University of New England College of Dental Medicine

Educating new dentists to care for Maine mouths

Several years ago, a young woman came into my family medicine practice complaining that she could not lose weight. A mother of two, she was busy with a full-time job, but still found time to exercise regularly. She told me that her downfall was her diet: she had difficulty eating healthy food. Rather than fruits, vegetables, and lean proteins, she often relied upon soft, processed food for nutrition. She ducked her head, as if ashamed, and smiled apologetically. I could see the smooth pink lines of her gums behind the hand she was using to hide her mouth. I realized that she had no teeth.

My patient is one of many Maine residents who have suffered from inadequate dental care. In a rural state like ours, many do not have access to dental practitioners, while others do not have insurance, or the means to have their teeth cleaned or repaired. The University of New England College of Dental Medicine is working to solve this problem: in 2013, the college admitted its inaugural class of 64 dental students, becoming the first dental school in northern New England.

“This was the largest geographical area left in the United States—Maine, New Hampshire, and Vermont—without a dental school,” says Dr. Jon Ryder, dean of the University of New England College of Dental Medicine. “The needs in this area are great.” In 2013, the Maine Center for Disease Control and Prevention’s Oral Health Program reported that more than half of Maine residents had lost at least one permanent tooth to decay. This is a problem that begins in childhood: the Maine Integrated Youth Health Survey in 2011 showed that 22 percent of kindergarteners and 33 percent of third-grade children had experienced tooth decay.

Ryder, who earned his graduate degree from the University of Iowa College of Dentistry, spent several years helping to develop dental education and studying the needs of oral health care in Cambodia. “The needs of the underserved in Cambodia were honestly similar to those in Maine,” says Ryder. “Cambodia is a very rural area, with a couple of larger metropolitan areas that you might compare to Portland and Bangor. The problem with distribution of healthcare professionals is very similar.”

Ryder says that having dental education available in Maine increases the likelihood that more dentists will settle in our state. “We know through research that if you come from a small town, you’re more likely to go back to a small town or at least practice in similar kinds of areas,” says Ryder. The first class of students included 24 people from 20 towns throughout Maine. Four years later, 43 percent of the students in all classes hail from northern New England.

This year, UNE will graduate its first group of dental students. “Dental school curriculum is arguably the most or one of the most difficult programs to go through,” says Ryder, who notes that dental students take 35 to 40 credit hours in one semester, while a typical undergraduate program requires 15 to 16 credit hours. In addition to spending time in a classroom, studying subjects such as dental anatomy, microbiology, and immunology, “dental students go into a lab or a simulation clinic and start cutting plastic teeth and doing procedures,” says Ryder. “We’re teaching how to develop hand skills and mind-to-eye-to- hand coordination.”

Dental students begin working with patients, under supervision, after their first year at UNE. Not only are they given the opportunity to spend time with dentists around the state of Maine, but they also work in their own clinical group. “Once you’re in the practice group, you’re in that group for the remaining three years,” says Ryder. The group is comprised of dental students with varying levels of experience, in addition to professors (who are also practicing dentists and dental hygienists). “As a team, you get to know your patients very well; they get to know you,” says Ryder. “We feel that it’s very patient-centered and also a student-centered way of learning and approaching patient care.” UNE students work primarily in the UNE Oral Health Center, which opened on the Portland campus in 2013.

University of New England dental students collaborate with members of their practice team to educate patients not only on the care and cleaning of their teeth, but also on oral health topics such as cancer prevention. Smoking is particularly bad for teeth, gums, and the sensitive tissues of the mouth and throat. In addition to causing mouth and throat cancer, smoking can lead to decay. According to the Maine Center for Disease Control and Prevention’s Oral Health Program report, 62 percent of current smokers in Maine had permanent tooth loss, compared to 40 percent of those who never smoked. University of New England dental students begin learning concepts related to public health, like the impact of smoking on the body, in their first semester. By the time they graduate, they will have earned a certificate in Dental Public Health Leadership.

“We’ve purposefully added more public health than average,” says Ryder. “We want them to graduate and go out into the community to be able to speak intelligently about public health issues, deal with legislatures, and address public health policies. They’re going to be the leaders of the future, so we need to educate them in that way.”

At UNE, dental students also work closely with students from other health-related programs. “A patient who has Parkinson’s disease, for example, who has trouble taking care of their teeth, can work with an occupational therapist to devise different kinds of toothbrushes or devices to assist them with that,” says Ryder. “At UNE, we have four doctoral programs, eight master’s programs, and eleven bachelor’s programs— all in healthcare. The opportunity for these students to interact is tremendous.”

After graduation, 80 percent of University of New England dental students will begin working in a dental practice. “Dentistry is still very much this cottage industry where you see one dentist in an 800- or 1,000-square-foot practice, and they become the community dentist,” says Ryder. The remaining students will go on for advanced training in specialties such as oral surgery and orthodontics.

UNE has already begun to make an impact on dental care in Maine. This past fall, UNE dental students participated in a program called Dentists Who Care for ME, founded by Dr. Demi Kouzounas and Dr. Barry Saltz, an assistant clinical professor in the College of Dental Medicine. Along with dental practitioners in the Portland and Skowhegan areas, 63 UNE students helped provide free services to 400 adults who could not afford dental care. Once the University of New England College of Dental Medicine is fully populated with students in all four years of the program, UNE says that it will provide approximately 12,000 to 15,000 patient visits per year in the Oral Health Center and an additional 20,000 to 25,000 visits per year in the community-based network. The center provides not only a place to train dental professionals, but also a place where a substantial number of Maine residents will receive care.

As a family physician, I’ve seen how important strong teeth are to a patient’s overall well-being. Access to dental care is a complex issue that deserves our attention. Ryder has high hopes for the UNE students who will be graduating this year. He believes that they are primed to take on the cause of oral health in Maine. “It takes time, and it takes leadership,” says Ryder. “We hope to provide this leadership.”