Feature Story

Hartford Magazine, December 1, 2009

Small School BIG Accomplishments

By Nancy Thompson

Bruce Gould was driving home from a meeting in Farmington one rainy fall evening when he noticed an elderly woman with a cane walking along the side of the road.

Gould, a physician and associate dean for primary care at the University of Connecticut School of Medicine and the medical director of the Burgdorf/Fleet Health Center in Hartford’s North End, pulled over. “Excuse me, ma’am, but can I help you?” he recalled asking.

Her response amazed him.

The woman, whom Gould described as “not walking all that well,” had taken a bus from her home in Danbury and was walking from the Farmington bus station to UConn Health Center. She was planning to sleep in the cafeteria that night so she could keep an early-morning appointment at the center's dental clinic.

“She said it was the only place she could get dental care,” Gould said. “I gave her a ride, handed her $5 for dinner and called security to be sure they wouldn’t kick her out.”

Gould, an outspoken supporter of health care reform, is the medical director for the City of Hartford’s Department of Health and Human Services, and the director of a federal program that works to improve dental and medical care for the state's underserved residents.

He said he was horrified. “It was a poignant moment to realize that in a state as wealthy as Connecticut, someone from Danbury had to go to Farmington to get dental care.”

The elderly woman’s visit was one of about 100,000 annual visits to a clinic operated by the University of Connecticut School of Dental Medicine – the single largest provider of dental care to urban, minority and other underserved residents in the state. The school provided an estimated $6.6 million in uncompensated dental care to people in need during 2007-08.

The school’s students work in community health centers throughout Connecticut. They study with social and behavioral scientists and other researchers to learn how best to provide services to patients whose cultural attitudes toward oral health may be far different from their own.

“The state is experiencing a changing population,” said R. Lamont MacNeil, a dentist and dean of the school. “We’re seeing health issues relative to those populations. A lot of dental disease is geographically or socioeconomically based.”

For example, MacNeil said, the school teaches students to consider issues relating to diet, which in some cultures is loaded with high-sugar or high­carbohydrate foods that can lead to decay and other problems.

“We teach students to look at treatment planning options. There are many different avenues, and [students] have to adapt to different cultures and the relative priority on dental care in each,” MacNeil said.

“There’s a very strong value-based element to oral health care,” said Steven M. Lepowsky, a doctor of dental surgery and the school’s associate dean for education and patient care. “Patients are from different backgrounds and have different priorities. We have to be sensitive to the values and desires of our patients.”

Dental students are required to work in the community. “It’s not an elective,” Lepowsky said. “Some core components of our curriculum are outside of the school.”

In fact, some of the community work takes place far beyond the school’s Farmington campus. Students have worked in Chile, Paraguay, Belize, South Africa, Haiti and Peru, in addition to sites in the U.S.

“Students determine what they do, but they all do something,” Lepowsky said. “They learn that they will have ethical and moral obligations for the rest of their careers.”

Small School Has Big Stature
The Farmington-based school is the fourth smallest dental school in the U.S., but despite its size, it’s the eighth-ranked dental school in the country in terms of funding from the National Institutes of Health and ranks 17th in terms of total research funding. It is also the only public dental school in New England.

One of the most prestigious dental schools in the nation, UConn receives about 1,400 applications yearly for its 40 or so vacancies, and with good reason. More than 90 percent of its graduates take training in specialized fields of dentistry, about double the percentage nationwide.

The school emphasizes service and science, combining an extensive network of clinics to help the state's underserved population with a faculty engaged in internationally recognized, cutting-edge research.

The school’s faculty is widely known for being on the leading edge of technology and research — and students are able to benefit from both.

UConn is one of only a handful of programs where students in the dental and medical schools take classes together for the first two years of their four-year programs.

“They learn about the relationship between dental disease and systemic disease,” MacNeil said. For example, he noted, there appears to be a relationship between periodontal disease and diabetes. Oral health also can point to risk factors for cardiovascular disease. “Our students are very in tune with these situations,” he added.

Some faculty members are researching how to suppress or eliminate excruciatingly painful mouth sores, a common side effect of cancer therapy. Another group is studying ways to regenerate bone, and others are involved in stem cell research. One researcher is looking at the possibility of regenerating teeth by programming cells to reform.

“We’re [also] looking at ways to improve fillings and make them more aesthetic,” MacNeil said.

He said about half of the school’s students do some research while completing their dental degree. Whether they do research or not, students are trained to think critically and not accept the status quo. One of the school’s more unusual classes is aimed at forcing students to “think outside the box,” MacNeil said.

“We want them to challenge why we do things, to debate and to offer alternatives.”

“We have an obligation to ensure competence, but we also have an obligation to be sure they leave here as thinkers,” Lepowsky said. “We want them to know they need to continue to learn, to read professional articles critically, not just assume that an idea has value. It’s a different approach, much less textbook-based. We want our students to understand facts and also know how to use them.”

Raising the Bar
UConn’s School of Dental Medicine has gained a national reputation since opening about 30 years ago. Most of its students are accepted into their first-choice residency program, a fact that reflects well on the school, Lepowsky said.

“It’s a remarkable achievement and it shows how residency programs nationally look at our students and our school’s programs in general.”

About half of the dentists in the state graduated from the school, and many others are part of its “community faculty,” MacNeil said. During training, “students get out into the state, so many of the out-of-state students get to know the area and stay here, or return after their specialized training.”

Looking to the future, MacNeil predicted that dentists will play a larger role in general health care and will be more involved in diagnosing ailments. He envisions multidisciplinary teams in which dentists, physicians, pharmacists and nurses will work more closely together and learn more about each other's work.

MacNeil believes it makes sense. “More Americans see their dentists on a regular basis than their physicians,” he said.