Sometime this year the one-millionth procedure — an x-ray, filling, crown, bridge, denture, or perhaps just a simple extraction — was performed in the University of Alberta dental clinics on one of about 3,500 patients currently on the charts. That's only a small fraction of the 125,000 patients examined since dental education began on campus 75 years ago. These impressive totals represent only the main dental clinics, and not the myriad other patient services that his faculty offers, says Dentistry's director of clinics and patient management, Dr. John Woronuk.
Woronuk says the Faculty's clinical program meets two demands: "We are a teaching institution, so one objective is to provide a teaching component. But, as in all health professions, there is also the necessity to serve a public need." Providing public dental service is only one benefit of the student clinics; fees are lower than in private dental practices, considering that treatment takes longer because students must be supervised at every step. Woronuk estimates, in today's dollars, that over 75 years the clinics have saved Albertans $45 million in reduced dental care costs.
The ancestor of the Faculty of Dentistry's extensive clinical education facilities was a single seven-chair clinic on the second floor of what was, in 1921, the Medical Sciences Building. Each station was equipped with a chair, a foot-driven drill, an instrument table, and a cuspidor. A bare electric bulb hung overhead. Facilities opened in 1948 in the East Wing addition to the Medical Sciences Building were somewhat more sophisticated, with 48 fully-equipped modern cubicles. The Faculty later expanded into the Centre Wing of Medical Sciences, where a 56-chair clinic was officially opened on 2 June 1961. Today, students and instructors scurry between clinical facilities that stretch over four of the six floors of the Dentistry-Pharmacy Centre, and extend to two hospital outreach programs.
A great challenge, according to Dr. Donald Collinson, Dentistry's associate dean, clinical affairs, is maintaining up-to-date equipment for all the facilities. "Considering the cost, we are not upgrading every time something new comes out, because we have to make sure it's adequate to meet patient needs." The current renewal program allows for five to 10 clinical stations to be upgraded every year.
Besides the main dental clinic, where first, second and third-year students perform procedures suited to their level of training, the Faculty also operates an orthodontic clinic as part of the graduate program in orthodontics, and a dental hygiene clinic, recently renovated to accommodate the program's increased enrolment this fall. In their final year, students from both Dentistry and Dental Hygiene gain experience in the general practice clinic, which simulates the conditions of a private dental practice.
Other components of the Faculty's clinical services include the dental hospital within the University of Alberta Hospitals, and the geriatric dental clinic at the Edmonton General Hospital. In the dental hospital, students are exposed to oral surgery, tumors of the mouth and jaw, and trauma injuries such as broken jaws or damaged teeth. The other dimension of hospital dental care is providing routine dental services to bedridden or medically compromised patients. Woronuk, who served as director of the geriatric dental training program last year, says, "Providing this kind of service is a major, major step in the right direction."
Dental and Dental Hygiene students are assigned to rotations in all the clinics, where they are supervised by professional dentists and hygienists serving as clinical instructors. While most of the clinical facilities are only open during the academic year, the orthodontic clinic, the screening clinic, the satellite clinics in northern Alberta, and the emergency area of the dental hospital are all open to patients year round.
The treatment process begins with screening to determine what the patient's dental needs are and what level of ability is required of the student practitioners who will treat them. Cases that are too difficult are referred to private practice. During the academic year, students spend a two-week rotation screening prospective patients, and in the summer the Faculty hires students to help staff the screening clinic. Christina Wong, a fourth-year dentistry student, was one of those hired to work in the screening clinic this year. Poring over an illuminated set of x-rays, she says, "We see more mouths than other students that don't work in the summer. You learn to pick things up fast, to quickly assess what is wrong with a patient. I think it's very good experience."
After a patient is accepted into the teaching program, the next stop is the diagnosis and treatment planning clinic (DTPC) — affectionately known by dental students as "ditpic," Collinson says. Here, in consultation with the patient, students consider treatment options and form a dental treatment plan. Since 1985 a computerized patient management system has tracked each patient's visits to the Faculty s clinics, and soon all the treatment and financial records for the clinics will be accessible through an on-line computer system.
Woronuk says the careful attention devoted to screening and diagnosis are the groundwork for any treatment done in the clinics. "I don't know where you can get a more thorough analysis of the patient needs than what is carried on at this institution," he says.
"It's more personal, more thorough, and the work has always been excellent," says Lila Fahlman, explaining why she has been a patient of the University dental clinics since the '70s. "I would recommend the clinics to anybody." Collinson says that patients include individuals, families, University students and staff, and "a lot of patients who come in because they wish to contribute to the University and the education process." He adds that many are repeat patients, who return to the clinics many times. Sheila Hunchak, who says she has been a patient since the early '60s, has seen many student practitioners come and go. Remembering back 25 years, Hunchak says, "In fact, the dentist we are going to now treated my daughter at the clinic when she was five years old."
Collinson says that the Faculty usually doesn't have any trouble finding patients for the clinics. "Sometimes we are short of patients in some areas, but that may be a good thing," he says. For example, the clinics are currently short of denture patients, simply because fewer and fewer people are losing all their teeth. To recruit patients the Faculty sometimes takes out ads in local newspapers describing the type of dental patients needed.
The "teaching patients" selected for the clinics are very pleased with the student practitioners, Collinson says, "But occasionally it happens that a patient wants to change students. We can say to the patient, 'You are a part of the teaching staff. Work with the student, open the doors, try and communicate. You are a teacher, you can help us.' I haven't had one patient who has turned around and refused to try to help the student in this manner."
Reaching Out to Remote Communities
"Dentistry was a foreign word to them. Some had never seen a dentist in their lives," says Florence Ingham.
Ingham, an administrative assistant in the Faculty of Dentistry, is speaking about the residents of northern communities when the University of Alberta's mobile dental clinics rolled into their towns. And this was Alberta in the 1970s.
She says that since the beginning of the program the type of dental care provided has changed considerably. "When we started in 1974 we did the basics — restoration and extraction. That's where the demand was. Now we do the whole gamut." The emphasis has switched to preventative care: "The patients are now realizing that if you take care of your teeth you can keep them for the rest of your life."
The program's current name reflects another change, says Dr. Gordon Thompson, chair of Dentistry's Department of Dental Health Care, which oversees the clinics. "We changed the name to satellite clinics (from mobile clinics) because they are an extension of the clinical teaching program on campus and because mobile' indicated that they were moving." Although designed to be portable, the trailer-style clinics no longer travel.
While the University's direct involvement with satellite clinics dates back to 1974, travelling clinics have been delivering dental care to Albertans since 1925. That year two dentists climbed aboard a travelling public health unit serving rural Alberta. The unit bumped over dirt roads by car, truck, and occasionally by old-fashioned horse power, until the service ceased in 1939.
Probably the first mobile clinic devoted exclusively to dentistry in Alberta was operated by Dr. A.O. Sproule of Grande Prairie. In his book A History of Dentistry in Alberta, the late Hector MacLean recounted working in Dr. Sproule's 'clinic' — built on the frame of a stripped-down Ford — during the summer of 1927 while he was a University of Alberta dental student: We never managed to build a driver's seat for this top heavy plywood structure, I became accustomed to sitting on the round gas tank and managed to steer It through country roads and a few sloughs only getting stuck once south of Halcourt. I would sleep in the office at the end of the day — after first lighting a smudge pail to partially control the mosquitoes. In 1974 the University's satellite dental clinic program began as a joint venture of the Alberta government and the Faculty of Dentistry, the former responsible for the location and the cost of operating the clinics, the latter for professional and student staff. Two trailers were located in Slave Lake that year, and between 1974 and 1980 the communities of High Level and Manning also received rotating service from the mobile clinics.
The era of the truly mobile clinics ended by accident in 1979. That year the November issue of the Journal of the Canadian Dental Association reported: "The mobile dental clinic is no longer portable because of damage to its undercarriage in its last move from Manning to High Level, Alberta, in the northern part of the province." Two new replacement trailers were added to the program in 1980 and stationed in the communities of McLennan and High Level, where they are still in use today. The third of the three current clinics is in La Crete. It was first used to provide dental services for the 1988 Calgary Olympics. The mobile-home-style clinics are stocked with equipment "as modern as you'll find anywhere in downtown Edmonton," Thompson says. Ingham is responsible for distributing supplies, and she visits the clinics and each community's officials several times a year. "As the auditor, I run a very tight ship," she says. Each clinic is staffed by one dentist, two dental students, and two dental hygiene students. The students spend two weeks in the satellite clinic rotation during the final year of their programs, living in furnished quarters supplied by the University. In the summer, the Faculty hires students to work in the clinics. Most of the dentists come from private practice in Alberta, and Thompson says the Faculty gives them an orientation to prepare them to work as clinical instructors with the students.
Ingham has nothing but praise for the dentists that take time out from their practices to work and teach in the satellite clinics. "It's a non paying experience. They do it because they want to give back to this program," she says. The clinics are meant to simulate the conditions of a private dental practice in rural Alberta. The hope is that the experience will encourage students to return to rural areas to establish return practices. This hasn't happened, however, says Ingham. "Unfortunately, this is one area where we have not been so successful. Students tend to want to stay in the cities." Students benefit greatly from experiencing the differences between urban and rural clinical settings, Ingham says, because in the mobile clinics, they see a greater number and range of dental problems than they would in the city. Tooth decay, she says, is still rampant in many rural communities (some of which do not have fluoridated drinking water), while it has largely been controlled in the urban population. As well, patients from rural areas without a resident dentist often require basic information about preventative dental care. "Urban patients take complete dental service for granted. Rural people are appreciative, they appreciate being educated," Ingham says. In the satellite clinics students also encounter some special situations, such as treating prisoners brought in for dental work. "I can't think of anything more stressful than having a guard with a gun standing there while you try to treat a patient!" Ingham says. Not only the students, but the rural communities and the University itself benefit from the satellite dental clinics. The communities gain regular dental service; the University gets increased exposure in rural Alberta. Thompsion says, "It's a high profile program in the communities; it demonstrates the activities of the University beyond central Alberta."
Published Autumn 1992.