Alan Phillips didn’t want to go to the dentist, but when he needed life-saving surgery to fix a weak aortic valve, the 65-year-old from Burlington, Iowa, didn’t have a choice. His doctor told him he’d have to get his mouth checked for cavities and infections or he wouldn’t be able to proceed.
As Phillips eases into the examination chair, he jokes about his health situation with fourth-year dental student Patrick Kolker, but it’s clear he’s nervous about his first visit to the University of Iowa College of Dentistry’s Geriatric and Special Needs Clinic. Kolker registers his patient’s anxiety and calmly explains what he’s about to do.
Observing the exam is Jennifer Hartshorn, a clinical assistant professor and graduate of the College of Dentistry’s Geriatric and Special Needs Certificate Program. Started in 2011, it is one of the few hands-on training programs in geriatric oral health care in the nation. Hartshorn completed the one-year program in 2013 and has been working in the geriatric clinic ever since.
“Geriatric dentistry wasn’t something I was thinking about when I applied to dental school, but I am glad I discovered it,” says Hartshorn. “Every patient you come across is so grateful. You feel so appreciated.”
The UI College of Dentistry has long been considered a leader in geriatric dental care. Since the 1970s, the school has required all students to enroll in an introductory course in the subject, and roughly two-thirds take the geriatric/special needs elective that puts them in Hartshorn’s clinic three days per week for five consecutive weeks.
The college also operates a mobile dental clinic—staffed by Hartshorn’s students—that serves 10 nursing homes in Iowa. The mobile clinic was started in 1982 by Ronald Ettinger, an emeritus faculty member and renowned advocate for geriatric dentistry, and Howard J. Cowen, clinical professor and director of the Geriatric and Special Needs Dental Program and Geriatric and Special Needs Postgraduate Certificate Program.
“Many of us will open practices in small towns, so we’ll see a variety of patients. I’m glad to have this experience.”
—Tim Schramm, fourth-year dental student from Swisher, Iowa
Recently, the college increased the level of care for elderly patients by adding a nurse practitioner and social worker to the geriatric dental clinic team. The additions are part of a joint effort by the College of Dentistry and College of Nursing to provide one-stop, total health check-ups for older patients. The effort is funded by a $30,000 grant from the Delta Dental Foundation of Iowa and could be expanded to include more nursing and social work students in the future.
“Having a nurse practitioner in the dental office expands the focus of the visit from strictly oral health to overall health,” says Larry Newman, assistant clinical professor and director of the Adult/Geriatric Primary Care Nurse Practitioner Program at the College of Nursing. “For the patient, it is an opportunity to see two health care professionals at once, saving time and energy.”
Community service is an important piece of the College of Dentistry’s educational mission, says Cowen. Many students come to the school wanting to open dental practices that serve their community—from pediatric to elderly patients. Students say that working in the geriatric clinic is a positive experience that helps build empathy for older patients as well as a better understanding of their unique needs.
“The clinic puts you in a different environment and it teaches you how to problem-solve, how to apply knowledge you already have to new and complex situations,” says fourth-year dental student Tim Schramm of Swisher, Iowa. “Many of us will open practices in small towns, so we’ll see a variety of patients. I’m glad to have this experience.”
Some students never lose their passion for helping the elderly. Willy Wever, a 2002 College of Dentistry graduate, owns a dental practice in Columbus Junction, Iowa, but once a month returns to campus to work side-by-side with students in the Geriatric and Special Needs Clinic.
“For me, it’s a way to stay current on the care of geriatric people,” says Wever, who purchased a van to transport elderly nursing home residents to and from his clinic. “My grandfather spent time in a nursing home, and I saw that he was getting no real dental care. Things have improved, but we’re still not there.”
In Iowa, as in most states, there is no legal requirement for nursing homes to provide dental care. This leaves residents vulnerable to cavities, gum disease, and infections, says Cowen.
Over the years, Cowen and others at the college have advocated for oral health training aimed at front-line nursing home workers. One such training program, Mouth Care Matters, was launched two years ago but has had trouble attracting students, Cowen says. This was due in part to the high turnover rate of nursing home workers and to a perceived lack of financial incentive by nursing home owners.
Cowen has launched a multi-year study that he hopes will contradict this perception. As part of the study, Cowen and his students will provide oral health care training to teams of nursing home workers and then compare patient hospitalization rates at the homes to those where only a small number of staff or no staff were provided oral health care instruction.
“Our hope is that we can show that providing good oral health care translates to a monetary benefit for nursing homes,” says Cowen. “It’s my experience that if you are providing proper oral health care to your residents, then you are going to have less hospitalizations and therefore less empty beds.”
Avoiding hospitalization also is the reason why Newman, of the College of Nursing, wanted to work in the geriatric dental unit. Since January, when he started visiting the clinic, Newman says he’s been able to offer patients a variety of health services, including overall wellness exams, blood sugar testing, answers to questions about medications, and connections to medical specialists. He also provides simple services, such as earwax removal and toenail trimming.
“When I meet someone who doesn’t have a primary care provider or hasn’t been to see theirs in over a year, I make sure to get them in for an appointment,” says Newman. “The goal of these visits is to improve overall health outcomes.”
On a recent afternoon, Newman chatted with Marie Jacbo, 71, of Winterset, Iowa, about her health history, including a bout of double pneumonia. Jacbo was visiting the geriatric clinic for help with a cavity but was happy to receive medical advice from the nurse practitioner as well.
“The people here,” she says, indicating the dental students and health professionals around her, “they are my hope.”