Transcription of Dr. Jon Ryder for the show Taking Care of Teeth & Treating Trauma #281
Lisa Belisle: Today in the studio we have Dr. Jon Ryder who is Dean of the University of New England College of Dental Medicine. He has served in leadership roles at the college since its opening including assistant dean for academic affairs and executive associate dean. Plus, you have a long and esteemed history in dental medicine.
Jon Ryder: Yeah that’s right, I don’t know about esteemed, but thank you.
Lisa Belisle: I think it’s pretty interesting what you’ve been doing. You’ve made your way from the middle part of our country, and really gone around the world from what I can tell.
Jon Ryder: Yeah it took me a while to get to Maine, but now that I’m here, I’m extremely happy to be here. What a beautiful place.
Lisa Belisle: I completely agree. Tell me about, why dentistry?
Jon Ryder: Well, I don’t know how far back you want me to go. I was born on a Thursday. I actually used to play in rock and roll bands, and one of the players in the, one of my bandmates was a dentist. I got to know him well and appreciated the lifestyle that he led, and also got to hear a lot about his stories of helping people and going on mission trips and things like that. I think that inspired me. Actually going back even further than that, when I was a child and going to the dentist I used to get little rubber animals as a reward. I think maybe that was the very first time I was inspired to go into dentistry. I had quite a collection as well.
I think that idea of, I think a lot of people that go into healthcare, they have this concept of helping people. I really did. I felt the idea of going to places that were underserved and in need. It’s always been an underlying passion, I guess, of mine and interest. I think that’s what drove me outside of the country as well, and into some of the adventures in southeast Asia and other places, and eventually to Maine because Maine is actually not that much different from a lot of the needs in southeast Asia and other places.
Lisa Belisle: Tell me about that.
Jon Ryder: I spent time in Cambodia, and I was helping with the curriculum development and with the dental schools there. Addressing the access to care issues in Cambodia. Cambodia is a very rural area which is similar to… a very rural company, which is actually similar to Maine in many ways. There’s a couple of larger metropolitan areas that you might compare to maybe Portland and Bangor and so on. The rest of the country is very rural, and the problem with distribution of health care professionals is, again, very similar.
When I was in Cambodia and working with the dental schools, we were actually looking at the new dental schools that were developing in the United States, and what was their mission and how might we borrow some of those ideas and apply them there. That’s what got me alerted to the new school that was opening in Maine, the University of New England as well as some of the others. I had known about the founding dean, and that he had opened another school in California, a dental school. The dental school curriculum is basically the same as any other dental school, but this was the largest geographical area left in the United States if you consider Maine, New Hampshire, and Vermont without a dental school. Definitely the needs in this area are great.
This idea of building a traditional dental school with a little bit of bent on adding more public health in the curriculum, having the fourth year students going out into community-based educational sites to start immediately addressing the access to care issues, and also the benefits of being trained in a real life environment like that. This was different, and it’s somewhat of a departure from a traditional training program or educational program.
I liked that idea when I first heard about it being in southeast Asia, and I bought into that idea, I guess, and it does really work. We tried to apply some of those things in Cambodia, some of those concepts which are being implemented now. Then when the opportunity came up to come to Maine and be involved with a school that had these same philosophies, then what a great opportunity. I only wish that I would have been able to come 10 or 20 years earlier.
Lisa Belisle: All good things take time right?
Jon Ryder: Right, that’s right.
Lisa Belisle: I’m thinking about dental school and medical school, and I know what the curriculum for medical school is because I’ve been through it. I don’t think that I’m very, well, I know I’m not familiar with the dental school curriculum, and I’m guessing that a lot of people who are listening are also not familiar. Can you explain that?
Jon Ryder: Yeah I think that dental school curriculum is arguably the most or one of the most difficult programs to go through. It’s very similar to a medical school program in the first two years where they’re…. Often dental schools and medical schools will combine courses and classes for the first two years. Harvard, for example, the medical students and the dental students attend the same courses and the same classes. Even where I went to school in Iowa, we spent a lot of the same courses with the, attended many of the same courses with medical students.
What happens when the medical students go off when they’re done with the course or with the class time and then they go off and study, the dental students have to go into a lab or a simulation clinic and start cutting plastic teeth and doing procedures. We’re learning how to develop those hand skills and that mind, eye, to hand coordination. At the same time you’re cramming all this biomedical science information and other types of information in your brain. It can be very difficult. The average number of credit hours per semester, dental school is about 35 credit hours for one semester, versus a typical undergraduate program which is about 15 or 16. Easily double the time and effort that it takes.
Then beyond that, the first two years, then we start to, concentrating more on seeing patients and doing these mini residencies for the last two years. It’s not an easy time, it can be very stressful for students.
Lisa Belisle: Do you do, training these mini residencies, do you learn about periodontia, or do you learn about other types of dental specialties? Where does one do these trainings?
Jon Ryder: Again there can be different philosophies and methods of training. At Iowa, for example, in the third year we spent 12 week rotations going around to each specialty. There’s oral surgery and perio and work canals and pediatric care and so on and so on. That was an interesting way to learn, where you would focus and immerse yourself in these different specialties. It’s similar to a medical type of a training.
Then in the fourth year, we’d go into what we called family dentistry, which is more comprehensive care. In our program at UNE, we think that we like to emulate the way one would practice after you get out. We have what we call a group practice model of training. In the beginning of the second year of dental school, you’re indoctrinated into one of these groups, group practices. Like Harry Potter where you get your name, Slytherin or whatever.
Lisa Belisle: Is there a hat? Does somebody pull out of a hat?
Jon Ryder: Yeah, it’s a magic hat that we pull the names out of.
Lisa Belisle: There’s a selling point right there.
Jon Ryder: Exactly, right. There’s a lot of magic in dental education. Once you’re in this group, the practice group, you’re in that group for three years, for the remaining three years. You team treat, the student team treat the same patient base for that three year period. The benefits are student helping student within the group, but also maintaining this comprehensive and continuity of patient care. You get to know your patients very well, they get to know you, and then there’s this trade off of the new ones that come in and the congratulations to the old ones that move out.
We feel that that’s a very patient-centered especially, and also a student centered way of learning, of approaching patient care.
Lisa Belisle: Now, you started this in 2013. The school did. You now have, a group of fourth year students are getting ready to graduate this year, 2017.
Jon Ryder: Right.
Lisa Belisle: Tell me what usually happens once one has a dental degree. Do you go right out into practice? Do you do additional training? What’s the general approach?
Jon Ryder: Historically, dentists when they graduate tend to go straight into practice. Statistically, the numbers tend to be about the opposite from medical school, where 80% of physicians graduating would go into, excuse me, specialty programs, 20% into primary care. With dentists it tends to be about 80% that go into, directly into primary care, and another 20 or 25% that would go into specialties. That number has been increasing a little bit, the specialty numbers in the last few years, but it’s stayed relatively steady.
Dentistry is still very much this cottage industry where you see one dentist in a 800, or 1000 square foot practice and in a community, and they become the community dentist. It is changing a little bit. I think the hand is being forced by changing issues in medicine and medical care in general. Affordable Care Act definitely has some influence on that. We are starting to see the rise of corporate dentistry, where a corporation may own several different practices or manage, manage practices in a variety of states.
I think we’re still looking at single or partnerships kind of an industry out there. There are several specialties that dentists can go into. Oral surgery, orthodontics are probably the most famous that people know, and the most popular. There’s also pediatric dentistry and endodontics specializing in root canals, periodontics specializing in the gums and surgeries and things like that. Public health is another area.
While we don’t have specialty training programs in our dental school, we definitely train our dental students to be very competent in those areas and prepare them to go out into the world and practice those procedures.
Lisa Belisle: It seems to me that I’ve seen different sets of initials behind dentists’ names. Even though everybody comes out and they’re all called doctor. I’ve seen DMD, DDS, probably many other alphabet soup type of initials. What’s the basic difference in what people come out with?
Jon Ryder: The first dental school in the United States was Maryland. They created a degree called the Doctor of Dental Surgery, which was the DDS program. Harvard came not too much longer after, and Harvard being Harvard, they created their own program called the Doctor of Dental Medicine. That’s where the DMD came from. The training programs were slightly different in the early days, but as time has gone on, there’s really essentially not that much difference. We can say that the Doctor of Dental Medicine degree which is the one that we have at UNE is, maybe spends more, has more emphasis on the medical philosophy and the medical model as opposed to a surgical model or a surgical approach towards care, but essentially they’re the same thing.
Then you’ll often see dentists with master’s degrees or PhDs. There’s the training, specialty training programs are not unlike medicine again, where you do a residency and you could either come out of that program with a certificate or board certification, that’s the primary objective. Often those training programs will have master’s incorporated with them, or potentially PhD. Then there’s fellowships that they’ll throw in the mix as well.
Lisa Belisle: Sounds like you could just keep getting educated for a really long time.
Jon Ryder: Oh yeah, yeah. It takes a long time to get to this point, and you can certainly keep on going, which is good. I think there’s continuing education that’s required whether you want to continue your education or not, to maintain your license in most states. I think it’s good that people continue and stay on top of what the…. There’s just too much happening in medicine too quickly. You have to read the journals and maintain this continuing education idea.
Lisa Belisle: I know we’ve heard a lot about the importance of oral health in physical health. We’ve heard a lot about gum bacteria and heart disease and every time I go to the dentist now, even though I don’t chew tobacco, they pull my tongue out. They look on either side. They palpate around, they make sure I don’t have any oral cancer. It seems like the specialties are becoming more and more integrated. Where it used to be teeth on one side, rest of the body on the other side, it seems like there’s this growing understanding that they’re all connected.
Jon Ryder: Yeah, hallelujah, they’ve discovered that the mouth is connected to the body, right? That’s a great epiphany and revolution, I think, that’s happening now. I don’t know why it’s… I guess you have to go back in history and try to find out, figure out why dentists have lobbied to stay somewhat separate from medicine, but medical training has very little training in the oral cavity. Even really the head and neck region. Medical students are typically, and I’m not slamming medical education, I’m just saying in my experience, medical education, or medical students tend to look passed the teeth and at the back of the throat, and that’s where diagnosis starts and interest starts.
The concept of inter-professional education, I think is very, very important and significant now. Not only is the research showing that the mouth is connected to the body, but other areas, other medical areas, allied specialties are also realizing that from their perspective back toward the mouth, even programs like occupational therapy or physical therapy are involved with dental students, or I mean dental patients and vice versa. A patient that has Parkinson’s disease for example and maybe 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.
Physical therapists working with patients with jaw or TMJ issues and so on. Pharmacy students, we have pharmacy students and pharmacists that interact with the dental students for example. Medical adherence issues and poly pharmacy issues that dental patients will have as well. Social workers. Dental patients sometimes, when there’s something again, magical about lying in the back of the chair, and they start to open up about their personal issues and issues. It’s often a time where you can diagnose, or maybe not diagnose, but suspect domestic violence issues or suicidal tendencies and things like that.
The dentist today has to know how to work with other health care professionals, recognize problems and get their patients to the proper areas and proper health care professionals. I think the idea of inter-professional education is, again, extremely important, and at UNE it’s, you know to give UNE a plug, we have four doctoral programs, six master’s programs, and four bachelor’s programs all in health care. The opportunity for these students to interact is tremendous.
Lisa Belisle: Hasn’t dental medicine always been somewhat on the forefront because it seems as if it’s really a team approach. It’s the doctor that I see at the end of the visit. I see him for very short periods of time, thank goodness, because I have nice teeth thanks to my parents who brought me to the dentist all the time when I was younger, but I spent a lot of time with a dental hygienist. There’s no separating it. You couldn’t have one without the other, and it always, at least in my lifetime, it seems like it’s always been the case.
Jon Ryder: Yeah, that’s a really good point, and I think that dentists do feel, approach patient care in a team way, a team effort. I think that that’s going to increase. I wouldn’t be surprised if, I need to finish my sentences, don’t I? I wouldn’t be surprised if we see multi-specialty types of health care practices in the future that would include dentists, hygienists, but also some of these, maybe physicians or specialty areas in dentistry, whatever. In Maine we have FQHCs, Federally Qualified Healthcare Centers, especially in the rural areas, these FQHCs often employ a variety of health care professionals and as well as inviting students in as well.
One of the benefits of sending our students to FQHCs, for example, is they have this opportunity to see what it’s like to team treat a patient with physicians and nurses and pharmacists and social workers and so on. I think that they would, most of them certainly would agree that that’s a really terrific way of approaching patients and getting the job done.
Lisa Belisle: I have to say, one of the most tragic things that I see is young people who have no teeth. This is sadly something that I see more often that I would like. I have a patient who can’t be 30, and she has no teeth at all. It goes back so far. It seems as though we haven’t had adequate dental coverage in the state of Maine. When I have patients who come in and they have dental issues, I don’t often have anywhere to send them. Or they’re on long waiting lists, or if they’ve got an infection or just some painful issue with their teeth, I have to prescribe them antibiotics and pain medication because they have to wait for a month to see a dentist.
To me this feels almost like a public health crime. There’s something wrong with this situation, because once you have no teeth, how do you eat? How do you eat good, healthy, nutritious food? How is that even possible? Then once you have no teeth, how do you afford to get new teeth? Because those aren’t often covered in this population. They don’t have any way to get dentures, and they don’t have any money.
Jon Ryder: Right. I think the literature would also show that the time taken off work or the time out of school due to pain and oral health issues is also enormous and often overlooked, I think, when it comes to public health initiatives. The access to care is a complicated problem. First we have to, at least our philosophy with putting a dental school here, is to build a dental school, recruit from areas that have need, recruit students from areas that have need, educate them, and then try to have them go back to those areas.
We know that, through research, that if you come from a small town, you’re more likely to go back to a small town, or at least to practice in similar kinds of areas. I think that’s part of addressing the access to care issues. However, you can lead a horse to water and you can’t always make him drink right? The other more complex issues are often cultural issues. You can, even in Maine, you can go from one county to another county and have surprisingly completely different culture. Thirty-year-olds that don’t have teeth are sometimes coming from a background or a culture that believes that that’s just what happens. You lose your teeth when you get to a certain age, and it’s time for your third set of teeth.
When I was a dental student, I’ll never forget, a family, nice family came in and they brought their 18 year old son in, and their complaint was that it was time for their son to have all of his teeth extracted and get a denture, because that’s what you did when you were 18. You just don’t have to worry about your teeth then anymore, and you’re not going to be in pain or whatever. Then we have cultural issues with some different ethnic groups that, especially working in different parts of the world, I’ve been exposed to people, or parents bringing in their children and wanting the canines extracted, for example, because the K9s are associated with erratic and crazy behavior. They come in about the same time as adolescence starts. There’s a lot of different types of philosophies.
We can be appalled or laugh, but they’re serious issues, and they’re real. We have to do our best to work with cultural beliefs, whether they’re here or overseas or wherever, and try to do the best we can to solve the problems, solve the issues. It’s going to take time. I think that’s, again, with our program, we have so much public health in our curriculum, and we’ve purposefully added more public health than average, that our students are going to graduate with a DMD degree, but also a certificate and dental public health leadership. We want them to graduate and go out into the community with, to be able to speak intelligently about public health issues, about being able to, comfortably being able to deal with legislatures, address public health policies and so on. They’re going to be the leaders of the future. We need to educate them in that way. It’ll take time, but it also takes well educated and engaged healthcare professionals.
Lisa Belisle: You make me feel optimistic for the future, and as a primary care doctor for the past two decades, I really appreciate the work that you are doing in this area, and I appreciate the fact that we finally have a dental school in Maine, and that we are working on these issues.
Jon Ryder: Right, thank you.
Lisa Belisle: I’ve been speaking with Dr. Jon Ryder, who is Dean of the University of New England College of Dental Medicine. I appreciate all the work that you do, and I appreciate the time that you took out of your busy schedule to come in today.
Jon Ryder: Thank you very much for having me in, it was my pleasure.