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Dental Medicine students strive to serve

By Kathryn Kennedy
ECU News Services

Weeks away from the graduation of its first class of 50 dentists, the East Carolina University School of Dental Medicine is already improving oral health for North Carolinians.

The school has created jobs, improved access to dental care in rural and underserved areas, and continues to pioneer a new model for teaching dental medicine.

Its reach extends far beyond Greenville. The dental school stretches into Ahoskie and Elizabeth City, Lillington and Lumberton. Davidson County in the Piedmont and the mountain towns of Sylva and Spruce Pine have a piece of the purple and gold in the form of community service learning centers, where ECU faculty train dental students and residents and patients receive care.

When they leave East Carolina in May, these Pirate graduates will be qualified to work as general dentists anywhere in the nation. But the school is betting a majority of them will work in underserved North Carolina communities.

“We only admit North Carolina residents, but we look beyond residency status to roots,” says Dr. Maggie Wilson, associate dean for student affairs at the dental school. “We want to see ties to the state. We want somebody who has a commitment to helping people, to putting others’ needs first; somebody who values service above self.”

One example is Maggie Pafford, a Nashville, North Carolina, native, who plans to practice in the East after completing an advanced general dentistry at ECU’s soon-to-open Brunswick County community service learning center.

Pictured above, from left, Grace Harrell and Dr. Alexis Brown treat a patient at the Ahoskie service learning center.

Graduating dental students, from left, Diana Luckhardt, Lara Holland, Kyle Duncan, Alex Crisp and Kyle Given pose in a patient-care area in Ross Hall.
“The past four years have been such a learning experience, not only dental-related but personally,” says Pafford, who got married during her senior year. “Dental school has taught me so much about myself, the person I am and the person I want to be.”

A statewide challenge

Pafford’s desire to work in her home region exemplifies the mission of the dental school. That is to address North Carolina’s oral health challenges, which Dean Greg Chadwick describes as “a perfect storm.”

A decade ago, North Carolina was rapidly growing, and the population was shifting from rural areas to the state’s urban centers—creating pockets with limited access to dental care. The state ranked 47th nationally in the number of dentists per capita, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. The national average was six dentists for every 10,000 people. In the rural areas of North Carolina, there were half that many.
At the time, four counties, all in the Northeast, had no dentists: Tyrrell, Gates, Hyde and Camden.

“Eighty-five of the 100 counties in North Carolina are rural,” says Dr. Alec Parker, executive director of the North Carolina Dental Society. “Although these rural counties are sparsely populated compared to the remainder of the state, the people living there deserve access to oral health care provided by a licensed dentist.”

There were also concerns about the number of dentists approaching retirement. A third of North Carolina dentists are age 55 or older.

“Everyone agreed we’re going to need more dentists,” Chadwick says. What wasn’t clear was how best to meet that need.

“Many believed that increasing the enrollment at the UNC School of Dentistry by 50 additional students was a better option since it would require less state funding than creating a new institution,” Parker says.

But the model East Carolina administrators proposed—and the tenacity of community members and the local legislative delegation —won over the Board of Governors and, eventually, the Legislature.
“We would educate the next generation of dentists,” Chadwick says. “But we would also deliver the care. We’re changing the model of dental education.”

An innovative teaching method

For the 204 students enrolled at the School of Dental Medicine, their education consists of two novel approaches: an innovative curriculum that relies on technology and online instruction such as discussion forums and electronic assessment tools. Add to that a network of dental centers spread across the state—yet connected to Greenville via teledentistry—where they hone their skills as fourth-year students and residents.

Their first two years of studies are a grind. Basic science classes and labs keep students working around the clock before they ever peer into a patient’s mouth.

One lab experience stands out for senior Micah Naylor of Marion. “(T)here was a moment in pre-clinical when I had completed a composite restoration on my plastic patient,” he says. “Dr. (Cheryl) Serio inspected the restoration and told me she would be proud to call the restoration her own work.  That meant a lot to me, and I think it will always hold a special place in my memories of ECU.”

By the third year, a student’s typical day combines course work and patient care at clinics in Ross Hall, the home of the school.

Ledyard E. Ross Hall, home of the School of Dental Medicine

Ross ’51, a retired Greenville orthodontist, pledged $4 million to the school.
Ledyard E. Ross

  • Construction began in 2010
  • Opened in 2012
  • 188,000 square feet spread over four floors
  • Home to classrooms, clinics, offices and teleconference rooms
The first two years of the school, students took classes in the Brody Medical Sciences Building. At the opening of Ross Hall, student (and 2015 graduate) Alex Crisp of Burlington said he felt like “I finally moved off my brother’s couch and got my own apartment.”

Once their fourth year rolls around, students leave Greenville in their rearview mirrors to go master complex procedures, exercise critical thinking and learn what working in a small-town, stand-alone practice is like.

They do that at the eight community service learning centers in rural and underserved areas across the state. It’s an innovative model for educating students that also has the immediate benefit of improving access to dental care statewide.

“It has been such an important part of my education to go to different cities and work with different patient populations,” says Bridgette Jones, who’s worked at the centers in Elizabeth City and Sylva. “It also allows us the opportunity to experience more real-world dentistry and learn from faculty with varied experiences. Lastly, it has allowed me to bond with my classmates.”

Each center is approximately 7,800 square feet and features modern treatment rooms, X-ray equipment, educational space and more. Each center has 1.5 dental faculty positions as well as a business manager, five to six dental assistants, two to three dental hygienists and two general dentistry residents. Thus, they create a local economic impact, which Chadwick estimates at more than $1 million per center, while ensuring a consistent educational experience for students.

Any member of the community—including Medicaid patients—may receive dental care at the centers.
“The bonds formed between my classmates and professors will be some of the most treasured memories of my life. We spend so much time together; it truly is more of a family than a group of people you work with. Every struggle has been met with such great success, and it is all due to a great support system and such a wonderful caring group of people.”

—Maggie Pafford, Class of 201

“Oral health is very important, and for many folks it goes unmet, undone,” Paula Carden, director of the Jackson County Health Department, said at the June opening of the Sylva center.

“This great facility is going to lower the burden on our emergency rooms. The School of Dental Medicine, from East Carolina, is going to give western North Carolina its smile back.”

Monecia Thomas, director of the Depart­ment of Public Health in Davidson County, where officials cut the ribbon on an ECU dental center in December, says access and cost can often be barriers to oral health care.

“Not everyone in our community has the same access to good health care and the opportunity to make healthy choices,” she says. Thomas and others across the state believe ECU’s community service learning centers are changing that.

Numbers attest to that belief. More than 14,000 patients have received care at the centers and Ross Hall combined.

In addition, the students at the centers act as informal ECU ambassadors, helping attract patients to the clinics and future students to the school. Fourth-year student Jorge Arriagada says he and his classmates are sometimes stopped as they run errands in their scrubs. People are curious about who they are and why they’ve come to their community, he says.

Chadwick hopes students continue to seek out these interactions with the public.

“They’re developing an understanding about people across the state,” Chadwick says. “Why (people) might not have access to care, why they might not hold oral health as a high priority.”

Student recruitment is key

Some dental students are getting their first exposure to rural communities and small-town life during their fourth-year rotations. But wherever they come from, they’ve been carefully selected to meet the challenge and for their commitment to their state.

“We want students who are not only academically capable, but who also have excellent non-cognitive skills, the ability to develop relationships…establish rapport, to show compassion,” says Wilson, the associate dean. “Having the most gifted oral surgery skills doesn’t matter so much if you can’t relate to your patients.”

Wilson says the school has received approxi­mately 400 applications a year for the school’s 50 student slots. East Carolina has become a destination for dental training, she says, and the mission appeals to prospective students.

Fourth-year student Kyle Duncan is one example.

“I feel like a big part of who I am is growing up here,” Duncan, a Bakersville native said at the opening of the dental center in Spruce Pine. “It’s just a special place for me. A lot of people drive to Asheville or Johnson City (in Tennessee) just to get a dentist appointment, and that certainly cuts down on the frequency of care. People will only go when something hurts, and that’s not good.”

Naylor says he could tell from his first visit to ECU that the school’s priorities matched his own.

“During my interview day at ECU I got the strong impression that the faculty here would help me become the type of dentist I wanted to be,” he says.

Beginnings of a school
Dr. Greg Chadwick
(Photo by Forrest Croce)

ECU officials tried once in the early 2000s to get approval to build a dental school, but that effort fell short.

But a second attempt, fueled by a report ECU and the University of North Carolina at Chapel Hill created called “The Plan for Dentistry in North Carolina” received the UNC Board of Governors’ endorsement in 2006 and state funding of $25 million the following year.

The plan called not only for a new school at ECU but also for UNC-Chapel Hill to expand its dental classes to 100.

The plan also noted that only 13 percent of dentists are minorities, compared to 34 percent of North Carolinians. Educating minority dentists is an area of focus for ECU.

From two employees in the mid-2000s—Dr. Greg Chadwick, who then was associate vice chancellor for oral health charged with planning the school, and an administrative assistant—the dental school now has 224 full-time employees and 20 advanced general dentistry residents working at Ross Hall, the community service learning centers and Vidant Hospital. Among those are 110 full- and part-time faculty members, plus many instructors who volunteer their time.

­—Doug Boyd
“It seemed clear to me that the faculty did not just want to mill out a bunch of dentists for North Carolina. They wanted to have a facility where they could shape students into dental care providers who wanted to make a difference in this state.”

Like UNC-Chapel Hill, East Carolina keeps tuition relatively low for dental students. The graduates will leave owing, on average, $123, 899, according to university figures. That compares to a national average of more than $230,000, according to the American Dental Education Association. Less debt decreases the likelihood graduates will be forced to seek out more lucrative urban or specialty practices.

Private giving can also encourage students to choose rural practices. For instance, Duncan is the recipient of a full scholarship from the Samuel L. Phillips Family Foundation, awarded with the understanding he will return to western North Carolina to practice for five years.
Flashback: Aug. 23, 2011
The first day of classes

“It’s been exciting,” said Bridgette Jones of Winston-Salem, a graduate of Spelman College in Atlanta. “I’ve been looking forward to it for over a year now. We’re making history.” She said she chose ECU because the school and university had a family atmosphere.

Today, she’s headed for a general practice residency program in Asheville. “My four years at ECU have been a roller coaster, but it has been the best four years of my life,” she says. “My favorite memories would be spending time with my classmates. Whether it be stressing over a test, celebrating passing, or staying up late studying with them, they have made my time at ECU truly wonderful.” 

—Doug Boyd

It’s all part of the dental school’s formula—one that in many ways parallels the success of the Brody School of Medicine’s “grow your own” approach to training providers who will practice primary care in underserved areas.

“It’s harder and harder to get students to practice in rural areas,” N.C. Sen. Ralph Hise said at a recent community service learning center opening. “But there’s one institution in North Carolina that does it and does it well, and that’s East Carolina.”

Aligning with ECU’s mission

The university’s commitments are engrained in its School of Dental Medicine. The faculty members serve the state’s residents while training the next generation of dentists to do the same.

“Our mission is to provide public service, to be a national model for regional transformation,” says Chancellor Steve Ballard. “We have no better example of what East Carolina tries to do for regions…than these service learning clinics.”

Some students admitted are first-generation college students or have followed non-traditional paths to higher education. And they’re promised an excellent, technically advanced education, manifested in the strong performance of this first class of students on the National Board Dental Examination.

“There’s been a lot of excitement, a lot of lessons learned,” Chadwick says. “But we’re going to be graduating the next generation of dentists. This group has been pioneers as the school has developed.”

After graduation, Chadwick hopes the school can take a moment to catch its breath. Leaders need to make sure their model is developing in the most effective way. This includes ensuring patients continue to make their way to Ross Hall and the service learning centers for treatment. And Chadwick sees numerous opportunities for research related to community health and primary care.

“Nobody realized what a big job this was going to be when we started it,” Chadwick says. “But this was a project that the people of eastern North Carolina needed—that the whole state needed.” East

Doug Boyd and Amy Ellis contributed to this article.