University Times

Public outreach in Pitt’s School of Dental Medicine means everything from welcoming a juvenile offender in shackles at the dental clinic to changing educational requirements so students can volunteer time helping AIDS patients rather than just reading about them in textbooks.

With public service and education as a large part of its mission, the school continues to develop programs to teach its students in the real world. Recently, the school expanded dental care services to more rural clinics in western Pennsylvania and to low-income, pregnant women at Magee-Womens Hospital.

According to Dean Thomas W. Braun, the outreach is part of a “determined effort of the school and faculty to ensure that practitioners of dentistry are prepared to assist a great number of people in need. And there is an increasing need as the population without any kind of dental insurance increases.” According to the U.S. Surgeon General’s report in 2000, more than a third of Americans lack dental insurance.

And the school takes a financial hit for all of its public care programs: It provided approximately $1.2 million of unreimbursed care last year, most of it serving medical assistance patients. Discount programs for low-income patients and senior citizens added to that total.

“It is our hope that all of our graduates take with them the recognition that we as health care providers have an obligation to provide to all our community members,” Braun said.

The school’s public service programs are varied because dental health means more than just clean teeth. Oral care is an important component of overall health, dental professors stress. For example, oral health is associated with herpes, teeth grinding and clenching, oral cancer and gum disease. And neglected dental problems can cause serious infections; loss of teeth can hamper everything from nutrition to getting a date.

Improving dentist-patient relationships

The dental school changed its curriculum in 2003, requiring students to volunteer their services. The move promoted better dentist-patient relationships, according to Richard Rubin, director of SCOPE, Student Community Outreach Program and Education.

Unique nationally, according to Rubin, SCOPE I requires all first- and second-year students to volunteer 40 hours of non-dental community service. “This program is set up to not only teach about patients with diseases, but to give students a broad empathy, communication skills and multi-culturalism — this is one of the main cultural competencies of the school,” he said.

To fulfill the SCOPE I requirement, students typically volunteer for the Big Sister program, Pittsburgh AIDS Task Force, Youth Outreach program, Hand-In-Hand Festival, Walk for Juvenile Diabetes and community church activities.

A journal of the students’ experiences is required. Rubin cites one journal entry from a former student: “Talking to people who attended the event (AIDS walk) gave me a different perspective on AIDS, it was something I was not familiar with except in textbooks and in the classroom.”

Such real-life exposure deepens a dental student’s understanding of who they are treating, Rubin said. “For the dentist, communication skills are critical. And those skills rely partly on the cultural competence of a dentist. He or she has to understand his or her own feelings and the patient’s. When patients come in, they’re whole Through SCOPE 2, third and fourth year students visit community sites throughout western Pennsylvania, working on patients at private clinics. The school serves 10 sites in western Pennsylvania and may extend its reach to Youngstown, Rubin said.

“We’re getting students to help not just for their sake, but it’s helping communities get their dentistry,” he noted. Rural and inner city areas are the most difficult places for people to access dental services, Rubin said. “The problem is in part financial, lack of dentists in the area, the family structure and transportation, especially in rural areas. Inner cities can have large families where a mother is taking care of four or five kids. For her, it’s hard to go on a bus for two hours to get to a dental appointment.

“Socioeconomic status is one of the biggest barriers to dental care – that population not only has more cavities, but more untreated cavities,” Rubin said. Approximately 80 percent of cavities are found in 20 percent of the population – mostly low-income people, according to national dental studies.

Keeping it clean

Prevention is better than tooth decay. The concept seems simple, but teaching it gets complicated when Pitt’s dental hygiene program serves inner city children and special needs populations such as those with disabilities. “Care is not always available to these populations,” said Angelina E. Riccelli, associate professor and director of the hygiene program. And awareness of dental health is key, she said. For some people, such as those with diabetes, gum disease may worsen their condition.

“My program is about teaching people to take care of their mouth. For example, if they can’t afford a crown or implant, that limits their chewing ability. And we can provide alternative treatment plans. Everything is integrated. Good teeth help with self-esteem and nutrition. It’s a holistic approach.”

For example, Riccelli is in the final stages of starting a hygiene program for pregnant women, primarily those on medical assistance, at Magee-Womens Hospital. Magee officials approached the dental school because dental health can impact an unborn child, Riccelli said. “With pregnant women, there is an association with pre-term, low-weight infants and mothers who have gum disease.”

Pitt student hygienists can be found in a number of outreach settings. They teach low-income parents and children how to through the Allegheny County Health Department maxi molar sealant program. Pitt has been providing dental health education for the program, which has served about 25,000 elementary school children in nine years, according to Riccelli. The student hygienists teach good oral health care while county dentists apply dental sealants to the children’s teeth.

The student hygienists also bring dental health education to various pre-schools, elementary and high schools in the region as well as to students at the School for the Blind and the DePaul Institute. They promote dental health at nursing homes. They also try to educate the public on the effects of smoking and chewing tobacco: Both can cause oral cancer, gum disease and other illnesses. Pitt’s dental school also is partnering with Carlow College to provide free teeth cleaning to students who successfully quit smoking.

In the mouths of babes and others

The name might be deceiving but the school’s Department of Pediatric Dentistry covers those up to age 18 as well as special-needs populations.

The department tends to people who have difficulty visiting a private dentist. For example, convicted juvenile offenders often are covered by state insurance plans, but many private practitioners do not accept those medicals plans, according to Deborah Studen-Pavlovich, professor and chair of pediatric dentistry. And add to that: “Nobody wants someone in shackles in THEIR waiting room,” she said. But they can come to Pitt’s dental clinic.

The department has coordinated dental service programs with Summit Academy and Sleepy Hollow, second-chance detention centers for 13- to 18-year-olds. These patients provide a good clinical opportunity for entry-level dental students, said Studen-Pavlovich. “The students get technical experience and learn how another part of the world lives.”

Pediatric dentistry offers specialty services such as educating parents and treating childhood caries, formerly known as baby-bottle mouth. Prolonged feeding of sweet liquids to babies causes the disease, characterized by severe decay of baby teeth. “This hits all populations, but poor people suffer the most — they might be uninsured or ignorant about prevention,” said Studen-Pavlovich.

Faculty and students participate in a host of events to educate and treat the public including Give Kids a Smile Day (last held in March). About 80 uninsured children received fluoride treatments, cleanings, radiographs, restorations, extractions and sealants. Similar services were rendered for the Special Olympics in May at Baldwin High School. “It’s a population that’s neglected,” said Studen-Pavlovich of the Special Olympians. “It takes longer to treat them. They might not understand ‘sit in the chair’ or it may be difficult for them to open their mouth. Dental anesthesiology helps us treat them.”

The department works with more than 20 agencies on a regular basis including Mom’s House, a group home for pregnant adolescents; Head Start children, and patients at Gateway Rehabilitation Center and Harbor Cree, two chemical dependency treatment centers in western Pennsylvania.

-Mary Ann Thomas