Why Gerodontics? (aka Geriatric Dentistry)

...down at the James River pipeline walk with a visiting cousin

Finding candy and Russian Easter bread ('Paskha' or Пасха) in my mailbox after a long school day and cold ride home was very pleasant. I have such a sweet (literally) mom : )

Long-awaited signs of spring...

It has been a year since I returned from Latin America. Where did I expect to be at this point?…maybe I hadn't made too many specific goals for myself. I was glad to be starting a new phase in my life, excited to welcome all the new experiences that moving to Richmond and starting dental school entailed. I definitely agree that I can trace some of my current passions and realities to that internship, but I'm not sure that I could have predicted how each individual experience would contribute to my current aspirations.

Arriving in Lexington a bit early, I stopped by the town's (NHSC Scholar-eligible!) Community Health Center.  They recently received a grant to transition from a free clinic to a sliding-scale, self-sustaining health center and have employed a retired dentist for two years until they can recruit a full-time dentist; they will also start a school dental outreach program in August 2013. During the State Science Fair at VMI, for which I served as a student judge with the Virginia Dental Association (VDA), I met the dental director of this health center (who practices privately and reported visiting some of his home-bound elderly patients, which are a major and growing population in Lexington). My enthusiasm for the center's advancements and my eager questions were welcomed and a visit may be arranged for later in the summer. Perhaps they might be able to use my public health-leaning energies in three years : )

A frosty football field on the VMI campus on the morning of the State Science Fair....

Jeremy Jordan (D2), me (D1), Dr. Timothy Russell (director of the VDA Science Fair awards), and Brian Mahoney (D3)...part of the VDA judging panel.

In looking back at my progression after returning from Latin America more specifically, I am amazed at how my interest in geriatric dentistry (and the elderly, overall) has developed throughout the year. I can't credit just once source for this inspiration but am convinced that every brief exposure has added to the still-assembling puzzle.

Last week, on the same day that I was accepted into the Gerontology graduate program at the VCU School of Allied Health, my older sister (an RN, wife, and mom of two toddlers) received notice of her acceptance into the JMU/SU Midwifery Program. When she prepared for her interview the previous week, she reflected to me that her decision to pursue midwifery was partly inspired by her pre-teen discussion about my mother's experience with the iatrogenic (clinician-caused) death of her firstborn son (the ethical, medical, and social problems with how the situation was handled). This made me wonder if my developing passion for the elderly emerged in part from incompletely understanding or experiencing my grandfather's struggle with Alzheimer's Disease. Partly because my family lived far from our grandparents and because I was young when he died, his condition and how it affected the family became a mystery to me, especially in my teenage years. I found myself trying to uncover these questions in college, choosing to write a senior ethics capstone paper on genetic engineering and human enhancement and interviewing my aunts and grandmother about their role as his care-takers for a paper exploring Attachment Theory (changes in attachment patterns that occur during the progression of Alzheimer's Disease for the affected individual and their families). In biochemistry, I gravitated towards choosing to present an article on amyloid plaques (prevalent in Alzheimer's Disease brain tissue). In all these endeavors, I found myself seeking the benefit of experiencing such a condition (reconnecting with those that were hard to connect with, fully being a part of your genetic lineage and embracing your own heritage, and experiencing an intense form of the universal disease of aging: increased inflammation load with decreased antioxidant capacities). Perhaps I will continue these explorations as I pursue training in Gerontology or they will serve as an avenue into something else (more dental-related?!).

I seemed to pack away these undergraduate interests when I traveled to Latin America and discovered a fascination for public health. Although I had worked mostly with children in schools and adults in villages, I was deeply impacted by visiting a Catholic "asylum" for abandoned elderly and handicapped individuals in Peru (see April 2012 posts A and B). Upon returning to the States, I was disappointed not to be able to initiate or plug into a dental education outreach program in elementary schools (...it seems that more qualifications are necessary here than in Latin America to attempt to do good). Participating in all the Mission of Mercy Projects that the dental school offered, becoming Community Service Chair for my class, and even visiting University of North Carolina at Greensboro's School of Public Health open house (to investigate what pursuing the community based research-laden Doctor of Public Health degree entailed), I wondered how my DDS training fit into the big picture that seemed to be dominated by interest in public health. Resolving that a concrete skill in dental surgery would always be useful in the grand scheme of 'helping people' in any way, I tried to focus more than half-heartedly on my dental studies.

Over Thanksgiving Break, I carpooled with an EMU classmate who was in her first year pursuing MD/MPH training at Eastern Virginia Medical School. Exchanging perceptions about the first year of health professional school and the transition from undergraduate pre-health education into our programs, my classmate told of her experience as a nursing home CNA prior to being admitted into medical school. She commented on the lack of attention to oral healthcare amongst the caregivers and the struggle of offering oral hygiene to some residents. I told her about encountering The Lucy Corr Village free dental clinic in the Fall 2012 VDA Journal (a Chester, VA nursing home had recently opened up an in-facility, two-chair clinic in which residents could receive cleanings and treatments; the center also hoped to educate caregivers on the importance of daily oral care). This conversation stayed with me over the holiday weekend and was revisited on our return to Richmond. It became evident to me that children were not the only ones unable to adequately access oral healthcare services; furthermore, programs shedding light on and addressing such problems for the elderly were far more scarce than those existing for children. By the end of the semester, I had visited the Lucy Corr and was put in touch with a board member of the VHCA/Virginia Health Care Association (a state network for long-term care facilities) to investigate the possibility of combining my NHSC service commitment with addressing the need for improving oral health in institutionalized (as well as independent) elderly. I also sought out possible residency/fellowship programs for training in geriatric dentistry/gerodontics. This made my fantasy public health training and career path a little muddy : /

Beginning the semester with more visits to the Lucy Corr and meeting with the VHCA, I consulted with any experienced dentist/faculty that promised an ounce of compassion for the elderly as to the history, realistic needs, and possibilities of a career in public health-oriented geriatric dentistry. After sitting in on a VDA Public Health Education committee meeting as a student representative (where I met Dr. Timothy Russell and was invited to participate in the State Science Fair at VMI), I was able to interact with several public health dentists, VDA board members, and the dean of our dental school during a networking luncheon. I was encouraged by the dean to start a geriatric study club at the school (as our curriculum does not specifically address geriatric dental care). My interest was eagerly received by a VDA board member who anticipated that he could 'count on me to be part of the VDA's next steps in this critical field.' Also, I eagerly participated in an MCV pilot study in which a medical student and I visited a senior mentor (residing in a retirement community) for several weeks to interact with her and get an idea of what it means to age. The hope is that this is an effective way to introduce first year professional students to gerontology in an interprofessional setting. Perhaps the experience will become a part of each MCV campus school's curriculum in the future. Now that this topic is on my radar, I recognize many dental or medical-related journals/articles currently being published address the 'looming baby-boomers,' the oral-systemic health link, and interprofessional education and collaboration in practice (especially important in meeting geriatric needs). Enrolling in the Gerontology program at VCU, I hope to gain a bio-psycho-social perspective on aging so that I might better navigate the non-dental aspects of providing dental care to the elderly. I had hoped to offer an interventional study to several nursing homes in the Valley this summer (evaluate plaque, educate/motivate for oral hygiene improvement) but am finding that there is quite some resistance from various fronts (administration, residents, caregivers, a few from every group involved) to such a project. Witnessing how attempted educational workshops/training sessions at the Lucy Corr (an established clinic!) are easily avoided and ignored, my desire for this summer is to simply interact with elderly and their caregivers to better understand the how's and why's before trying to intervene. Is this the 'roots-up' approach that I was so excited to encounter during my Latin America internship?!

In my dental school application, I quoted Einstein, who said that "once we accept our limits, we go beyond them" (I encountered the quote on the syllabus of a self-guided Calculus course that I did the summer when I applied to dental school). In the personal statement, I admitted that as an immigrant child, I was faced with a dilemma when I realized that I was significantly different from my peers and might not ever completely assimilate: I had to choose between being inferior or extraordinary. Thus, my life has seemed to take the pattern of defining, meeting, and often exceeding my limits (exemplified by my perseverant entrance into the second-grade advanced reading group, becoming a conflict manager in 5th grade, and entering my first college course at age 15). Thinking that I'd almost 'arrived' when beginning dental school (on my way to a settled career in dentistry), I must have found it natural and subconsciously necessary to seek out the next limit. Gerodontics may provide exactly that! Working with the elderly provides a challenge (interprofessional collaboration and treatment of a bio-psycho-socially complex individual), an avenue for enacting justice and providing a needed service (something that has also become an organic and essential part of my life), as well as a place where I can offer compassion, honor, and an earnestly caring and most-humanely humble connection with another human being. I've made quite a few elderly friends and find interacting with them more satisfying than with some of my younger friends; perhaps this is like enjoying the taste a ripened fruit rather than a tart one. When so many take for granted what our geriatric population has to offer, I don't want to miss out on all the fun!

...So that's where I've wandered so far : ) Perhaps this is why there aren't too many 20-year old dental students--Most folks are smart enough to figure things out before they begin a graduate degree. However, I am convinced that one opportunity opens up into the next (life as a journey where we lay down stepping stones and connect dots, "Day to day pours out speech, and night to night reveals knowledge"--last post from February 2012). I look forward to reflecting in the future on where this new stepping stone will project me from here.

Alya, me, and Tayyaba represented the D1 class in the Molar Roller Bike Ride that occurred during the dental school's reunion weekend 

...Riding alongside the James River with some dental classmates and colleagues

An EMU senior photography major's project showed '100 Pictures, 100 Stories' of women of all ages, each commenting on what they enjoy most about being their age. I was most interested in the above half of the exhibit : )

EMU: "A Christian university like no other" The morning rain forced us inside the gym for the ceremony (a graduating class of just over 400 makes that possible...) but things calmed down in the afternoon so that graduates, families, and friends could mingle on the parking lots and lawns.

Another exciting recent occurrence is the publication of an article to which I contributed as a dental 'professional' (student). Titled Health disparities among highly vulnerable populations in the United States: a call ot action for medical and oral health care. I have been very fortunate to become involved with the Inter Health Professions Alliance on the MCV campus and will likely serve as the student group's president during the coming school year. Along with continuing the monthly Kroger Outreach blood pressure screenings, offering Educate Then Advocate instructional sessions for all health professions students, and reaching out to pre-health undergraduate students, the group hopes to implement an oral health focus in light of the oral-systemic health link that has recently been emphasized. This summer, in partnership with the IHPA's overseeing office, I've agreed to lead a 5-week Introduction to Organic Chemistry workshop for pre-health undergraduate students that are involved in MCV's acceleration program. Needless to continue, this is an exciting group in which to be involved.

You might be able to see the little worm on the lower right hanging from a thread of som sort (perhaps if you click to enlarge the photo). These guys have been hanging around during the past few weeks from nearly every tree. They've kept me alert while cycling and I've learned to dodge them from afar. I nearly swallowed one when smiling a couple of days ago...I am reminded of my friend mocking me for subconsciously smiling during our track meet races in middle school 

It's been fun to avoid studying for tomorrow's physiology final by taking notes en route, but I come to a close, lest I neglect to value in practice (ie, tomorrow's exam) the current opportunities that I have been provided with.