On the Front Line Drs. David Jacobson, Juan Johnson, Vernon Rie29 Adjunct Faculty Teach Students, Help Patients

Design by Chris Jung. Photo by Per Kjeldsen.

4 Deans Speak o Importance o Transorming Health Care Education

Dean Peter Polverini spoke o the School o Dentistrys commitment to

developing alternatives to educating oral health proessionals o theuture at the annual convocation ceremony. Guest speaker Dr. James

Woolliscrot, dean o the U-M Medical School, spoke o the need or an

integrated approach to proessional health care education.

7 Paperless Records a Reality in Browne Orthodontics Clinic In late July, the Robert W. Browne Orthodontics Clinic completed a

transition rom an environment where patient inormation had been

stored on paper to one that is now completely electronic.

8 New Pain Clinic Extends Dental-Medical Collaboration

9 Dental Scholars Help Area School

U-M School o Dentistry Dental Scholars made a major dierence at anAnn Arbor School this summer. Their community service helped the

Perry Nursery School save about $1,800.

13 U-M Dentist Invents Product or Clinics

Dr. Louie Khouri (DDS 1989) has invented a product he believes can helporal health care proessionals and their patients.

30 Faculty Prole Dr. Stephen Steanac, Associate Dean or Patient

Services

He supervises one o the Schools largest departments with more than

80 employees. But when he told his high school guidance counselor

about his plans to become a dentist, the counselor told Stephen

Steanac that he should frst take a pottery or ceramics class.

7

30

13

In This Issue ...


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DentalUM Fall 2007

EPARTMENTS

Fall 2007

38 Alumna Prole Dr. Patricia LucasMy parents were strict, wanted us to go to college, earn a degree,

and become proessionals, says Dr. Patricia Lucas. They frmlybelieved and told us oten that hard work and a good educationwere the keys to success.

41 Graduation 2007School o Dentistry graduates were reminded o the Schoolstradition o excellence and innovation and also urged to advancethat tradition to beneft society.

36 Faculty News

46 Development51 Dental Hygiene

51 - Online Degree Program Begins in January

A new programthis one onlineleading to a Bachelor o Science

degree in dental hygiene will be oered by the School o Dentistry

beginning in January.

52 - Alumna Urges Congress to Expand Healthy Kids Dental

Program

Dental hygiene alumna Christine Farrell recently appeared beore

a Congressional committee urging lawmakers to help the State o

Michigan expand the Healthy Kids Dental Program.

57 Research News 57 Saliva Test Kit Advances in Testing

New test results show a portable device developed by a School o

Dentistry proessor could tell patients in just minutes i they have

periodontal disease, which would be a major improvement over

current methods.

58 New Programs Put Money in Students Pockets

Two new programs designed to attract more dental students tocareers in clinical research oers them opportunities to learn and

earn. A one-year program oers a year o ully-paid tuition and

a stipend o about $20,000. A three-month program includes a

stipend o nearly $5,200.

66 Research Fulflling, I Want to Stay InvolvedIt seemed the Michigan Center or Oral Health Research was myhome away rom home, said dental hygienist Janet Kinney as she

talked about her 18 months o clinical research.

72 Department Update: Orthodontics and Pediatric Dentistry

80 Alumni News

81 In Memoriam Dr. Thomas Graber, Keary Campbell

58

51

66

41


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DentalUM Fall 2007

DENTISTRY

o m e o t h e S c h o o l o

Dentistrys most important

achievements during the

past year, and a hint o

things to come, were presented by Dean

Peter Polverini during the Schools

ourth convocation ceremony in

August.

During the annual ceremony,which celebrates the start o the new

academic year, he highlighted some o

the achievements o the past 12 months

and identiied uture challenges and

opportunities or the School.

Perhaps the single most important

accomplishment this past year was

the completion o our strategic sel-

assessment, Polverini told students,

aculty, and sta.

Beginning in March 2005, a

21-member committee o aculty,

students, and sta perormed a critical

introspective analysis o the Schools

strengths and weaknesses. [DentalUM,

Spring & Summer 2006, pages 8 to

13.]

As part o the process , we

deined a vision or the uture that

included developing a new clinical

education model, a major investment

in technology to support our education

and patient care programs, targeted

growth o our research enterprise,

and a commitment to revitalize our

research and patient care acilities,

he said.

In late August, a team o external

reviewers visited the School to review

Completing Strategic Self-Assessment

and discuss the sel-assessment.

The indings rom the visit will be

submitted in the all to U-M President

Mary Sue Coleman and Provost Teresa

Sullivan.

Educational Programs

A m o n g t h e m a n y r e c o m -

mendations developed during ourstrategic assessment was the key

conclusion that we must explore

alternatives to our current predoctoral

clinical education program, Polverini

said. We must transor m the

predoctoral, hygiene, and graduate

educational programs so they serve

as role models or dental education

in terms o innovation and inancial

sustainability.

He added that the programs

must continue to emphasize the

Schools commitment to educating

the oral health proessional o the

uture, encouraging exploration and

discovery, and creating excitement

about academic dentistry as a career

choice.

To help ease an impending national

shortage o dentists-scientists, while

seeking to improve the publics oral

health, we will expand our emphasis

on educating dental special ists ,

masters, and doctoral level dental

scholars, he said.

We will consider more sel-

directed orms o education that will

enable students to take more control

o their learning. We will challenge

them to explore and participate in

developing new, innovative educational

collaboration, he added.

Research and Discovery

Polver in i sa id research and

discovery cont inues to be the

centerpiece o the School o Dentistry.

The work we do in our researchlaboratories and clinics distinguishes

us rom our peers and enables us to

attract some o the best aculty and

students rom around the world.

He noted that during 2006, the

School ranked irst in research and

training award grants rom the

National Institute o Dental and

Cranioacial Research, a part o the

National Institutes o Health, totaling

more than $10.6 million.

During the same time, the School

was second among the nations

dental schools receiving more than

$13 million in research and training

awards rom NIH.

In addition to laboratory research,

Polverini highlighted the leading role

the School is playing in addressing

the problem o access to care. Under

the leadership o Dr. Amid Ismail, the

Detroit Center or Research on Oral

Health Disparities is investigating the

social, economic, environmental, and

biological causes o disparities in oral

health.

External Impact

Polverini said the School o Dentistry

Dean Outlines New Initiatives During Annual Ceremony

S


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DentalUM Fall 2007

DENTISTRY

will continue to establish unique

interdisciplinary collaborations with

other U-M schools and colleges andother institutions o higher learning

around the world.

The creation o new knowledge

and the advancement o best practices

will be the guiding principles in

establishing new educational and

research partnerships locally and

globally.

The learning curve will be steep

as we come to grips with the cultural,

economic, and political realities both

here and abroad, he said. We have

little choice but to move this agenda

orward i we hope to expand our

global presence.

Global Collaboration

Polverini said that during the

past year, the School established

memoranda o understanding with

dental schools in England, Brazil, andChina. [See sidebar.]

In the months ahead, he continued,

U-M and the School o Dentistry will

explore emerging global opportunities.

Working with other U-M units, the

School o Dentistry wil l develop

cultural immersion programs that

that will support aculty and students

in this eort.

As we begin the new academic

year, we will continue to ace signiicant

challenges that, i not addressed, will

impede our vision to become a school

o the uture, he said. I am conident,

however, that we have the people in

place who have the ingenuity and

creativity to shepherd our School

through these trying times.

Memoranda ofUnderstanding

The School o Dentistry establishedmemoranda o understanding withthese dental schools around the worldduring the past year:

UniversityofLeeds(England)

UniversityofSaoPaulo(Brazil)

FederalUniversidadeRioGrande

doSul(Brazi l)

ShanghaiJiaotongUniversity

(China)

PekingUniversity(China)

FourthMili tary Medical

University-Xian(China)

XianJiaotongUniversity(China)

our Most Important AccomplishmentJerry Mastey

DeanPeterPolverinispokeoftheSchoolofDentistryscommitmenttodevelopingalternativestoeducatingoralhealthprofessionalsattheSchoolsannualconvocationceremony.

Guestspeaker,Dr.JamesWoolliscroft,deanoftheU-MMedicalSchool,spokeoftheneedforanintegratedapproachtoprofessionalhealthcareeducation.


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DentalUM Fall 2007

DENTISTRY

A compelling need exists among

health care aculty and administrators

to develop a new approach to educating

students in dentistry, medicine, public

health, nursing, and other health

care proessions. The approach must

be integrated, encompassing alldisciplines.

That was the message rom the

Dean o the University o Michigan

Medical School, Dr. James Woolliscrot,

to administrators, aculty, sta, and

students during the School o Dentistrys

ourth annual convocation ceremony in

August. The event celebrates the start

o a new academic year.

In developing a new model o

educating health care proessionals,

Woolliscrot emphasized the importance

o being proactive.

Society is demanding change, he

said. Those involved in health care

must take the lead because i we dont,

government will mandate change, and

mandates may not be what any o us

will be happy about.

Tracing the evolution o health care

education and treatment, he said the

Civil War was a major turning point that

aected educators and the public.

There was an incredible outcry

then about deplorable medical conditions

because o the way soldiers were treated

or their wounds, he said. The outcry led

to a handul o the nations institutions o

higher learning, including the University

o Michigan, to pioneer what turned

By 2015 or 2020, there will only be a few global educational institutions of higher learning.

Others will become regional, specialty education institutions or relegated to oblivion.

out to be major reorms in health care

education and training in medicine,

dentistry, and other proessions.

Those reorms were things that

we as educators now take or granted,

including educational prerequisites,

clinical training, more classroomtraining, and research, he continued.

Because U-M and the other colleges

and universities responded, they survived

and thrived.

For those that didnt, the uture was

bleak.

The colleges and universities that

did not embrace change then, including

many that were prominent at the time,

are now historical asterisks because

they didnt respond or they didnt have

a vision, Woolliscrot said.

That lesson rom the past is the

lesson or today. However, today, medical

and dental schools and other health care

proessionals must be in the vanguard.

A conluence o events, he said,

is driving the need or an integrated

approach to health care at colleges and

universities.

T h e y i n c l u d e c h a n g i n g

demographics, globalization, higher

levels o education, an explosion o

knowledge ueled by advances in

technology, and a growing need to

provide health care that is aordable.

The schools o higher learning were

the drivers o change then, and those o

us here at University o Michigan must

be in the lead today, Woolliscrot said.

Michigan is better positioned than most

institutions o higher learning in the

nation or the world to be a leader in a

new, integrated approach to health care

education.

Urgently Needed:An Integrated Approach to Professional Health Care Education

Dr. James Woolliscroft, Dean, University of Michigan Medical SchoolRemarks at School of Dentistry Convocation, August 2007

iPod Initiative Lauded

Dur ing remarks , Wool l i sc ro f t

applaudedtheSchoolofDentistrys

iPodinitiativethatallowsdental

and dent a l hy g iene s t u dent s

opportunities to listen to classroom

lecturesontheir iPodsorother

portablelisteningdevices.

We at t he Medi ca l S choo l

havecopiedwhatyouhereattheSchoolofDentistryhavedonein

makingourclassroomlectures

availabletoourstudents,hesaid.

I t s a fundamental change in

howstudentslearnthat,Ithink,

will continue or the oreseeable

future.

Woolliscroftsaidhefrequently

has students tell him that they listen

to lectures and other presentations

ontheir iPods,butusuallyatahigherspeed.Theyllsay,Illlisten

atspeedsbetweenone-and-a-half

to two times normal because it

orces me to pay closer attention

towhatsbeingsaid.Butiftheres

somethingIdontunderstand,Ill

gobackandlistenagain.


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DentalUM Fall 2007

DENTISTRY

Paperless is now a reality in oneSchool o Dentistry clinic.

In late July, the Robert W. Browne

Orthodontics Cl inic completed a

transition rom an environment where

patient inormation, or decades, had

been stored on paper to one that is now

completely electronic.

T h e m o v e i s o n e o m a n y

technological initiatives in recent

years [DentalUM, Fall 2005, pages

4-31].

This is a major milestone or the

School, said Dr. Sunil Kapila, chair

o the Department o Orthodontics

and Pediatric Dentistry, who said the

paperless clinic would be a model as

other clinics throughout the dental

school become paperless in the

uture.

Our aculty, residents, and sta

are now able to electronically retrieve

a wealth o inormation about our

patients instead o having to sit

through mounds o paper, he said.

E v e r y n e c e s s a r y p i e c e o

inormation about each patient,

Kapila continued, including his or

her dental history, appointments,

treatments, radiographs (x-rays),

photographs, payment history, and

more is now available at chairside.

The inormation is accessible at 27computers in the clinic.

Being able to instantly retrieve

inormation, Kapila added, will save

valuable time, beneit patients, and

help those providing oral health care.

Dr. Scott Conley, clinical assistant

proessor o dentistry, coordinated the

Departments eorts with the Schools

Paperless Records, Patient Information

Now a Reality in Ortho Clinic

Department o Dental Inormatics.

Another Important First or U-M

Ho we v e r , t h e r e i s a n o t h e r

important irst worth noting about

the paperless clinic.

According to Roger Gillie, director

o programming services in the Schools

Department o Dental Inormatics,

the School o Dentistry has become

the irst and only unit in the entire

University o Michigan system that

allows aculty members, since theyhave inal authority or patient care,

to access patient records using their

university-approved identiication

card.

They swipe the card in a slot

near the computer monitor the same

way they do when buying something

at a store using a credit card, he

said. However, its important to

emphasize that there are security

measures in place designed to prohibit

unauthorized access.

Gillie and members o his team

installed the hardware during a

weekend in May and then tested the

hardware and sotware, MiDent, or

several weeks.

They also took advantage o new

technology to minimize costs.

Behind each computer monitor is

a Mac mini rom Apple Inc. Aboutseven inches square and two inches

deep, the unit is the smallest desktop

computer marketed by the company

and can be used as a Mac or a Windows

personal computer. Their small size

cuts down the need or counter space

or storage space and cables too, Gillie

said.

The Robert W. Browne Orthodontics Clinic is the rst o the Schools clinics where patient inormation is now available electronically

at chairside. Dr. Sunil Kapila (right), chair o the Depar tment o Or thodontics and Pediatric Dentistry, watches Dr. Scott Conley (let),

who coordinated the depar tments transition to a paperless environment, retrieve a patients records. Roger Gillie (center) led a Dental

Inormatics team that installed the hardware and sotware in the clinic.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Dental patients suering romacial pain and TMD can get help at

a new acility now being run by the

School o Dentistry in partnership with

the U-M Health System.

The TMD and Oroacial Pain Clinic,

at 325 E. Eisenhower, just north o

Briarwood Mall, is a collaborative

venture that involves the School and

units rom the U-M Health System

including Physical Medicine and

Rehabilitation, the Spine Clinic, andOral and Maxilloacial Surgery.

The U-M Hospitals Medical Pain

Clinic and the Headache Clinic will

be at the same location in the near

uture. Other specialty units rom the

Taubman Center, including neurology,

otorhinolaryngology, and psychiatry,

will also be involved.

Benets to Patients

Patients experiencing TMD and

oroacial pain will have better access

to care and treatment and will ind it

easier or them to be seen, evaluated,

and treated by oral health care and

medical proessionals under one roo.

The Clinic opened earlier this year

to address an unmet need or treatment

among a segment o the population

experiencing TMD and oroacial pain,

said Dr. Paul Krebsbach, chair o theDepartment o Biologic and Materials

Sciences. The Department oversees the

Clinics operations.

He credited Dean Peter Polverini

or launching the new acility and

ostering greater collaboration with

other U-M units.

A Complex Problem

Because o the complexity in

understanding and treating such

complicated conditions , a team

approach that utilizes expertise in

both medicine and dentistry will likely

have the best opportunity or success,

Krebsbach added.

Dr. Lawrence Ashman is the

director o the new clinic. For nearly

thirty years, his general dentistry

practice ocused on evaluating and

managing TMD and oroacial pain.

He will collaborate with Dr. George

Upton in the Department o Oral and

Maxilloacial Surgery who has a long

history o treating TMD patients.

Noting that approximately twenty

percent o the population experiences

some kind o acial pain, Ashman

New Pain Clinic Extends Dental-Medical CollaborationTo Better Serve Patients with TMD & Orofacial Pain

Dr. Lawrence Ashman is the director o the TMD and

Oroacial Pain Clinic. The Clinic is a collaborative venture

that involves the School o Dentistry and units rom the

U-M Health System.

said, temporomandibular disordersand other oroacial pain disorders

are complex clinical problems that

oten involve both dentistry and

medicine.

Because these conditions are

complex, he added, that is why we

need to work closely, not just with

our dental colleagues, but those in

the medical community i we want

our patients to have the best possible

treatment or their pain and avorableoutcomes.

Ashman said the clinic will

always be ocused on patient care.

But because o the inormation we will

be gathering as we help patients, we

may ind, over time, that the Clinics

mission could evolve to encompass

teaching, education, and research, he

said.

When he was at the U-M School o

Dentistry, Dr. Christian Stohler ran a

pain clinic that sought to gain urther

insights into the reasons or a patients

pain. The new clinic is more ocused

on managing a patients pain.

The TMD and

Oroacial Pain Clinic

325 E. Eisenhower

Suite 100

Ann Arbor, Michigan 48108

Telephone: (734) 936-7175

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Dental Scholars Begin 2nd Yearwith Community Service

U-M School o Dentistry Dental Scholars made a major dierence at an Ann

Arbor School this summer.

Their community service painting classrooms, cleaning acilities, and

scrubbing cots helped the Perry Nursery School save about $1,800. We can

now use those unds or our program to purchase educational supplies and

or instructional purposes, said Heavenly Jackson, the schools development

director. Jackson said she and others at Perry eel ortunate to have such

caring partners. Were deeply thankul the dental students were here. Their

generosity and enthusiasm was something to behold. Wed love to have them

back again, she said with a smile.Established in 1934 to help children rom impoverished amilies, Perry

provides aordable high quality schooling, on a sliding ee scale, to approximately

100 children throughout Washtenaw County ranging in age rom 30 months to

our years. The state-licensed school is one o only seven percent nationwide to

be accredited by the National Association or the Education o Young Children.

Students Enthused

In late August, a second class o 14 Dental Scholars joined their colleagues

rom last summers inaugural class with a Friday evening dinner ollowed by

the Saturday morning work at Perry.

The experience was one dental students and aculty members and Perryadministrators will always remember.

This is great, I really enjoyed being here and doing this, said Eric Skulsky

a second-year dental student and member o the irst class o Dental Scholars.

Ben Anderson, another second-year Dental Scholar agreed. This was cool,

he said. I really enjoyed being able to help.

Dr. Robert Eber, who was one o several School o Dentistry aculty members

who helped, was surprised with how much was accomplished in three hours.

Dental Scholars:

Overview

L au nc hed in 2006, t he S c ho lar s

Program in Dental Leadership, as its

ormally known, brings together a

select number o exceptional students

with diverse backgrounds to help

them develop a leadership mindset

and the skills they can use to promote

change in dentistry, dental hygiene,

education research, or academia.

More inormation is on the School

o Dentistry Web site: www.dent.umich.edu/prospective/spdl.

(let): James Skousen, Thao Le, and Hannah Budzinski paint a

hallway outside a classroom at the Perry Nursery School.

(above): Dental hygiene students Maria Alspaugh (let)

and Audrey Stratz cleaned dozens o sleeping cots. In the

background is Anne Gwozdek, adjunct dental hygiene clinical

lecturer and a Dental Scholars mentor.

Jerry MasteyJerry Mastey


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DentalUM Fall 2007

DENTISTRY

Its amazing how much you can dowhen so many people are working

together at one time, he said.

Outdoor Team Building Exercises

Ater lunch, boarding a bus, and

traveling to the U-M Recreation Area,

Dental Scholars participated in several

outdoor activities that challenged them

to reach a goal through communication,

collaboration, adapting to change, and

leadership.M o s t o t h e t i m e , s t u d e n t s

participated in groups o eight or nine.

In one activity they were challenged

to cross an imaginary river, hemmed

in by electric ences, using only two

crates, two boards, and a small pole.

However, their inal outdoor

activity challenged all o them.

One by one, the Scholars stepped

onto a long plank that represented a

boat. Beneath the plank in the center,

was a board that made the boat teeter

when it was unbalanced. At each o the

our corners were small, air-lled balls

that would squeak when that occurred.

When the Dental Scholars heard a

squeak, all o them had to get o the

plank, reassess their strategy, and then

reboard. They had just 30 minutes to

develop a successul plan.

Even more challenging was thatthey were not allowed to speak as they

approached the plank or once they

were on it. Communicating was done

using hand signals. Ater several alse

starts and subsequent collaboration

the Scholars succeeded in reaching

their goal.

A Transormation

TheworkofDentalScholarsimpressedPerryNurserySchooladministrators,

includingfamilyservicesdirector,MaryFabirkiewicz.Thephotosaboveshowa

roombeforebookcasesweremovedfromthecenterofaroomtowallssochildren

couldmoveaboutfreely.Theresultsoftheirworkareevidentinthephotoonthe

right.Wow!Whatatransformation!Fabirkiewiczexclaimedasshewalkedinto

theroom.Icantbelievewehavesomuchspaceagain.Itswonderful!

DentalScholarsalsofoundwaystohavesomefun.Aftercleaningoneclassroom,somefoundsunglassesandposedforthisphoto.

Picturedlefttorightare:RobertWiesen,DarleneOccimio,SaraArnold,KeithDobracki,JuliaLatham,EricSkulsky,MeganDubois,

LindsayRayburn,andKarenJanusz.

Jerry MasteyJerry Mastey

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Zahid Ahmed

Maciak Dolata

Christie Springstead

Robert Wiesen

Irene Haddock

MalijeOnwueme

Eric Skulsky

New Dental Scholar Julia Latham balances hersel on one board as she begins placing a second across

an imaginary river during Dental Scholars challenge activities. Mansi Goyal (let) and Sarah Miller

(right), with the U-M Challenge Program, are ready to catch Latham should she all.

James Skousen (let) and Jason Schrotenboer use hand signals to communicate with Dental Scholars

on how to position themselves so the plank, representing a boat, did not capsize.

Stephanie Nuez (D1)Meghan Dubois (D1)

Julia Latham (D1)

Lindsay Rayburn (D1)

Javana Cosner (D1)

Victoria Lucas-Perry (D1)

Elizabeth Caplis (D1)

Jerry Mastey

Dr.Russell Taichman

New Dental Scholars

Stephanie Munz (D1)Karen Janusz (D1)

Michael Barber (D2)

Sara Arnold (D2)

Robert Wiesen (D2)

Malije Onwueme (D3)

Maria Alspaugh (DH3)

These photos, taken by Dr. Russell Taichman,

director of the Dental Scholars program, show

some of them at work and having fun at the

Perry Nursery School.


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DENTISTRY

New Field, New Opportunities BiodonticsBlending Dentistry, Business, Innovation, and Technology

Personal computers. The WorldWide Web. The Internet.

When these words and phrases were

spoken or appeared in print or the rst

time, most people scratched their heads

wondering what PCs, the Web, and the

Net were all about.

Is history repeating itsel? Maybe.

Consider the early years o the

Twenty-First Century.

Heres a word you probably havent

seen in print or heard about beore biodontics.

What is biodontics, you ask?

Basically, its an emerging ield

o study that encompasses several

disciplines clinical dentistry, research,

business , entrepreneurship, and

technology. The goal o biodontics is to

try to determine what innovations rom

a biological research laboratory may one

day be combined with technology.

The ultimate goal o biodontics is

to commercialize products that dentists

can use in their clinics and, in the

process, improve the oral health o the

population at large.

Earlier this year, a number o

U-M School o Dentistry aculty,

administrators, and Dental Scholars

met to learn more about the emerging

eld and even come up with some new

ideas o their own.Biodontics is a relatively new

eld.

It was created only six years ago

by Dr. Edward Rossomando, a proessor

at the University o Connecticut School

o Dental Medicine. He spoke during a

spring weekend program at the Michigan

Center or Oral Health Research.

During the program, the Dental

Scholars and others worked in small

groups to brainstorm and develop ideas

that, someday, could become reality in

the dental proession.

The groups were pretty creative,

said Dr. William Giannobile, proessor o

dentistry and MCOHR director.

Some o the ideas included using

the Internet to deliver instant messages

in the handle o a toothbrush to remind

patients o dental appointments or

give them important oral health

inormation.

It was an interesting program that

was designed to spur creativity anda sense o business entrepreneurship

in the students, said Dr. Russell

Taichman, director o the Dental Scholars

program.

Biodontics: Primary Goals

Developeducational,translational

research,andclinicaltrialsprograms

designedtointegratebasicscience

discoverieswithclinicalapplications.

Encouragethedevelopmentof

novelapproachestoclinicaland

translationaltraining.

Provideauniversity-based,objective

testingandevaluationprogramfor

dentalmanufacturers,distributors,

andlaboratoriesperformedin

state-of-the-artfacilitiestoensure

thehigheststandardsofevaluation

throughitsproducttestingdivision.

Provideauniqueopportunityfor

dentalmanufacturinganddistribution

companiestopresentproductsto

dentalstudents,residents,andfaculty

inafocused,structuredsetting.

Providedentalmanufacturinganddistributioncompaniesaccessto

multipleprogramsthroughits

associatemembershipprogram.

Source:www.biodontics.org

Dr.William Giannobile

Darlene Occimio (let) listens to a presentation by Jason Schrotenboer during the biodontics program. Next to him are

Eric Skulsky and Christie Springstead.


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DentalUM Fall 2007

DENTISTRY

Evidence is growing that the

dentists role as a health care provider

has become increasingly important to

their patients.

Oral health and general well-

being are inextricably linked as noted

by the act that many conditions

plaguing the body are maniested

in the mouth, Dr. Kitrina Cordell

told members o the Norman Mette

Foundation Board o Directors during

their annual spring meeting at the

School o Dentistry.The groups meeting marked the

17th consecutive year that more than

a dozen members o the board came to

the University o Michigan School o

Dentistry and the U-M Health System

to learn more about advances in oral

health care, medicine, classroom and

clinical education, and research.

Cordell, an oral and maxilloacial

p a t h o l o g i s t , c l i n i c a l a s s i s t a n t

proessor, and associate director o

the Schools oral pathology biopsy

service, brieed the group about the

growing awareness o relationships

between oral health and systemic

disease. [See sidebar, page 15.]

Dr. Russell Taichman, proessor o

dentistry and director o the Scholars

Program in Dental Leadership, also

addressed the group, describingdiscoveries about l inks between

periodontal disease and heart disease

and diabetes.

The Mouth as an Early Warning

System

We constantly emphasize to

our students, in both classrooms andclinics, that they are not just dentists,

theyre also health care providers,

Cordell said.

Underscoring that point, she

cited a report rom the U.S. Surgeon

Generals 2000 Report on Oral Health

that noted the mouth can unction as

an early warning system or some

diseases and that early identiication

o oral disease can contribute to

diagnosis and treatment o systemicdiseases.

The general dentist is on the

ront l ine o the de ense o ora l

disease, she said. Since not all

patients receive regular medical

care, the dentist may be the irst to

diagnose a systemic disease based on

oral indings.

S h e s a i d t h a t d i s e a s e s c a n

b e d i a g n o s e d d u r i n g c l i n i c a l ,

r a d i o g r a p h i c , m i c r o s c o p i c ,

biochemical, or other examinations.

Taking a patients blood pressure

was cited as one example.

In response to a board members

question, Cordell said all dental and

dental hygiene students routinely

take a patients blood pressure and ask

about the health history o patients

treated in the Schools clinics.

Pointing to research cited bythe National Institute o Dental

and Cranioacial Research, Cordell

said that periodontal disease may

exacerbate existing heart conditions

and that people with periodontitis

may be more l ike ly to deve lop

cardiovascular disease than those

Oral Health-Systemic Health Links DescribedMette Foundation Board Learns More During Dental School Visit

Dr. Kitrina Cordell outlines links between oral and systemic health to members o the Norman Mette Foundation

during their annual visit to the School o Dentistry.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

This is a key study that shows

how periodontal disease may aect

systemic health.

Taichman added, Other clinical

studies and some laboratory studies

are showing that diabetes seems to

be a major risk actor or periodontal

disease. Im emphasizing the word

seems because we have yet to prove

a link between the two. Its diicult

to do because research is both time

consuming and expensive.

without periodontal inection.

C o r d e l l a l s o n o t e d t h a t

systemic lupus erythematosus has

cardiovascular implications such as

increased atherosclerosis, as well as

other systemic implications that canbe potentially lie threatening.

From Early Suspicions to Todays

Research

Taichman discussed some o

the oral/systemic links, including

diabetes and periodontal disease.

One observation he shared with

board members was rom a sailors

diary nearly our hundred years ago

as he circumnavigated the globe with

Ferdinand Magellan in 1520:

We entered the Pacific Ocean,

3 months and 20 days without

fresh food of any kind. The

gums of the upper and lower

teeth of some of our men were

so swollen that they could not

eat under any condition. 19 of

our men died.

Even back then, we had some early

suspicions about possible connections

between oral and systemic health,

Taichman said, because the condition

described then, compared to what we

know now, was most likely due to a

lack o suicient vitamin C.

Taichman said he believes the

Rosetta Stone that points to possible

denta l and sys temic l inks was

discovered more than a decade ago,

in 1994, by the School o Dentistrys

Dr. Walter Loesche. Loesche and

others investigated the oral and

systemic health o more than ive

hundred individuals at the Veterans

Administration Hospital in Ann

Arbor.

In a nutshel l , the research

showed that those with periodontitis

were about three times as likely to

have coronary disease, he said.

Studies have shown a relationship between dental

disease and: Systemic infect ions

Cardiovascu lardi sease

Diabetes

O steopo ro si s

Part o the observed associations may be compounded by:

Smoking

Stress

D ie ta ry i ntake

Behavioralfactors(selfcare,professionalcare)

Association Between Dental and

Systemic Disease

We constantly emphasize to our students, in both

classrooms and clinics, that they are not just dentists,theyre also health care providers.

Dr. Kitrina Cordell


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DentalUM Fall 2007

DENTISTRY

The Gateway to Better Oral HealthBegins Herethe PAES Clinic

Here is a sound I know youre looking orward to hearing, Dr. David

Jacobson says jokingly, drill in hand, to patient Amanda Shaer as she settles

into a dental chair in the School o Dentistrys Patient Admitting and Emergency

Services (PAES) Clinic.

Shaer has come to the Clinic or treatment o a ractured tooth.

My mother told me about what the dentists and dental students do hereto help patients and urged me to come to get this taken care o. So here I am,

she says with a smile.

A ew minutes earlier, Jacobson, the Clinics director, introduced himsel,

asked Shaer questions about her condition, and explained what he would be

doing to help.

Moments later, Shaer hears the whirring sound o a drill as Jacobson begins

his work.

During the next twenty minutes, he requently pauses to ask questions,

usually to determine i Shaer is eeling any pain and i shes comortable. He

also takes time to explain what will happen next.

When he inishes, Jacobson asks Shaer to look at a hand-held mirror hegives her. She looks into the mirror, opens her mouth, checks her teeth, smiles,

returns the mirror, and thanks Jacobson or his help as she gets up and leaves

the Clinic.

A Very Busy Place

Shaer is one o thousands o patients who come to the PAES Clinic each

year or oral health care.

In recent years, the number o patients seen at the Clinic has consistently

exceeded 11,000 annually. [See chart page 17.]

Dr. Stephen Steanac, associate dean or patient services who oversees

the Clinics activities, says the Clinic, more oten than not, is a very busy

place.

Between 50 and 60 patients are seen daily. However, there have been times

when those numbers have been higher. A record 99 patients were seen on a

single day in late February 2003. Although he doesnt remember the reasons or

the surge, Jacobson says, because o the work o the sta, their commitment,

and the loyalty o the students, we were able to help every one o the patients

who came here that day.

D e n t a l S c h o o l s H o s p i t a l E m e r g e n c yRoom Helps Pat ients from across Michigan

Amanda Shaer looks at a

mirror to check the work

Dr. David Jacobson did or

her in the PAES Clinic.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Its a demanding environment,

even in the best o times, or Jacobson

and two other ull-time sta dentists

Drs. Vernon Rie and Juan Johnson and

part-time dentists Drs. Justin Dugas,

Aaron Ford, and John Seago.

Located on the irst loor o the

dental school, the Clinic is the gateway

to better oral health that serves the

public in two important ways.

One is to help patients who need

emergency care, typically walk-in

patients who do not have a scheduled

appointment, but need prompt attention

to alleviate pain. As the chart shows,

the PAES Clinic has treated more than

5,000 patients annually in this category

or the past our years.

The other is to screen patients

seeking comprehensive care who are

interested in receiving longer-term, on-

going treatment at the dental school.

More than 6,000 patients annually are

in this category.

Emergency Care

When a patient needing emergency

care arrives, Jacobson, or two other

sta dentists, and ourth-year dental

students, spend time listening to the

patient and asking questions about

their condition.In emergency situations, patients

are told that only their particular

problem will be addressed.

Our objective is to get the patient

out o pain, Jacobson says. But on any

given day, he adds, about hal o our

walk-ins are reerred to oral surgery

or extractions.

Some o these patients, Jacobson

says, involve an alarming number o

young people with rampant caries due to

their consumption o soda pop and other

sot drinks. [See sidebar, page 21.]

Other patients, however, may

be reerred to other clinics such

as periodontics or orthodontics or

endodontics or speciic procedures.

It is not uncommon during the

course o an emergency examination

or a patient to be told that he or she

will need comprehensive care that will

have to be provided over an extended

period o time.

Comprehensive Care

The PAES Clinic screens every new

patient who makes an appointment to

receive long-term comprehensive care.Although many o these individuals

are new patients, there are some who

have not been to a dentist or some

time, in some instances, ive or even

ten years.

When irst-time patients arrive,

they watch a new six-minute video that

describes what they will experience

and how the Clinic works.

A signiicant portion o the initial

screening amounts to what Jacobsondescribes as a ree consultation.

Each patient receives a cursory

examination to see i there are

any problems that might require

immediate treatment and a screening

examination or oral cancer. I there

are no immediate problems, the

inormation that is gathered is used to

assess the patients needs and discuss

what needs to be done. Emergency

radiographs are also ordered, when

necessary, or the PAES Clinic.

However, these new patients do

not receive any preliminary treatment.

Instead, they are assigned to a dental

student in one o the Schools our

comprehensive care clinics.

For the past our years, more than 11,000 patients annually have come to the School o Dentistry s PAES

Clinic to receive oral health care. Many live within a 30- or 40-mile radius o Ann Arbor. However,

others drive two, three, our, and sometimes ve hours to receive care.

PAES Clinic Patient Visits


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DentalUM Fall 2007

DENTISTRY

The clinics give students in allour dental classes and the three

dental hygiene classes opportunities

to work together , with aculty

supervision, to achieve high levels o

clinical experience and competence.

Also known as Vertically Integrated

Clinics, students obtain basic clinical

training that prepares them or more

advanced clinical experiences during

their inal years in the dental and

dental hygiene programs.However, patients may also be

reerred to a specialty clinic.

Regardless o whether a patient

is treated in a specialty clinic or a

comprehensive care clinic, they are

told about the major dierences

between being treated at the School

and a private practice.

We emphasize to patients that

because we are a teaching acility,

everything will take longer than it

would in a private oice, Jacobson

says.

However, they are happy to

learn that the School s ees are

approximately one-hal o what area

dentists and specialists charge or the

same procedures, he adds.

Providers o Last Resort

Many patients who come to thePAES Clinic live within a 30- or 40-mile

radius o Ann Arbor.

However, others drive two, three,

our, and sometimes ive hours to

receive care. Those patients typically

come rom the western part o the

state , the Upper Peninsula, and

northern lower Michigan. A ew even

come rom outside Michigan.

W i t h M i c h i g a n s e c o n o m y

what it is now because o corporate

d o wn s i z i n g s , e s p e c i a l l y i n t h e

automobile and automotive supply

industries, were seeing more patients

than ever who have nowhere else to

go to be treated or their conditions,

Steanac says. In many instances,

were the providers o last resort.

Compounding the problem is

that, in recent years, many oral

health care providers have decided

not to oer dental care to Medicaid

patients because their cost to do so,including supplies, substantially

exceeds reimbursement rom the

state.

A c c o r d i n g t o t h e M i c h i g a n

Department o Community Health,

the number o Michigan dentists

accepting Medicaid payments has

declined 39 percent, rom 1,578 in

2000 to 961 currently. Only about 15

percent o the states 6,500 dentists

take Medicaid.

The state currently spends about

$8 billion on Medicaid, nearly twenty

percent o its budget, to provide

health care coverage, including dental

care, to about 1.46 million low-income

children, adults, and seniors. O that

amount, approximately $80 million,

or one percent o the budget, is or

dental-related services.

G i v e n t h i s c o n l u e n c e o

developments , it is common or

p a t i e n t s s c h e d u l i n g t h e i r i r s t

appointment to wait six to eight weeks

or initial visits that are required prior

to receiving comprehensive care.

Student/Sta Dentist Teamwork

The PAES Clinic, though, is not just

a treatment acility. It provides dental

Fourth-year dental student Brian Shaughnessy (let) discusses his plans to treat a patient who has come to the

PAES Clinic or emergency oral health care with PAES Clinic Director Dr. David Jacobson.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

students with learning opportunities

while oering services to patients,

many o whom eel they have no

where else to go.

Fourth-year dental students are

required to be in the Clinic or at least

10 hal-day sessions. They triage,

examine, and administer emergency

care to walk-in patients.

However, dental students in other

classes may visit and observe as oten

as they wish.

We want the ourth-year students

to see as much pathology as possible,

Jacobs on says . In act , th e sheer

volume o patients who are treatedhere insures students will see cases

they generally dont experience in one

o our comprehensive care clinics.

Dental students agree. [See story,

page 22.]

Sta dentists attempt to rame

each experience in the context o

how it might be handled in a private

practice.

Jacobson wi l l o t en present

students with this situation: Suppose

youre in the middle o a crown prep

and a patient walks in at which

point he describes other activities

occurring in the dental oice that

need resolution.

We want students to look at these

urgencies with a creative problem

solving mindset, he says. Its not a

case where there are necessarily right

answers. Instead, we would like them

to consider a number o options rom

which to choose, he says.Jacobson, Rie, and Johnson work

with the dental students. More oten

than not, however, they keep a low

proile so the dental student learns

how to manage the psychology o a

patients pain rom the moment they

greet the patient. The reason or this

approach is to allow each student todevelop their skills, increase their

comort level with diicult issues,

and, ultimately develop their own

style.

But when a procedure is beyond

the scope o a students training,

sta dentists are there to perorm

the treatment. In these instances, the

student will watch, or perhaps assist

a sta dentist. However, in similar

uture cases, they are expected to domore.

Were there as a saety net or the

dental students and we know when

to intervene, Jacobson says, but

we want each to develop their own

style and their own way o working

with a patient. That includes

explaining their indings, diagnoses,

and discussing treatment options

with each patient.

The sta dentists say all o these

experiences make it easy to remain

enthusiastic.

I t h o r o u g h l y e n j o y t h e

opportunity to practice dentistry

here at Michigan, teaching students in

the Clinic, working with aculty, and

handling a large variety o patient

cases, Dr. Juan Johnson says.

D r . V e r n o n R i e , wh o i s i n

private practice, but once thoughtabout becoming a teacher as an

undergraduate, says, the opportunities

I have daily to educate new patients

who come to our Clinic or treatment,

as well as mentoring the dental

students who help here, is the best o

both worlds.

Dr. Juan Johnson and ourth-year dental student Nathera Balachandran review radiographs and discuss options

to treat a patient receiving care.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Crucial Collaboration

Playing a major role in the successo the PAES Clinic are the Schools

patient care coordinators (PCCs).

T h e s e i n d i v i d u a l s a r e

intermediaries between the students

and the patients. They work with

the clinic directors to ensure that all

patients receive the care they need,

and that the students get the support

and experiences they need to become

competent and are prepared to take

state-required licensing examinations

prior to graduation.

Jacobson , R i e , and Johnson

requently work with the coordinators

to help patients and dental students.

Dental students who learn o an

appointment cancellation by one o

their patients have an opportunity

to ill their empty chair.

Working with the PCCs, the PAES

sta matches those students looking

or work with patients needing

help. That dental student may be

able to proceed immediately with

a comprehensive oral exam and

treatment plan that otherwise would

occur during the patients next

visit, Jacobson says. Its a win-win

situation. We save the patient a visit

and provide a student with a learning

and treatment opportunity.

The PAES Clinic maintains an

open door policy. Anytime a dental

student has ree time and is looking

or something to do, they can stop

at the PAES Clinic. The patient care

coordinators have allowed us to try

this out, and it works, Jacobson

says.

With all the activity in the Clinic,

Jaco bson says , we are consta nt ly

measuring and trying to improve

what we are doing here.

Its an exciting time to be here

in the PAES Clinic, he adds. We

have received a lot o support rom

Dean Peter Polverini, patients tell

us they appreciate receiving the

quality o care theyre getting, and

the interaction with the students

continues to be highly rewarding. For

me, its incredibly gratiying whenyou can both help a patient and teach

a student something new about the

art and science o dentistry.

Dr. Vernon Rie adjusts a patients denture ater the

patients mandible was ractured in an accident makingit dicult to use. The adjustments allowed the patient

to use the denture until a new set o custom-made

dentures was available.

Jerry Mastey

Located on the rst oor o the dental school, the PAES Clinic isthe gateway to better oral health that serves the public in two

important ways. One is to help patients who need emergency

care. The other is to screen patients seeking comprehensive

care who are interested in receiving longer-term, on-going

treatment at the dental school.


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DentalUM Fall 2007

DENTISTRY

A headrest that attaches to wheelchairs makes it easier or

both the patient and the dentist.

Although most patients seen at the PAES Clinic can walk into the Clinic

without assistance, there are those who cant, primarily patients in wheelchairs.

Their special needs are being accommodated.

A special cubicle is available or those patients. In addition, a device is

being used that makes it easier or both the patient and the dentist.

The new device is a dental headrest. Its clamped to the handles o a

wheelchair so these patients dont have to be physically transerred rom their

wheelchair to a conventional dental chair. The headrest allows patients to

comortably tilt their heads backwards.

We want our students to get more experience treating special needs patients

so they develop a sense o comort and acceptance that will carry over to their

private practice, says Dr. David Jacobson.

In May, 48-year-old Michael Flynn arrived in a wheelchair needing emergency

treatment. When he was 16, Flynn broke his neck and severed his spinal cord

in a diving accident.

Jacobson perormed a pulpectomy on Flynn, much to his relie. When it was

over, Flynn thanked Jacobson telling him, that was a very painless procedure.

Very well done. Youve made my day, I appreciate that, Jacobson said as

Flynn let the Clinic.

Soda+

Caries =An Alarming Problem

Analarmingproblemweseein

patientsthatcometousforcare

iscariescausedbytheexcessive

consumptionofsodaandothersoftdrinks,saysClinicdirectorDr.David

Jacobson.

Jacobsonsaysthatheanddental

studentsintheClinicstillheara

prevalentmythfrompatientsthat

low-calorieorno-caloriesoftdrinks

donotcausecavities.Manybelieve

thatifthereisnosugarinthediet

soda,itslikedrinkingwater,he

adds.Whenwehearthat,wetell

thepatient,Thatdefinitelyisnotthecase.Intheseinstances,theculprits

arecitricacidandthephosphoric

acidinthedrinks.

Whenitcomestocausingcaries,

Jacobsonsaysthatonascaleof

zerotofive,withwaterbeing

zero,regularsodapopisfive,but

patientsarereallysurprisedtolearn

dietsodaisthree.

Wetellpatientsthatthey will get

caries,butthatitwilltakelongerthaniftheydrinkasugar-laden

beverage,hesays.

Intheirroleaseducators,PAES

Clinicdentistsanddentalstudents

encourageallpatientstoreadsoft

drinklabels.

Accommodating Special Needs

Patients

A special cubicle in the PAES Clinic allows patients using

wheelchairs to be treated.

Jerry Mastey Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Fourth-Year Dental Students Say PAES ClinicA Very Valuable Experience

Fourth-year dental student Sarah

Miller says she eels more conident

diagnosing and dealing with patients

who have emergency dental needs

ollowing her experiences in the PAES

Clinic.

Instead o taking a month o

between the end o her third year

and the start o her ourth year in

the predoctoral program, Miller chose

to work in the PAES Clinic two days

a week. She did so to learn more

about the types o cases the Clinic

handles and also learn more about the

admitting process or new patients.

The Clinic was much aster

paced, and I saw more patients than

usual, sometimes about ten a day, she

said.

Fourth-year dental student NatheraBalachandran agreed, adding the

range o treatments patients needed

was revealing.

More Variety

Theres a lot more variety in the

PAES Clinic that you dont see in the

comprehensive care clinics, she said.

Balachandran said she oten came

to the Clinic as a third-year student

when some o her patients didntshow up or their appointments in the

comprehensive care clinics.

In addition to learning more about

emergency dental situations, Miller said

she too observed and helped patients

with a range o dental problems.

Some were minor, like questions

about bruxism or temporaries alling

o, but there were some major traumacases, she said.

One major trauma case involved

two anterior tooth avulsions with

maxillary alveolar racture and nasal

racture. I learned there are many

ways o dealing with a case like this,

as well as many actors that go into

the prognosis o an avulsed tooth,

she said. Because o the severity o

the case, the patient was ultimately

reerred to the hospital or ollow-uptreatment and care.

Mostly, however, Miller said she

saw and treated patients with a

range o endodontic problems. Some

had reversible pulpitis. Others were

irreversible. And there were many

patients with cases o pulpal necrosis.

Up to this point, I had not seen an

endodontic case within my patientpool in the comprehensive care clinic,

and had no real dental emergencies to

speak o, she said.

Millers experiences with dental

emergencies in the PAES Clinic instilled

conidence. Im much more conident

in testing, diagnosing, and giving a

patient all the options available about

their speciic problem, she said.

Her PAES Clinic experiences were

beneicial or another reason.It also allowed me to see what it

was like to be in a more real lie setting

with numerous patients to examine

and care or, she said. I eel much

more conident o my skills diagnosing

and dealing with emergency dental

problems as a result.

Fourth-year dental student Sarah Miller and PAES Clinic sta dentist Dr. Juan Johnson review a patients

radiographs to try to locate the source o the patients oral pain.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Medical Residents Learning About Dentistry First-Hand

The medical proession is gaining a better understanding and appreciation o the importance oral health plays ina patients overall health and well being.

For the past year, several medical residents rom the U-M Hospital have come to the dental school to learn more

about how to deal with common dental emergencies they oten see in the hospitals emergency room.

This is an elective or them, so its totally voluntary i they want to be here, and theyre ree to come and go as

they please, said PAES Clinic director Dr. David Jacobson.

However, he continued, most ind the time they spend with dental students in our clinic and with specialists in

our oral surgery clinic is very inormative and helpul.

Jacobson said he, along with Drs. Vernon Rie and Juan Johnson and dental students, try to help the medical residents

recognize the reasons or a patients pain and oer advice on choosing the proper medication when necessary.

Were ocused on the basics, primarily, how to help the patient and get him or her out o pain, Jacobson said.

Kurt Hessen, MDDr. Kurt Hessen, now in the second year o his our-

year residency program at U-M Hospital, spent about

two weeks at the dental school earlier this year.

It was a great learning experience, he said, not

just in the PAES Clinic, but also in the oral surgery

clinics at the hospital and the dental school.

Hessen said he and others see a air amount o

pain with patients who come to the U-M Hospital,problems like ractured teeth, pain rom cavities,

and things like that. So learning more about these

conditions and what we as physicians might be able

to do in these cases was a great learning experience,

he said.

Hessen said he also learned, rom watching

dental students and their clinical supervisors, how

important it is or emergency room physicians to ask

patients about their oral history and any medications

they may be taking.

Brett Russell, MDNow in the third year o his our-

year residency program at U-M

Hospital, Dr. Brett Russell said, We

see just about everything in the

hospitals emergency room, but

having this opportunity to ocus on

dental-related emergencies was very

helpul to me.Russell said he was surprised at just how awesome

the PAES Clinic is and what the sta dentists and dental

students do to help patients in pain. In addition to

observing what takes place in the Clinic, Russell also

spent time in the Schools oral surgery clinic.

The experiences, he said, helped him recently

evaluate a patient who came to the hospitals

emergency room complaining o pain.

Russell said that probably the most important thing

he learned during his two weeks at the dental school

was becoming amiliar with the dental blocks that areused to help patients in pain.

He said he also learned important lessons about

distinguishing between patients who are truly in pain

and need some kind o medication to lessen that pain

and those who may be complaining o pain but, upon

urther questioning and examination, are not in pain

and may be trying to obtain a prescription or other

purposes.


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DentalUM Fall 2007

DENTISTRY

It gives us more time to devoteto the other unctions o the PAES

Clinic while also precisely conveying

the same inormation to everyone

who seeks comprehensive care as a

new or returning patient, said Dr.

David Jacobson o a video all new

patients see moments ater arriving

at the PAES Clinic.

Produced by Jacobson with help

rom the Schools Digital Learning

Laboratory, the six-minute videoincludes still photos with Jacobson

explaining in detail what patients

can expect.

He begins with an overview o the

Schools dental education program

and how the dental students in the

PAES Clinic work with patients ,

under aculty supervision, to provide

care; the process o treatment, that

begins with a comprehensive oral

exam; the treatment options that are

available to a patient ollowing their

visit; and inormation about ees and

payment options.

Time vs. Cost Tradeos

Everything a student does must

be evaluated and approved by a

clinical instructor, Jacobson says in

the video. He notes that students are

required to stop at prescribed pointsand ask an instructor to check and

evaluate their work. As a result,

he adds, this is a time-consuming

process where appointments can

oten last up to three hours.

However, in return or their

time, Jacobson says that patients are

compensated with lower ees that

2 New Videos Produced for PAES Clinic

are about hal o what a private

dentist in this region would charge

or the same procedure.

Beore their treatment begins,

patients are told a comprehensive

oral examination is required. It

includes taking blood pressure and

radiographs, i necessary; compiling

inormation about the patients

medical and dental history; checking

t h e p a t i e n t s h e a d a n d n e c k ;conducting an oral cancer screening;

and assessing the patients oral

hygiene.

In the v ideo , Jacobson te l l s

patients there is no charge or a

brie screening exam or a limited

consultation with a sta dentist they

will receive.

The screening , which takes

less than ive minutes in most

cases , de termines the pat ient s

overall needs and treatment options.

The vast majority o patients are

assigned to predoctoral students

i n t h e S c h o o l s c o m p r e h e n s i v e

care clinics. However, others may

be reerred to one o the Schools

graduate specialty programs, such

as orthodontics or periodontics, or tothe Dental Faculty Associates Clinic,

a acility in the School where aculty

members with dental or specialty

degrees treat patients.

Krystal Gore and her ather, Larry, watch a video that explains what takes place in the PAES Clinic and what

patients can expect when they are treated.

Jerry Mastey

First Video Offers Patients Valuable Information


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DentalUM Fall 2007

DENTISTRY

We want all o our ourth-year dental

students to get an idea o how closely the

PAES Clinic mimics what goes on in a private

practice while also giving them an idea o

what to expect beore actually setting oot

in this Clinic.

Thats how Dr. David Jacobson, PAES

Clinic director, describes a new hal-hour

video ourth-year dental students must

watch beore beginning their rotation inthe clinic on the main foor at the School o

Dentistry.

Crediting Dr. Stephen Steanac with

bringing us into the Twenty First Century as

dental educators, Jacobson says the video,

now being used or a second year, has been

benecial.

Previously, we would present an

orientation to each new group o ourth-

year dental students, he adds, but that

slowed down taking care o patients andalso raised the possibility o omitting some

vital inormation.

As part o their video orientation, dental

students also receive a list o questions to

answer beore their irst rotation.

The video has been so well received that

Jacobson also sends it to third-year dental

students to encourage them to stop by the

Clinic to observe or lend a hand.

Words o Wisdom and Suggestions

The psychology o the patient in pain

is something you will be managing rom the

moment you say hello, Jacobson tells the

students in the video.

These patients will pick up on your

cues. They are looking or a sense that

Second Video Tells Dental Students What to Expect

you have seen their distress beore, that you

know what it is, that you know what youre

going to do about it, that they are in good

hands, and that youre going to get them

out o pain, he adds.

S t u d e n t s a r e t o l d t h a t t h e i r

responsibilities involve data gathering,

including inormation about a patientsmedical and dental histories, conducting

diagnostic tests, making a diagnosis,

explaining the diagnosis, and discussing

treatment options.

However, beore explaining their

indings to a patient, Jacobson advises

students to choose their words careully.

Because they will not treat most o those

patients themselves, students are advised

not to make any promises that other

students or departments have to keep.

Although three sta dentists are

available to help, Jacobson says, As time

goes on, we hope that you will gain an

awareness o your progress and development.

Ultimately, we want you to be able to reer

to yoursel as doctor with conidence.

Jerry Mastey


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DentalUM Fall 2007

DENTISTRY

Dr. Juan Johnson

Sta Dentist

IthoughtIwouldbehereforayear,perhaps

twoatmost,butnowitsbeentenyearsand

Imstillenjoyingmyself,saidDr.JuanJohnson

(DDS1991).

Ienjoy theopportuni ty to pract ice

dentistryatMichigan,teachstudentsinthe

Clinic,workwithfaculty,andhandlealargevarietyofpatientcases,headded.

Althoughheworksfortyhoursaweekin

thePAESClinic,Johnsonalsohasapart-time

privatepracticeinAnnArbor.

Raisedon the is landof Ok inawaand

uentinJapanese,Johnsonsaidhisinterestin

dentistrybeganinhighschool.

OnOkinawa,Italkedtomanymilitary

dentistsandlikedthefacttheyhadalevelof

autonomywhilepracticing,hesaid.

Johnsonalsothoughtaboutbecoming

aghterpilot,buttheyewwhereandwhen

theyweretold,hesaid.WhenItoldthemIwasalsoconsideringdentistry,theysuggested

becominga dentistandearninga private

pilotslicensesoIcouldywheneverIwanted.

Johnsonhasntobtainedaprivatepilotslicense,

butdoesreturntoOkinawaeveryyeartospend

timewithhisfamily.

JohnsoncametoU-Mforhisbachelors

degreeandthenadentaldegree.Fortherst

twoyears,hepracticeddentistryinapublic

healthclinicandthenlearnedabouttheneed

forastaffdentistinthePAESClinic.Iwas

veryinterestedinworkinginPAES,especiallysinceIknewthedirector,Dr.DavidJacobson,

Johnsonsaid.Wehavemanysimilarinterests

andthatmakesbeingintheClinicevenmore

enjoyable.

Whenhes not practi cing denti stry,

Johnsonenjoysrunning,playingbasketball,

chess,andhisbiggestpassion,golf.Youmight

saydentistrysupportsmygolfhabit,hesaid.

Per Kjeldsen


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DentalUM Fall 2007

DENTISTRY

Dr. Vernon Rife

PAES Clinic Dentist

IvebeenadentisthereinthePAES

Clinicsince1993andcontinuetoenjoy

theinteractionwiththepatients,helping

themunderstandtheirdentalcondition,

discussingoptimaltreatmentplans,andreferringthemtothoseintheSchoolwho

canbesthelpthem,saysDr.VernonRife.

Afterearninghisdentaldegreefrom

U-Min1975,Rifepracticeddentistryfor

18yearsinHartland,Michigan,before

returningtohisalmamater.

Ien joyeddent is try,but d is liked

doingthepaperwork,makingthehiring

decisions,andalltheotherthingsthatarea

partofaprivatepractice,hesaid,sowhenI

learnedoftheneedforastaffdentisthere,

IappliedandsoldmypracticeonceIacceptedthejobhere.

Rifesaidheenjoysanotherpartofhis

workinthePAESClinic,teaching.

Ithoughtaboutbecomingateacher

whenIwasanundergraduate,orperhaps

workinginmedicineordentistry,hesaid.

TheopportunityIhavedailytoeducate

newpatientswhocometoourclinicfor

treatment,aswellasmentoringthedental

studentswhohelpthepatientsinthePAES

Clinic,isthebestofbothworlds.

When h es no t a t t he Sc hool of

Dentistry, Rifeworks part-timeat a privatepracticeinBellevilleanddirects

amenschorusathischurchinHighland,

Michigan.Ialsodirectavolunteerchoir

atChristmastime.Ivebeensingingsince

Iwasingradeschoolandstillhavealotof

fundoingit,hesaid.

Per Kjeldsen


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DentalUM Fall 2007

DENTISTRY

Adjunct Faculty Teach Students, Help Patients

Justin Dugas, DDS

I had some

amazing

instructors

when I was a

dental student,

especially Drs. Joe

Kolling and Dan

Edwards, said

Dr. Justin Dugas (DDS 2005).

They wanted me to succeed,

to understand what I was doing

and why. They took the time, even

ater hours, to explain procedures or

techniques when I had questions. Im

trying to emulate them, so thats why,

since January, I have been here one

day a week, he added.Dugas, who practices in Dearborn

our days a week, spends Tuesdays

in the Clinic helping patients, when

needed, but mostly supervising dental

students and guiding them.

But his counsel extends beyond

dental plans and treatment.

Because Im so close in age to the

ourth-year dental students, I oten

nd that Im a resource or career

advice, he said. Many students,he said, have questions about being

in a private practice or whether

they should enter an AEGD or GPR

program, so Im glad to answer those

questions too. I want to make the

same dierence in their lives that Drs.

Kolling and Edwards made in mine.

In addition to three staff dentists in the PAES Clinic, several private practice dentistsreturn to the Clinic one day a week to teach students and help patients.

John Seago, DDS

Its a great

honor to give

something

back to this

School and

this University

or the great

education I

received, said Dr. John Seago (DDS

1986).

Being here in the PAES Clinic

every Wednesday is my way o

showing my appreciation and,

I hope, will inspire some dental

students to think about also doing

this as their way o giving back in

the uture.Seago, who r uns a private

practice in St. Clair Shores our

days a week, has been an adjunct

instructor in the Clinic or nearly

two years. I keep returning because

it seems theres something new

everyday, he said. This is also

a great learning environment or

the students and I enjoy the many

opportunities I have during the day

to pass along some o what I havelearned to help them.

Aaron Ford, DDS

Unlike his two

other adjunct

colleagues, Drs.

Justin Dugas and

John Seago, Dr.

Aaron Ford is

the new kid on

the block. Ater

earning his dental degree in May, he

began working in the PAES Clinic a

month later.

It eels a bit strange seeing

and talking to some o my ormer

dental classmates, he said. But Im

excited to be here at the School and

helping patients.

Ford, who is in the Clinic onThursdays, spends his other our

days providing oral health care in

downtown Detroit as a part o Dr.

Amid Ismails oral health disparities

program.

Eventually, Ford said he would

like to work in a private practice

ater his wie completes her

emergency residency program at

Henry Ford Health System in Detroit.

From November 2000 to May2001, Ford was with the U.S. Army

as a medical platoon leader at Camp

Doha, Kuwait, where he oversaw the

treatment o over 900 patients and

20 MEDEVAC situations.


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DentalUM Fall 2007

DENTISTRY

FA C U LT Y P R O F I L E

Stephen Stefanac, DDS, MS

Associate Dean for Patient Services

Clinical Professor of Dentistry

e supervises one o the Schools largest departments

with more than 80 employees working in 11 dierent

areas. So theres plenty to keep Dr. Stephen Steanac

busy on any given day.

However, away rom the School o Dentistry, theres another

side not many see.

His hobbiesas a potter and restorer o old pinball

machinesare activities that help him to get away rom it all

when hes not at the School o Dentistry.Steanac returned to the U-M School o Dentistry in the

summer o 2004 as associate dean or patient services, a position

similar to the one he held or six years at the College o Dentistry

at the University o Iowa.

He earned a bachelors degree in biological sciences rom U-M

in 1976 and a masters degree in oral diagnosis and radiology 11

years later.

The Infuence o a U-M Dentist

Family and riends are here, and some o my ondest

memories are o my days here as a student, as well as when I

was living here in Ann Arbor and running my own practice in

South Lyon and practicing part time in Detroit. So it was natural

to want to return, he said.

What Steanac seems to especially cherish, now that hes

back in Ann Arbor and at the School o Dentistry in a leadership

role, are the opportunities to meet and talk to Dr. William Gregory

(DDS 1953, MS 1983), an adjunct clinical proessor.

Per Kjeldsen

H


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DentalUM Fall 2007

Documents

DentalUM Fall 2007