Fall 2017

Filling a Need in Maine

In a state without enough dentists, postgraduate residencies boost access to care.

Monica Jimenez

Source: June, 2017, U.S. Department of Health and Human Services

When the little boy first came into Community Dental clinic in Portland, Maine, he was so nervous that he wouldn’t sit in the chair. “He had huge cavities,” said Jennifer Barton, D16. “We were able to numb him up and do the filling but it took a long time.” By being patient and taking it a little bit at a time, Barton got the boy to sit through the appointment—and to return for the next. “His mom was very appreciative that we were so patient with him,” said Barton, a resident who trained at Community Dental last year through the School of Dental Medicine’s new Advanced Education in General Dentistry (AEGD) program.

It’s a success story that has become more common at the nonprofit clinic as well as at Community Dental’s Lewiston and Biddeford locations, where Barton also trained. According to Gina Terenzi, an associate professor at the School of Dental Medicine and director of the AEGD program, these areas, like the rest of Maine, are in the midst of an oral health-care crisis. More than 50 percent of the state’s practicing dentists are getting ready to retire in the next 15 years. “People have been closing their offices,” Terenzi said, “and until recently there was no dental school in the state.”

This lack of access to care is most keenly felt among low-income and other vulnerable populations, including those with disabilities, the elderly and, especially, children on public assistance. “There are only a handful of pediatric dentists who are board-certified in the area, and they can only handle so many people,” Terenzi said.

Now, thanks in part to a five-year grant from the federal Health Resources and Services Administration, many more of those children are receiving the treatment they need. Supporting training and service in general dentistry, public health and pediatrics, the 2015 grant helps support the new AEGD program, a collaboration among Tufts, Maine Medical Center and Community Dental. The program is modeled after Maine Medical Center’s partnership with Tufts School of Medicine. Postgraduate dental residents gain hands-on experience working with a diverse group of patients, and communities gain much-needed access to quality dental care.

The grant is also bolstering the dental school’s existing pediatrics program by bringing in pediatric dentists from the greater Portland area as faculty. AEGD residents shadow these faculty members, supplementing their hours working with children in Community Dental’s clinics.

This has been a unique opportunity for Barton, who was a member of the third cohort to go through the program in 2016-2017. “I knew I wanted to do general dentistry but also liked working with kids. In dental school, we had some exposure to working with children but I wanted a residency experience that did more work with pediatric patients,” said Barton, who now works in a private practice in Standish, Maine.

Rotating through Community Dental’s three clinics and seeing 40 patients each week—about half of them children—Barton saw firsthand the role that dental care can play in a child’s life. She remembered one 17-year-old boy who hadn’t been to the dentist in seven years and complained about pain for three months before his mother was finally able to take him. He had many deep cavities and two teeth that required root canals. “They can’t focus at school; they can’t sleep,” Barton said. “It makes a big difference in their day-to-day life.”

Peter Bates, senior vice president for academic affairs at Maine Medical Center, hopes the AEGD partnership continues to blossom. He pointed out that the number-one cause for emergency room visits by people on Medicaid in Maine is dental pain, due to the lack of available preventive care. “There is a need among dental school graduates to have more experience working independently in practice,” Bates said. “And the partnership can leverage the ability of local nonprofits to see more patients than they otherwise would be able to care for.”

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