50 Years of Excellence in Patient Care
Dedication to Patients a Constant Amidst Change
By Salwa Choucair
From the outside looking in, patient care at UT Health San Antonio School of Dentistry is drastically different than it was 50 years ago when the school was founded. Today, patients are seen in a state-of-the-art building offering beautiful views from its walls of windows, spacious waiting areas, open operatories and the latest in technology—the best in comfort and care.
That’s a far cry from the school’s humble beginnings in a small unfinished space under the medical school auditorium in 1970. The growing school moved into its own building in July 1975. The original dental school building offered few windows and cramped clinic space with chairs in hallways for patient waiting areas.
Visionary leadership, however, strategically planned and continually advocated to advance academic programs both in general dentistry and post-graduate specialties, in research and patient care, placing itself on the forefront of dentistry.
Because of that vision, the Center for Oral Health Care and Research (COHCR) opened in July 2015 featuring 198,000-square-feet of clinical space, and while buildings and facilities have changed, what hasn’t changed in 50 years is the emphasis placed on patient care when it comes to educating and training excellent dentists.
“As a dental school, patient care is important because in order to train students we need to do patient care. What’s remained consistent is developing the rapport and relationship with your patient so that they believe in the care you are going to provide,” says Peter M. Loomer, B.Sc., D.D.S., Ph.D., MRCD(C), FACD, dean of the school. “That’s a constant that everyone needs to learn—how to respect their patient.”
That’s not to say that patient care hasn’t evolved, it has, even when it comes to its role in educating the next group of dental practitioners.
“In dental school at the end of four years, our graduates must be ready to independently treat patients,” says William W. Dodge, D.D.S., former dean of the school from 2013 to 2018. In order to provide them with the best opportunity to learn, dental students have to treat patients and gain hands-on skills with close supervision.
“In the 1990s, we realized that the best learning takes place where the best patient care occurs, and we began to do everything we could to make the clinical experience good for the patient,” says Dr. Dodge, who joined the faculty in 1978. This change laid the foundation for the expansion of clinics and the creation of the COHCR.
Over the last 50 years, the dental school has maintained its focus as a comprehensive dental school, taking great pride in graduating well-trained general dentists. Today, patients are also referred to the specialty clinics within the COHCR including dental emergency care, endodontics, geriatrics, oral and maxillofacial surgery, orthodontics, pediatrics, periodontics, prosthodontics and more.
In addition, today’s clinics are a source of much-needed revenue for the school which has continued to see its funding from the state decrease. In order to be able to continue offering an affordable education to students, revenue must be generated by the practice.
However, everyone is welcome regardless of income or insurance. “We have different types of providers today,” Dr. Loomer says. “We have dental students and dental hygiene students, supervised by our expert faculty, who provide care at a low-cost or subsidized cost which provides a safety net for the community since in Texas there is no government-sponsored coverage for adults for dental treatment. It is important that we provide that for the community.”
Patients also can choose to be treated by dental specialty residents at a less discounted cost, or by expert faculty members at comparable costs of a private practice.
While the importance of patient care hasn’t changed in 50 years, everyone agrees that certain areas which enhance patient care have changed and continue to change. This includes technology, the patient experience and the diversity of the clinicians.
Technology In the past 50 years, the entire world has become more dependent on technology, and dentistry is no different. Technology touches every aspect of dental education and patient care—from how students receive their lessons, interact with patients, treat patients, and maintain their training and knowledge.
“Of course, technologies are tools,” says Gary F. Guest, D.D.S., associate dean for patient care and a 1980 graduate of the school. “Dentistry will still be dentistry, but technology lets us do it more efficiently, safer and with better outcomes. The sophistication today is 100-fold what it was back in the 1970s.”
A few upgrades in applied technology that benefit patient care included both point-of-care computing with the student laptop program, chairside computers, electronic dental record systems and changes to imaging. New cone-beam computed tomography (CT) scans provide less exposure to radiation compared to the older traditional dental radiographs; 3D imaging emerging in the last 20 years provides a better view of an area; and the introduction of computer-aided design/computer-aided manufacturing (CAD/CAM) technology has revolutionized dentistry.
CAD/CAM allows dentists to design restorations—including ceramic crowns, veneers, onlays, inlays and bridges—on a computer screen. The CAD/CAM computer displays a 3D custom image of the prepared tooth. Once the design is created to the dentist’s satisfaction, the crown, inlay, onlay, veneer or bridge is milled right there.
Benefits of this technology to the patient is time saved going back and forth while waiting for the process to be completed, the use of stronger materials which are less likely to fracture, and better fit.
Edward Ellis, D.D.S, M.S., chair of oral and maxillofacial surgery, explains how the imaging combined with computer planning has changed everything in his specialty.
“Even the way we plan our surgeries today is virtual,” Dr. Ellis says. “We plan it on our computer screen and take that plan to the hospital to do our surgery. The benefits include precision and accuracy. I can go to surgery and place a jaw within a millimeter of where my plan was. I can also take that same plan and if five other surgeons perform that surgery, we will all get the same result.”
Multi-disciplinary care
Another big advancement in technology has nothing to do with dental equipment at all. It has to do with patient records and the ease of accessing them electronically by dental health care providers. With the advancement of moving patient records from paper files to electronic patient records, now the patient’s record is at the dentist’s fingertips.
This provides greater opportunities for multi-disciplinary care.
As a 1983 graduate of the dental school, Brian Mealey, D.D.S, joined the faculty of the school after serving 21 years in the United States Air Force. Currently, he is the graduate program director in the Department of Periodontics. In his role, he has seen an increase in patient involvement as well as collaboration among colleagues, all due to advances in technology at the COHCR.
“I don’t have to run down the hall and try to see if I can find another dentist to come look at some x-ray in my office. I can now call a colleague on the phone and say, ‘Hey, can you do me a favor and pull up this patient’s record from the server?’ We have this type of interoperability in dentistry today. What does that do for the patient? Everything. For example, I work very closely with prosthodontists who make the prosthesis. Now the patient care is 1,000 times better, because we as colleagues do not have to guess what the other one is doing. We can plan it together.”
Dr. Loomer believes that shared electronic patient records with other areas of UT Health including medicine will be available within the next few years. Once that is integrated, patient care will be much more seamless between the different health care professions.
Instrumentation and safety
While today dentistry takes pride in safety protocols such as sterilization of equipment and personal protective equipment (PPE) for staff, that wasn’t always the norm. In fact, a dentist’s office looks and sounds quite different today compared to 1970. Dr. Dodge recalls learning to use belt-driven hand pieces and dental drills which were quite loud. He also remembers how physically demanding the day could be for dentists who stood all day performing examinations instead of sitting down.
The patient’s chair was not contoured like today, and the round spittoon sink which sat next to the chair was awkward, to say the least.
More importantly, however, is how the management of the instruments and the safety measures for both dentists and patients have changed. In fact, during the 1970s, dental instruments were not sanitized like they are today, and dentists did not wear gloves, gowns or face coverings. That all changed, however, in the 1980s with the discovery of AIDS and a growing concern over exposure to infectious diseases.
Dental staff have been wearing PPE for more than 30 years now. When the COVID-19 pandemic struck the U.S., the profession knew the importance of protecting themselves and their patients.
“For the past 30 years, dentistry has been gowning, masking and covering up using PPE in order to prevent cross contamination for the patients and for the clinical staff,” says Dr. Dodge, who finished dental school in 1971. “When I first started, however, if you were to do any surgical procedures, you didn’t wear gloves. Your hands got bloody, and we didn’t think about it.”
Dr. Loomer points to COVID-19 as a significant change in safety protocols for dentists and other health care professionals.
“We really had to rethink how we deliver dentistry safely,” Dr. Loomer says. “How to reinvent our clinics to still provide the training, create distancing and safety, educate our students while providing care, and keep our faculty, staff, students and patients safe. I think we have done a fantastic job in doing it.”
Diversity
In the past 50 years, one of the most significant changes in dentistry is its demographics. More women and minorities have entered the profession.
Dr. Mealey recalls only 15 or so women in his class of about 152 in 1979, and today, 50 percent of the school’s classes are made up of women.
“I feel like female dentists offer a different perspective,” Dr. Mealey says. “I think that has been a great benefit to patients. It has also allowed us to use different models of care. Now that we have a higher number of women in the field, we recognize that not every dentist has to work 50 hours a week. This has improved dentistry.”
Dr. Dodge agrees recalling that no females were in his 1971 graduating class, and when he began working at UT Health in 1978, very few women and minorities were enrolled. Fast forward to today, each year’s dental class is representative of the demographic profile of the state.
“We have to make sure that we can get care everywhere that it needs to be, and I think that is one of the real advantages of having a diverse demographic swath in our student population,” Dr. Dodge says.
The Future
The future of patient care at UT Dentistry will continue to follow its roots, developing relationships between patients and the next generation of dental health professionals. Using new and ever-changing technology to teach prevention and the necessary hands-on skills needed to become competent dentists.
Thanks to a generous donation from the David Mosimann Foundation, Bien Air Dental USA has installed control panels and electric power sources in the school’s clinics and simulation labs. The Class of 2024 will be the first group of students to learn on electric as well as air-driven equipment during all four years.
“We will continue to train the next generation of dentists and dental hygienists to convey the message of prevention to their patients,” Dr. Loomer says. “It is really about getting them to invest in their patients in order to change their patients’ attitudes and behaviors to prevent future disease. We still have work to be done, there is still a tremendous amount of dental disease in our local community, and globally, oral diseases are amongst the most common of all diseases.”
With the addition of the planned UT Health San Antonio multi-discipline hospital, collaboration will continue to expand, ultimately benefitting patient care as well.
“Our alignment with UT Health Physicians, which has its largest medical practice facility next door to us on Floyd Curl, will soon be enhanced by the addition of the new UT Health hospital that they will be building on the other side of our building. This “clinical campus” will help facilitate inter-professional care with patients being able to see their doctors and their dentists all in the same area.”
Additionally, the dental school plans to open a new clinic in the COHCR for Special Care Dentistry patients which includes patients with physical and cognitive disabilities or complex medical needs. This will be an inter-professional clinic where patients will have dental treatment but will also receive treatment from health care professionals across the campus.
The school is in the planning stages of expanding its dental hygiene program into South Texas as well as community outreach in the San Antonio area.
“The future is really bright,” says Dr. Loomer. “There are so many opportunities to expand our educational programs and our clinical enterprise. There is tremendous need, especially in South Texas, and the opportunities are unlimited to improve the oral and general health of our community. As university President William L. Henrich (M.D.) says, the community in San Antonio and South Texas is what the rest of the United States will look like 20 years from now. We are at the forefront of advanced health care for the U.S., because we are a microcosm of the U.S.”
On this, its 50th birthday, the dental school is ready to help lead this life-changing and life-improving effort.
