Author Archives: Angelique Bannag

Profiles in Courage

Nader A. Nadershahi, Dean

After finalizing this issue, we received the sad news about the passing of Dr. Arthur A. Dugoni ’48 on September 23, at the age of 95. Please see the inside front cover for the link to a special In Memoriam website. We held a virtual celebration of life on Saturday, December 12 for all members of the Dugoni School family and dental profession. Our spring issue of Contact Point will be dedicated to the life, legacy and impact of Dr. Dugoni—a teacher, friend, mentor and inspiration to us all.

As I reflect on recent months of what the Dugoni School and our society have gone through—and all that is ahead of us—one of the values that comes to mind is courage. 

Courage, woven into the fabric that supports our humanistic education, is one of our core values. Courage involves taking risks—doing what is right, not just what is easy. It took courage to step out of our comfort zones to deliver our dental curriculum in new ways and to learn the new infection control protocols in the clinics as a result of the COVID-19 pandemic. It took courage to find new ways to communicate, shop for groceries and other essentials, exercise and perform other daily activities behind our face coverings using our sanitizer-scented hands. It took—and continues to take—courage to handle the daily news and stay strong physically and mentally while facing this pandemic.

As the Dugoni School navigated through the uncertainties of the past several months, many of our other qualities also shone through. In this issue, you will read how the Dugoni School family rallied to make sure our graduates became licensed by hosting our first simulation-based WREB exam. You will see examples of our crisis management in action and learn more about how so many individuals showed their leadership in such challenging times.

The story of the pandemic is far from over. However, we will build a better future and emerge even stronger than before. We are embracing innovation in teaching, patient care and our use of technology. We are pursuing research opportunities to understand the pandemic’s impact on oral health. We are reshaping the curriculum to prepare graduates to lead in the evolution of oral health care.

The Dugoni School of Dentistry family is strong, resilient and courageous. Our commitment to excellence and a world-class dental education remains at the forefront. A pandemic tried to get in our way, but our family rose to the challenge by harnessing their courage. I have never been prouder of being a part of this great organization.

“Fear is a reaction. Courage is a decision.”

—Nader A. Nadershahi ’94, MBA, EdD

Opportunity in Crisis

By Kirsten Mickelwait

In mid-March 2020, when the country began responding to the COVID-19 pandemic with shelter-in-place directives, dental facilities were among those most seriously hit. The Centers for Disease Control (CDC) warned that “dental settings have unique characteristics that warrant specific infection control considerations.” The American Dental Association (ADA) advised dental practices to close their offices to all but emergency care, and many closed entirely. For an institution like the Arthur A. Dugoni School of Dentistry, with nearly 550 students and residents, hundreds of faculty and staff members and thousands of patients, the implications were clearly deep and far-reaching. How could dentistry be taught effectively in the time of COVID-19? And how could the Dugoni School of Dentistry approach this crisis in alignment with its defining characteristic of humanism? 

Compassionate Leadership

“This challenging time has sharpened our focus on the needs of our students and residents, and our sensitivity to the challenges many families have been facing during the pandemic,” says Dean Nader A. Nadershahi ’94. “We’ve deepened our respect for each other and our unique needs as students, faculty, staff, patients, alumni and friends. Flexibility, open communication and transparency have been more important than ever.”

Nadershahi has also led the school to become an invaluable resource during the nationwide quarantine, demonstrating best practices in policies and procedures on how to reopen that other schools have followed. He currently chairs the Council of Deans for the American Dental Education Association and meets bi-weekly via video conference with all dental school and military deans throughout North America. He is part of the COVID-19 Public-Private Partner Dental Coordinate Group, organized by the assistant surgeon general and chief dental officer of the U.S. Public Health Service, and has worked closely with the task force on accreditation that was formed to address the needs of students and dental education programs related to COVID-19 as well as with the California Dental Association, Dental Board of California and other testing agencies. Because of the Dugoni School of Dentistry’s accelerated academic calendar, it was among the very first dental schools to resume clinical operations after sheltering in place.

“Our focus has been to maintain our culture and sense of family even during times of physical distancing, remote work and virtual teaching,” Nadershahi says. “We’ve tried to provide a sense of stability and hope, and reminders about the importance of wellness.”

Within the school, Nadershahi has “walked the walk” of open communication. He has sent daily email messages to the entire dental school community with campus resumption plans, clinical and academic updates and words of encouragement and inspiration. He’s made calls to check in with stakeholders from managers to future students, connected with alumni through the Alumni Association’s Newsflash e-newsletter and has held regular Zoom meetings with student leaders, faculty, staff, alumni and other groups. 

“Our focus has been to maintain our culture and sense of family even during times of physical distancing, remote work and virtual teaching,” Nadershahi says. “We’ve tried to provide a sense of stability and hope, and reminders about the importance of wellness.”

The success of Nadershahi’s efforts was reflected in a recent email from Dr. Mia Tittle ’18, an alumna who is currently in the Endodontic Residency program. “I’ve been amazed by the innovation, collaboration and devotion to clinical excellence shown by faculty and staff during these unprecedented times,” she writes. “Thanks to your incessant hard work, the Dugoni School has once again led the way for other institutions and dental schools across the nation. I want to thank you for continuing the legacy of humanism and integrating the importance of mental health awareness into the core of our culture at Pacific with the Peer Support program.” 

A faculty member recognized Dean Nadershahi’s actions by simply stating, “That is what leadership looks like.” 

From Didactic to Remote Learning Overnight

Suddenly, schools around the world, from elementary through graduate level, discovered the term “distance learning.” “When the city’s first shelter-in-place directives were issued, we marshalled forces to transition our didactic courses to remote formats,” says Dr. Cindy Lyon ’86, associate dean for oral health education. “We had just enough time before the building closure for our instructional designer, Dr. Sinky Zheng, to orient our students and course directors to learning platforms and technology that could be used in the face of a quarantine.”

San Francisco’s stay-at-home orders were issued during finals week, requiring the postponement of exams to the following week. The dental school’s administrative and information technology teams reviewed, selected, purchased and installed software to expand the school’s electronic testing platform to include student identification verification and electronic proctoring. Staff, faculty and students were trained for the testing launch, and students were able to download enhanced security features and complete a mock examination before final exams were taken.

Because early city and state directives originally indicated just a three-week interruption, the didactic curriculum was front-loaded and transitioned online so that, upon returning to campus, maximum time could be dedicated to direct patient care and hands-on technique simulation. As the severity and length of the pandemic grew, class schedules were redesigned several more times before settling on a plan that allowed students to complete the final weeks of spring quarter in late June and early July.

Beginning in June, San Francisco city directives allowed some faculty and staff to come back onto campus to provide patient care and support simulation training. But didactic courses remained online, conducted both synchronously and asynchronously, and many included virtual breakout rooms for small-group discussions or case presentations, as well as chat space for faculty/student interaction. Faculty members have been able to provide virtual office hours as well. A university-wide survey noted that, more than any other students at University of the Pacific, Dugoni School of Dentistry students appreciate online learning options. 

“With the invaluable support of Dr. Zheng, many of our faculty were already providing high-quality online content before the pandemic,” Lyon explains. “Course directors were able to adopt a standardized online syllabus for easier student navigation and implement a number of new learning strategies. And, in addition to real-time training, Dr. Zheng curates an online web page with learning tools and tutorials that many in the extended dental education community can access and utilize.”

The dental school’s Division of Continuing Dental Education (CDE) pivoted quickly to shift its in-person lectures and symposia to live, interactive virtual programs. Despite the cancellation or postponement of hands-on workshops, the Registered Dental Assistant in Extended Functions spring cohort was able to complete its 410-hour program, with the assurance that participants would be welcome to return to prepare in advance for state licensure exams. And the CDE team made some online webinars available at no cost to second- and third-year students in June.

Rethinking Emergency Care

Of course, dental emergencies don’t recognize pandemics or quarantines. Following stringent guidelines from the ADA and San Francisco Department of Public Health (SFDPH), the Dugoni School of Dentistry’s clinical team immediately adapted its protocols to conduct emergency care for existing patients in a new way. “Our wonderful ER team—led by Dr. Debra Woo ’86 working with our former chair of endodontics, Dr. Ove Peters—developed a triage process, including the introduction of telehealth methods to access cases and a new appointment system,” explains Dr. Des Gallagher, associate dean for clinical services and chair of the Department of Clinical Oral Health Care. “Initially, faculty triaged each case to determine the level of care required and whether the patient should be treated with medication or verbal directives. As we mitigated risk, patients who required in-person appointments were prescreened for symptoms. To ensure efficient and prompt care, our emergency team developed a second-level triage to provide access to specialty care from oral surgery, pediatric dentistry and endodontic specialists.”

From mid-March to the end of June, the Emergency Clinic treated approximately 150 patients per month, relieving pressure on local emergency rooms and allowing hospitals to focus on COVID-19 patients. Following SFDPH directives, on June 8 the clinics began resuming care in phases and clinical staff closely monitored the situation as it safely continued to grow its clinical patient load; by early August, it was back to about 45% capacity. 

Of course, personal protective equipment (PPE)—both the supply and the required level of protection—and clinical hygiene became more critical than ever. As an internationally known expert in infection control, Eve Cuny—director of environmental health and safety, associate professor of diagnostic sciences and assistant dean of global initiatives—has been in regular contact with the CDC and other public health officials.

“In the midst of every crisis there lies great opportunity,” goes the saying. And that belief has been manifested across the entire Dugoni School of Dentistry community since the COVID-19 crisis began. 

One major change, Cuny says, has been the use of N95 respirators instead of regular surgical masks when providing patient care, a move that required staff to undergo medical clearance, qualitative fit testing and training on how to wear and use a respirator. All patients undergoing procedures considered high risk for generating aerosols are asked to have a COVID-19 test immediately before their appointments. Upon arrival, patients are screened again for symptoms. And the dental school’s information technology team developed an app that generates a QR code, scanned upon entry, that evaluates those symptoms.

“We’ve examined air flow in various areas of our clinics to determine the safest way to position patients,” Cuny says. “Aerosol-generating procedures are only done in designated spaces, and we’ve supplemented our already excellent ventilation with HEPA-filter ventilation.” Patients are treated as quickly as possible to minimize their time in the clinic, and the disinfecting of all clinical surfaces has been intensified. 

A New Approach to Board Exams

Meanwhile, the Class of 2020 was anticipating the Western Regional Examining Board (WREB) exam. “It soon became apparent that it wouldn’t be possible to conduct a live, patient-based examination this year,” Gallagher says. To solve this problem, Dean Nadershahi worked with the Dental Board of California to explore other options and to lobby for a non-patient exam. While many other schools had to delay the WREB exam, the Dugoni School of Dentistry was able to host a simulated examination during the first weekend in June. The school’s building operations team reconfigured its third-floor clinic chairs for simulated patient care, providing expanded simulation capacity on two floors so that all students could complete the exam on campus in one weekend. 

But the weekend before the exam was to be held, there were protests, rallies and civil unrest in San Francisco in the wake of George Floyd’s death. A local curfew was imposed, making it even more difficult for students to attend practice sessions. Despite the mounting obstacles, “Our DDS and IDS graduating students were able to return to the building just days before the WREB exam to refresh their skills and prepare for this professional milestone,” says Lyon. “Our extensive building preparations, safety precautions, faculty dedication, staff support and student resilience were on full display during this challenging time.”

Once the WREB results were in, Dugoni School of Dentistry students celebrated a 97% pass rate. A few weeks later, dental hygiene students achieved a 100% pass rate. And current seniors in the Class of 2021 were able to take the prosthodontic portion of the ADEX exam and earned a 100% pass rate.

You Changed the Ending

“In the midst of every crisis there lies great opportunity,” goes the saying. And that belief has been manifested across the entire Dugoni School of Dentistry community since the COVID-19 crisis began. 

Dr. Alysia Mascolo ’20 served as president of the graduating class and spoke at a recent Dugoni School Foundation Board Zoom meeting. “Our class went from planning our spring break trips and planning for the WREBs to the terrifying thoughts of sick families, unfinished patient cases and no idea if we would be graduating in June,” Mascolo said. “Within three weeks I was preparing our peers for an entirely new idea of school and dentistry. Every morning we would wake up with 50+ notifications waiting to be addressed.”

Kirsten Mickelwait is a San Francisco-based copywriter, content provider and professional storyteller.

Dr. Bernadette Alvear Fa | Coming Full Circle

By Ashley Musick

The year Dr. Bernadette Alvear Fa ’06 was born, her father received his license to practice dentistry in California, solidifying a multi-generational lineage of dentists who provided the foundation for Fa to discover her passion for dentistry.

Though she never anticipated following in his footsteps, Fa visited her father’s dental office throughout her childhood, often crawling into the chair to play (or some might say, practice) with the instruments after a patient left. Fa’s childhood interest in her father’s work unconsciously inspired her to apply to University of the Pacific’s pre-dental undergraduate program on the Stockton campus—the beginning of what now marks more than 13 years of teaching dentistry. 

Like her parents and grandparents before her, Fa and her husband, Dr. Jesse Fa ’06, met during dental school. What began as an introduction of two first-year students in the elevator of the Student Housing building evolved into trips to the bookstore for Sour Patch Kids candy, and eventually led them to move to Chicago after graduating from the Arthur A. Dugoni School of Dentistry in 2006. It was while teaching part-time at the University of Illinois at Chicago College of Dentistry that Fa realized teaching was the intersection of her passion for dentistry and her desire to help others. 

One of Fa’s first instructors at the Dugoni School of Dentistry was Dr. Jim Dower, associate professor, director of the local anesthesia curriculum and faculty advisor of the Christian Medical & Dental Association (CMDA) chapter. A steward of stimulating excitement for dentistry in his students, Dower was incredibly influential in Fa’s first experiences in dental school—so influential, in fact, that years later, Fa asked him to be the officiant for her wedding. 

It was Fa’s own incredible mentors and faculty—Dower among them—who inspired her to return to the Dugoni School of Dentistry to teach. In a serendipitous twist of fate, Bernadette and Jesse moved back to the Bay Area in 2010, the same year that Dower announced his retirement. His encouragement and mentorship led Fa to humbly follow in Dower’s footsteps, taking over both his position as the director of local anesthesia and stepping in as the faculty advisor for the dental school chapter of CMDA.

From volunteering for outreach mission trips to the Philippines alongside dental school students and fellow faculty members to performing a Polynesian dance at an employee spotlight event, Fa’s enthusiasm has enabled her to develop close relationships with students and colleagues alike. When asked about her involvement in such a wide variety of activities, she explains, “People simply ask me to take part in things, and if it’s something that will bring joy to myself or others, I say ‘yes.’” 

Fa’s dedication and commitment to her students extends beyond the traditional classroom setting, something that inspires her colleague and close friend, Dr. Debra Woo ’86. “Bernadette has such a kind heart. She’s very generous in professional matters, and gives a lot of herself on a personal level. She’s wonderful at taking charge and being a leader.” 

Inspired by weekly, physical fitness boot camps, organized by her supervisor at the time, Fa worked to get her personal training certification so that she could keep the evening boot camps running at the dental school. Fa earned her personal training certificate in 2012, followed by a specialty in women’s fitness in 2014. She also has a background in cheerleading and teaching luau dances. 

She says at first people stopped attending her evening boot camp classes because they were ” too intense,” despite Fa teaching while pregnant at the time. But she continued to encourage physical activity. As the content coordinator for a self-care and wellness course at the Dugoni School of Dentistry, Fa began incorporating stretch sessions into her interactions with students, and found that students reacted positively and it helped them feel more energetic. 

Fa is passionate about teaching people to be more mindful about taking mental and physical wellness breaks and reminding students that self-care is an essential aspect of the dental profession, as well as their lives overall. She even encourages stretch breaks while teaching her courses remotely. 

In 2014, the Dugoni School of Dentistry appointed Fa as chair of the Health and Wellness Committee, enabling her to implement wellness programs, fitness classes, guest speakers and an e-newsletter that benefit not only students, but also faculty and staff. The goal of the committee to promote healthy habits, physical fitness and balanced behaviors. 

Fa attributes her energy and passion for self-care as the reason she is often asked to be a mentor for students’ Personalized Instructional Program (PIP) projects. She loves the variety of the projects and subject matter, noting that some students create brand-new videos, while others develop pamphlets on topics such as dental anesthesiology or yoga. Recently, Fa was asked to be a mentor for a project about Medicine in Motion, a non-profit organization composed of a diverse group of healthcare providers whose mission is to address medical burnout through fitness, interdisciplinary community building and philanthropy. 

“Bernadette is such a developed, well-rounded person, which is something I really appreciate about her,” says Woo. 

To Fa, dental school feels like family, and families take care of each other. Fa’s lifelong passion for self-care and helping others has culminated in 13 incredible years (so far) of teaching dentistry—and helping those around her be their healthiest selves. 

Ashley Musick is a freelance writer from Anaheim, California. 

Hitting a Major Milestone

By Dan Soine and Dr. David W. Chambers

The COVID-19 pandemic has caused dental schools across America to reimagine many aspects of their programs, including clinical operations, infection control, educational technology—and one of the first major milestones for dentists: initial licensure exams. 

Due to the shelter-in-place orders in the San Francisco Bay Area, the Arthur A. Dugoni School of Dentistry needed to take a new approach for its spring quarter and to determine how it would prepare graduating students for these crucial exams. Routine dental care was not allowed during shelter-in-place, which meant that no patients could be scheduled and graduating students would not be able to treat their patients for the performance part of initial licensure examinations. 

Dugoni School leadership worked closely with the Western Regional Examining Board (WREB) and the Dental Board of California to come up with options for the licensure exams. WREB is one of the five examination agencies for dentists and dental hygienists in the United States.

Dental degrees are granted by schools, based on a student’s competency of being able to perform the skills expected of beginning practitioners, understand the scientific foundation for oral health care and exhibit appropriate professional values. All U.S. dental schools are accredited by the Commission on Dental Accreditation and must provide evidence that their curricula prepare students to meet competency for beginning practice and that schools have evaluation systems in place to ensure this.

Licensure is a commercial qualification regulated by individual states to provide standards of protection to consumers who cannot evaluate the quality of the work being performed. Financial advisors, building contractors, real estate agents and others are licensed. A branch of the state government, such as the Department of Consumer Affairs in California, sets regulations consistent with state laws, manages enrollment of licensees and monitors and disciplines them as appropriate. Members of licensing boards all serve as public members regardless of their professional qualifications.

The Arthur A. Dugoni School of Dentistry and other California dental schools used a simulation-based exam for the first time this spring. The manikin-based exam had the additional advantage of occurring during one weekend—June 6 to 8—at the Dugoni School of Dentistry campus in San Francisco. Typically, the patient-based exam is scheduled over two weekends with half the graduating class taking the exam one weekend and the other half taking it the subsequent weekend.

The Dugoni School of Dentistry’s building operations and clinical operations teams worked diligently to prepare the dental clinics for this new approach. The school turned 72 of its dental clinic operatories on its third floor into simulation stations by removing the headrests and installing dental manikins to serve as patient simulators. This engineered solution allowed students and test takers to authentically simulate the patient care experience using exactly the same instrumentation and ergonomics used for direct patient care. Along with a host of safety measures for screening, 

advocacy supported licensure for the graduating students. Equally important, this advocacy allowed for these dentists to enter practice and begin addressing the pent-up need for oral health care in our communities after a prolonged sheltering in place. The Dental Board of California and California Department of Consumer Affairs ultimately approved the non-patient-based exam and allowed it to move forward. 

At one time in history, each state constructed and administered its own licensure test. But recent years have seen major shifts in this model. Currently, there are five regional testing agencies and a test is being developed under the 

leadership of the American Dental Association (ADA). There is no national standard. Only one state, Louisiana, administers its own performance examination. All states have unique standards for licensure that recognize results of some testing agencies but not others. For example, Delaware does not recognize the results of any examining agency and requires three years of practice in another state or completion of a general practice residency or specialty program. The rules change constantly, and other states that recognized the traditional WREB examination process may not recognize the manikin model completed by Dugoni School of Dentistry students.

States have delegated performance testing to various examining agencies. These regional agencies are commercial organizations that charge candidates for examinations and use volunteer practicing dentists as graders. Most states require an additional written test covering the state’s practice act. State licensing boards also require that candidates have passed the nationally standardized and validated National Board examinations that cover competency in the foundational knowledge of oral health care. They also require graduation from a U.S. accredited dental school and a verified criminal background check. States have various systems of granting licensure by reciprocity, based on successful practice in other states for certain periods of time. Of the many requirements for licensure to practice dentistry, state boards do not actually test or gather first-hand data on the qualifications of dentists, other than perhaps knowledge of the practice act. All of this is delegated to various entities, particularly the dental schools and commercial testing agencies.

Feedback about the simulated exam from students and examiners alike has been positive. The school’s clinical leadership had a debriefing with the WREB chief examiner who was very complimentary about how well prepared the students were for this new exam format. 

“It was definitely nerve-wracking being one of the first classes to take the manikin-based exam, but the school did a great job of preparing us the week beforehand,” said Dr. Leah Life ’20. “I’m grateful we had the opportunity to take it so soon after the Dental Board of California approved the manikin-based exam. I think it was a great test of our abilities and our class did well.” 

A performance-based examination as a requirement for licensure in the health professions began in the early 1900s. It has been discontinued by all professions except dentistry. When dental schools were for-profit operations with very little clinical experience, independent testing of the graduate made eminent sense. William Gies, in his landmark 1926 study of education, thought the practice had served its usefulness and was creating an unnecessary tangle of political and regulatory requirements. The period between 1940 and 1960 saw the publication of papers and reports by groups representing both education and boards working together on standards for education and practice. Former Dean Dale Redig campaigned effectively for making the tests anonymous. Dean Emeritus Arthur A. Dugoni had long advocated for change, including licensure upon graduation. Dr. David W. Chambers was an early advocate for portfolio licensure where candidates submit documentation showing successful completion of representative procedures performed to board standards while in dental school.

Dr. Letitia Edwards ’20 commented, “Being the first class in the nation to take an entirely manikin-based licensure examination felt like history in the making. Organized dentistry has been advocating for years to remove the patient-based components of the licensing exams in lieu of a manikin portion, and we’ve finally done it! I hope that this will continue for years to come. I can’t thank the Dugoni School family, WREB examiners and staff members enough for helping us in our journey to become licensed dentists. Everyone truly came together to ensure that the exam ran smoothly, without any hiccups, and that we could perform our best even under these turbulent circumstances.”

The issues, of course, are validity and portability. Validity is a technical term for the degree to which scores on an examination provide robust predictions regarding future performance. In the case of licensure, the validity question is whether those with scores above a certain cut score on a licensure exam serve the public’s oral healthcare needs while those below the cut score are a danger to the public. There are no published data in the peer-reviewed literature that supports this claim for past examinations’ procedures or for any of the alternatives being considered as replacements.

Portability is the matter of whether qualifications for licensure in one state will be recognized in others. Historically, this has presented some challenges to increasingly mobile professionals. The regulations are not consistent across the country and change frequently. Some state boards have already discussed whether they will recognize licensure based on the ADA’s new protocols or on manikin tests.

Each year in California, approximately 80 dentists have their licenses disciplined by the state board. That is roughly equivalent in number to half of each year’s Dugoni School of Dentistry graduating class, although Pacific graduates are almost entirely absent from this group and half of dentists practicing in California did not attend dental school in the state. These records are available online. The leading causes are incomplete records, overtreatment, overbilling, insurance fraud and a range of personal challenges, such as improperly dispensing or using drugs, DUIs, sex with patients and even crimes such as assault and impersonating a state board investigator. Only one case has been found in recent years of a dentist losing his license for a technical procedure tested on licensure exams. The average age of a dentist with a disciplined dental license is 57, the same age for physicians.

The schools, the ADA and student groups such as the American Student Dental Association and the Student Professionalism and Ethics Society have long called for an end to performance-based testing for licensure. The arguments have centered on lack of validity evidence, ethical abuses of patients engendered by the process and the substantial financial burden on graduates who are required to take the test a second time. Repeat testing, which results in a virtual 100% pass rate for candidates, can lead to lost associateship opportunities, missed participation in the military and other loan forgiveness programs and direct costs.

The response over the past half century has been a gradual constricting of the domain of performance testing. Gold foil is gone; periodontal treatment is scaled back; denture work and 

crown fabrication are going to the lab. Currently the ADA is leading a consortium in developing and validating a single test to be accepted, it is hoped, by all states in order to ensure professional movement. Known as the Dental Licensure Objective Structured Clinical Examination (DLOSCE), the platform is based on station challenges with radiographs, three-dimensional models and patient descriptions that candidates rotate through and mark with multiple choice answers like the National Boards. This format offers an advantage in providing each candidate with exactly the same challenge that other candidates face, evaluated by means of objective standards. The focus is clinical judgment. In states such as Oregon, DLOSCE was used instead of the patient-based or manikin-based test this spring.

“I’m so proud of the entire family here at the Dugoni School of Dentistry and all of our partners, especially the California Dental Association, who helped make this simulation-based licensure exam a reality,” said Dean Nader A. Nadershahi ’94. “This creative approach ensured that our graduating students could finish up their programs and pass this key milestone before moving to the next phase of their career, instead of having to wait many more months or longer to take the WREB exam. While the pandemic has caused much disruption, it has also allowed us to pursue innovative approaches to dental education and licensure. I am confident that these graduates will help shape an even stronger future for our great profession.” 

Expert on Staff

By Jennifer Langham

Eve Cuny calls her career in infection control a “happy accident,” but it’s one that has spanned 35 years at the Arthur A. Dugoni School of Dentistry—positioning Cuny as a nationally renowned leader in the field with expertise that has guided the school’s pandemic response. 

Wearing many hats at the Dugoni School of Dentistry—her current titles include director of environmental health and safety, associate professor in the Department of Diagnostic Sciences and assistant dean of global initiatives—Cuny has helped develop the school’s national reputation for infection control and put in place protocols during the pandemic allowing students to continue their education while keeping faculty, staff, students and patients safe.

Dean Nader A. Nadershahi ’94 says that Cuny’s life work has uniquely prepared her for COVID-19. “It’s almost as if she has spent her whole life preparing for this moment. She is someone who could help not just the Dugoni School family, but the profession and dental education broadly, with everything she has achieved, her background and the connections she has made.”

The Preparation for this Moment

In the mid-1980s, after working as a dental assistant in private practice for eight years, Cuny took a job at the Dugoni School of Dentistry as a teaching assistant just before the HIV/AIDS epidemic began to sicken patients and affect healthcare systems throughout the world. Cuny recalls how the dental field had to adjust. “We didn’t wear any of the PPE that we use today—no gloves, no masks—and we were all learning together how to treat these patients,” she says. Cuny was asked to teach some courses on the subject and then to take over as infection control coordinator. 

As Cuny put policies and procedures in place and trained faculty and staff across the dental school, infection control became integrated into the curriculum across the students’ three years at the Dugoni School of Dentistry. In contrast, at some dental schools there is no dedicated leader for infection control or the subject is not covered as extensively in the curriculum.

In 2001, Cuny earned her master’s degree in health services administration from St. Mary’s College. She says that appreciation for the importance of infection control at the Dugoni School of Dentistry has come from the top. “Leadership here has always supported infection control and recognized its importance as part of a safe environment for both patients and faculty, staff and students,” says Cuny.

Networking has enabled Cuny to share the Dugoni School of Dentistry’s success in the field of infection control and for her to learn best practices from others. As the head of global initiatives, Cuny has connections with colleagues around the world. Whether working in Tanzania to refurbish the country’s only dental school or creating educational exchange opportunities for dental students in China, Cuny has helped create opportunities for dental knowledge to be shared globally.

On a national level, Cuny is active in organizations such as the American Dental Education Association and the Organization for Safety, Asepsis and Prevention (OSAP), where she serves on the board of directors. 

And her involvement as an expert resource in the infection control community has only continued during the months of the COVID-19 pandemic. Of the more than 350 invited presentations on Cuny’s CV, she includes several webinars delivered to state and national dental and endodontic associations since the shelter-in-place order in mid-March.

Dealing with a Pandemic

Like many healthcare professionals, Cuny has spent much of the last several months keeping up with the latest research on COVID-19 and applying that knowledge to the task of creating safe ways to care for patients and educate the next generations dentists. She was part of the team who created a phased-in plan for treating patients at the Dugoni School of Dentistry. A key step during the pandemic was working with local officials to get permission for students to work with dental manikins, especially for students trying to complete their studies in the spring. 

“We wanted students to get practice doing procedures and building their hand skills so that they could be evaluated by faculty,” says Cuny. “We were looking for creative ways of providing clinical education in a situation where we knew we wouldn’t be able to have our normal volume of patients.” 

Dr. Des Gallagher, associate dean for clinical services and chair of the Department of Clinical Oral Health Care, says that Cuny’s leadership was crucial in helping the school navigate the state and county stay-at-home orders. “She was really instrumental in working with the San Francisco Department of Public Health so that we could move forward to hold the Western Regional Examination Board (WREB) exam on campus to make sure that our Class of 2020 could graduate on time.” Other dental schools haven’t yet been able to deliver the WREB exam for their 2020 students, Gallagher says, “But the Dugoni School has licensed dentists out there, makingadifferenceinCaliforniaandbeyond.” 

The dental school held summer quarter classes with a mixture of online and in-person instruction, following constantly-updated protocols for safety. “We decided early on to decrease our clinic volume to 25-50% of previous patients, and we rotate students so that only half of them are on site at a time,” says Cuny. 

The Way Forward 

Through Cuny’s network and communication with dental school colleagues from across the country, the DugoniSchoolofDentistry’sexperience inholdingclassesduringsummerquarter is serving as an example for other dental schools. Cuny says she fielded many calls from schools wanting to hear what protocols the Dugoni School of Dentistry had in place for instruction. 

In her field, says Cuny, COVID-19 presents a grim chance for learning. “This is an unfortunate opportunity, but attention is strongly on infection control right now, and I’m getting people to understand that change is not just procedural, it’s behavioral.” She explains thatthisbehavioralchangerequiresdental health professionals to become more self-aware when they are in a patient environmentwhereeverythingtheydoand everything they touch affects the patient. 

“I was always trying to get people to wash their hands, and thank goodness, now it’s happening,” Cuny says. 

She remains optimistic about how dentists can come through the pandemic. “They have a really good track record with infection control, and I think with the heightened awareness they’re going to be even better.” 

Much as the HIV/AIDS epidemic transformed the protocols of the dental profession in dealing with a bloodborne illness, Cuny predicts that COVID-19 will further change the standard precautions for caring for dental patients with possible respiratory illnesses. 

“This is an unfortunate opportunity, but attention is strongly on infection control right now, and I’m getting people to understand that change is not just procedural, it’s behavioral.” She explains thatthisbehavioralchangerequiresdental health professionals to become more self-aware when they are in a patient environmentwhereeverythingtheydoand everything they touch affects the patient. 

“I was always trying to get people to wash their hands, and thank goodness, now it’s happening,” Cuny says. 

Sheremainsoptimisticabouthowdentists can come through the pandemic. “They have a really good track record with infection control, and I think with the heightened awareness they’re going to be even better.” 

Much as the HIV/AIDS epidemic transformed the protocols of the dental profession in dealing with a bloodborne illness, Cuny predicts that COVID-19 will further change the standard precautions for caring for dental patients with possible respiratory illnesses. 

“There was a gap in how we educated students about transmission precautions for airborne and droplet transmission diseases,” she says. “Previously, we educated students to delay care if patients have respiratory illnesses because, with flu and similar illnesses, there will be symptoms. But, we’re seeing with COVID-19 it’s not as clear which patients may or may not have the illness.”

As a leader in national organizations monitoring the impact of COVID-19 on the dental profession, Cuny is aware of some of the ways the virus is affecting dentists out in the field. Difficulty in getting a comfortable supply of personal protective equipment (PPE) and reduced revenue from lower patient volume are examples.

But one of the biggest issues dentists are dealing with is uncertainty, says Cuny. “There’s just not enough information about the procedures which generate fine particles and whether or not there is an increased risk with these procedures.” She notes that the entire dental community needs more research and guidance on aerosols and methods of mitigating their effects.

As research about aerosols adds to the knowledge dentists have about how best to protect themselves, their patients and their families, Cuny will continue guiding the Dugoni School of Dentistry community in best practices.

Dean Nadershahi says that, in addition to all the professional accomplishments on her extensive resume, Cuny’s personal leadership qualities make her ideally prepared to handle a time like this. “In a situation like COVID-19, when everyone is going crazy, Eve is exactly the kind of person you want involved,” Nadershahi says. “She’s level-headed and calm, she’s looking at the science and evaluating the evidence and she’s helping people find their way through.”

Jennifer Langham is a contributor to Contact Point and other University of the Pacific publications.

Old School: When We Knew the Flu

A.W.Ward Museum of Dentistry

When the deadly Spanish influenza hit San Francisco in late September 1918, it quickly reached epidemic proportions, jumping to more than 20,000 cases by the end of October. Desperate to slow its accelerating spread, the city passed and enforced a mandatory mask-wearing ordinance, with 110 negligent citizens being arrested and fined or jailed on October 27 alone. According to the San Francisco Chronicle, the Board of Health also voted to close all places of public amusement, ban all lodge meetings, close all public and private schools and prohibit all dances and other social gatherings. Residents flocked to Golden Gate Park and other outdoor attractions since most indoor venues were closed during the epidemic. Sound familiar?

On October 24, 1918, P&S dental and medical students, who had enlisted in the WWI Naval Reserve as hospital corpsman, were recruited to join in the fight against this “unseen enemy,” its mortality rate being 20 times greater than in the trenches. At the San Francisco Hospital, P&S students helped open a new ward in six hours (much faster than the usual 24 hours required), covered nursing shifts and worked alongside American Red Cross volunteers.

Dr. Ronald Borer | A Living Legend

By Marianne Sampogna Jacobson

Dr. Ron Borer, former associate dean for clinical services, has been an upbeat inspiration to Dugoni School of Dentistry students and alumni for decades. “His dedication to education is well known and he is fondly regarded as one of Pacific’s ‘living legends.’ He encouraged students to reach their potential while maintaining student dignity, respect and self-esteem,” said the late Dr. Arthur A. Dugoni ’48, dean emeritus, on the contributions Borer has made to the dental school. 

Borer strove to know each student individually, including their unique strengths and development areas. His students remember his lessons decades later. Dr. Judee Tippett-Whyte’86, president-elect of the California Dental Association, shared, “Dr. Borer taught me to always remain calm when procedures aren’t going as planned. He taught much more than just clinical skills. He was one of my greatest ‘cheerleaders’ and one of the many reasons I can say I loved dental school!” 

Born in Ohio, Borer “played just about every sport in the world.” He parlayed his love of sports into a college football career at Xavier University where he graduated in 1957. He then attended Loyola University Dental School in Chicago, graduating in 1961. His family dentist in Fremont, Ohio, Dr. Nunemaker, inspired Borer to pursue dentistry and became Borer’s mentor. Borer spent a great deal of time with Nunemaker and his wife at their dental office learning how they ran their practice and managed a healthy, work-life balance. 

After dental school, Borer joined the U.S. Navy. He was stationed in San Diego, California, where he was trained in the specialty of endodontics. In 1968, Borer returned to Cincinnati and built a thriving practice over 10 years, where he thoroughly enjoyed caring for his patients. Borer also had a passion for working with students and began teaching at the University of Kentucky College of Dentistry. Borer was satisfied with his private practice but realized he loved teaching even more. 

Thus, when dental school classmate Dr. Jim Pride, an associate dean at Pacific’s School of Dentistry, asked Borer to join him in San Francisco to launch a new strategic teaching initiative, he was intrigued. It took coaxing from Pride, but Borer finally accepted. Together, in 1971, they helped launch the most significant curricular program in the school’s history. Borer was one of the group practice administrators to implement the comprehensive patient care model, a core part of the current Dugoni School of Dentistry education and now the gold standard for clinics everywhere. Dr. Richard E. Fredekind, former associate dean for clinical services, summarized Borer’s lasting impact: “For years, the University of the Pacific School of Dentistry has been well known for the strength of its clinical programs. Dr. Borer was instrumental in developing and nurturing this image.”

Borer contributed to the dental school in many ways, helping create the new core team structure, teaching for nearly 30 years and founding the Ronald F. Borer Endowment for Endodontics. For his outstanding contributions and service, he was recognized with the Alumni Association’s Medallion of Distinction in 1998 and the University’s prestigious Order of the Pacific in 2001.

According to friend and colleague Dr. Joseph Schulz, “Ron is unselfish with his time and gave genuine care to students during his long career at the Dugoni dental school.” Schulz emphasized Borer’s devotion to teaching, sharing that he learned the incoming students’ names before the first day of school to address them personally from day one. Students were impressed and this gesture led to an impactful student-teacher relationship. Echoing that, Fredekind remarked, “Paying attention to how Ron worked with people taught me so much about education and helping people reach their full potential.” 

As well as being a superlative instructor, Borer has a fun side and a contagious laugh. He hosted an annual beer and hot dog social for first-year students at a local pub to celebrate the completion of the required pre-clinical endodontic lab block, which became a much anticipated gathering for students and faculty to socialize. 

Another alumnus, Dr. James D. Stephens ’82, admiringly recalled, “Dr. Borer was a significant presence in the dental clinic. He was a steady instructor with a gentle manner who gave clear and succinct instruction. His many years of teaching and distinguished service helped the Dugoni School of Dentistry become one of the most respected dental schools in the world.” 

Borer fell in love with the wine country and bought a home in Sonoma in the 1990s, where he currently resides. Since his retirement in 2000, he has played lots of tennis and golf and has had many memorable outings with friends and Dugoni School of Dentistry alumni with whom he stays in touch. Borer expressed delight that his own dentist, Dr. Philip Gruell ’72, is a former student. Reflecting on his choice of profession, Borer is completely content. “I wouldn’t have wanted to be anything else.” 

Marianne Jacobson, BA, MBA, is a freelance writer from Marin County. 

Alumni Profile | Dr. Eric Curtis ’85 Making Familiar Things New

By David W. Chambers 

“The two most engaging powers of an author are to make new things familiar and familiar things new.” Attributed to Samuel Johnson, William Makepeace Thackeray and others.

If you want to see some examples of the latter, read Dr. Eric Curtis. It is worth it.

Curtis graduated from the Arthur A. Dugoni School of Dentistry in 1985, followed by a year of residency at the University of Lausanne Faculty of Medicine. His first of many articles in Contact Point appeared in 1990—30 years ago.  In addition to histories of the American Association of Orthodontists and the University of Oklahoma, he chronicled the amazing twists and turns of the first hundred years of our school.

“The two most engaging powers of an author are to make new things familiar and familiar things new.”

In his book, A Century of Smiles, Curtis recounts significant moments in the dental school’s evolution under the leadership of various deans. P&S students were the first in the country to wear gloves, masks and gowns in the clinic in 1906. That was because of a brief outbreak of the plague following the earthquake and fire. In 1923 four alums bought the charter of the school from its entrepreneurial founder Charles Boxton for $50,185. The contract stipulated that Boxton’s wife Elsie would stay on as janitor. In the 1930s, P&S introduced the nation’s first six-year combined BS + DDS degree program, which still exists. P&S remained the last independent dental school even though the Second World War saw a blossoming of interest in public health dentistry, research and technology such as the high-speed handpiece. Dean Earnest Sloman’s collaborative work at Stanford University almost led to an amalgamation in the early 1950s. Deans John Tocchini, Dale Redig and Arthur Dugoni turned what was once called the “school that would not die” into one that others wanted to be like. Dr. Ed Sims graduated in 1983, but just barely. Because of a motorcycle accident a few weeks before he could complete his clinical requirements, the school rallied to his assistance. That included professor of dental materials Armand Lugassy personally mixing impression material. Somehow, Curtis has the magic of putting us there so we can see it for ourselves.

Curtis practices in rural southeast Arizona. His has been a family practice in every sense of the word. For 31 years he worked side by side with his father, Dr. Kay D. Curtis. Eric’s daughter, Jillian, has been the hygienist in the practice for seven years. And the patients, they are like family too, both in the sense of many three-generation families and in the way people are treated.

Somehow, Curtis has the magic of putting us there so we can see it for ourselves.

What would a creative writing dentist have to say about this? Listen to excerpts from “Half Pipe Dreams,” a story that appeared in the Journal of the American College of Dentists in 2009:  A make-shift roller dome mysteriously appeared in the backyard one weekend and Curtis wanted an explanation from his son. “Tristan responded to my complaint with the single-minded, numbing circularity that makes parents fear their kids will grow up to be lawyers. ‘Tristan, why didn’t you ask us?’ ‘Um, I didn’t think about it. Scott was here this week, and you know, he knows how to build half pipes. Besides, you might have said ‘no.’ ‘Of course I would have said no.’ ‘Then why would I have asked you?’” Aren’t you there, totally amazed by a sloppy construction and the sloppy, but perfectly adolescent logic that supported it? But Curtis can see deep things. “Tristan vows that he will teach his children to skate and be ‘gnarly.’ Tristan will be blindsided by the coming irony. His children will grow up, blossoming unpredictably, carnations on rose bushes, to become—not inconceivably—studious, complicated and non-skaters.  He will rebel.  He will hate their music.”

There is humor and beauty and depth in the details that Curtis assembles for us to consider. He knows that we will separate the meaningful and human from the superficial. He calls it writing the truth. “It is value-laden and personal, an interpretation of reality.”

Curtis has been active in dentistry at the organizational level, including the American Dental Association, where he took an assignment on the Council on Communications, and the Arizona State Board of Dental Examiners. He has served stints as president of the American Academy of the History of Dentistry, the American Association of Dental Editors and Journalists, the Arizona Dental Foundation and the Arizona Dental Association. For 30 years, he has served as editor of the Arizona Dental Association.

Curtis is comfortable working at the policy level, but his writing allows us to touch and feel the small things, the personal reality on which dentistry is based. His collection of very short essays, From Hand to Mouth: Essays on the Art of Dentistry, is filled with glimpses of the ordinary but special things of practice. He notes that “artists and doctors both take on dual functions as participants in and detached observers of society.” 

“As a dentist, I write to find out what I do,” says Curtis. Writing makes the patient into a person, and the dentist, too. “If the reader comes away with any broader appreciation of dentistry’s cultural weight, I will count this volume a success.” 

The story “Hurry Up and Wait” reminds patients and dentists alike of a faint sense of lost status when the waiting room is too full for the patients and not full enough for the dentist. He muses that the American Association of Dental Surgeons initiated a pledge of no amalgams in 1856 and was defunct by 1859. He has an essay on the art of small talk at chairside, including mastering the art of the one-way conversation. Ironically, dentistry has killed pain and its association with guilt and inevitability. Pain, when it does happen, now suggests lack of caring or competence. “Open and Say Aw” is a commentary on dentistry’s surrender of craftsmanship in the name of efficiency.

He notes that “artists and doctors both take on dual functions as participants in and detached observers of society.” 

There is nothing to do but smile as you thumb through the titles of essays in From Hand to Mouth: “Dr. Jargon and Mr. Hide,” “The Incarnations of S Mutants,” “The Culture of Painlessness,” “Believe in the Tooth Fairy” and “Paddling Down the Root Canal.” 

Curtis teaches creative writing in the Arizona state educational system and practices family dentistry. He makes familiar things new.

Dr. Eugene LaBarre | Extraordinary Professor

By Marianne Sampogna Jacobson

Highly respected and much loved by patients, students and colleagues, Eugene LaBarre, DMD, MS, is undeniably deserving of his recent honor, the 2019 University of the Pacific Distinguished Faculty Award. Former student (now colleague), Dr. Cindy Lyon ’86, associate dean for oral health education, captured his essence, “He’s such a thoughtful, unassuming servant-leader and one of the best role models of what special things can happen when you bring together head, heart, hands, a generous spirit and sincere conviction to patient care and student education.” Throughout his extensive and productive career, LaBarre has contributed to the Dugoni School of Dentistry in a myriad of ways including course content creation, fundraising for local and global service initiatives, chairing numerous committees, garnering many awards and—most significantly—teaching.

A product of a Bronx, New York mother and West Virginian father, LaBarre considers himself “an unusual cultural amalgamation.” After moving around as a child, his supportive upbringing led him to Harvard University where in addition to his pre-med studies he was a member of the crew team. Inspired by his father and grandfather, both dentists, LaBarre knew from a young age he would likely pursue a career in health care. On visits home from boarding school, he had become familiar with how a dental practice operates by spending time in his dad’s dental office in Marietta, Ohio.

LaBarre first got the idea to teach while at Tufts University School of Dental Medicine, which he described as a place where “the culture of educational Darwinism weeded out the weak.” As the course material came naturally to him, he tutored his struggling classmates in his free time and found the experience gratifying. After graduating, instead of private practice, LaBarre headed to Temple University to teach full-time. His first assignment was tricky. He was partnered with a cantankerous old-guard professor who employed punitive educational practices. LaBarre had to tread lightly, balancing a relationship with his senior colleague while finding ways to help and encourage students rather than malign and frustrate them. His firm but quiet style prevailed and the students felt like the sun came out for them when he inherited full rein of the course.

In every role, Gene has always represented the very best of our profession. — Dean Nader A. Nadershahi ’94

After teaching for two years, LaBarre was ready to learn more himself. He attended what he describes as “the rich creative environment” at University of North Carolina School of Dentistry, to earn a master of science degree and a certificate in prosthodontics. This began a lifelong curiosity and passion in the areas of prosthodontics and dental materials. He arrived at the Dugoni School of Dentistry to teach in 1981, during a period he calls “a revolution in dentistry.” It was an exciting time in the field, and he was placed on the school’s first implant team, so he was immediately involved with innovative materials and processes. He has enjoyed watching and contributing to the developments in the prosthodontics specialty and witnessing the introduction of cutting-edge techniques, which he brainstormed with entrepreneurs. Digital technology has changed the arena forever, and LaBarre is thrilled to be a part of the exciting transition to biocompatible materials from “boiling wax and cooking plastic.”

While he has delivered nearly 50 scientific presentations, he describes himself as “a teacher first and foremost.” But, he explains, “part of being a good teacher is staying current and having an ear towards research trends.” Teaching for more than 40 years but still enthusiastic about his profession and his calling, LaBarre is devoted to both his patients and his students. Dr. Yan Wang, professor and assistant dean at Guanghua School of Stomatology, recalls that LaBarre “taught continuously for hours without rest and his dedication greatly moved us” while on exchange in Guangzhou, China. Dean Nader A. Nadershahi ’94 describes him as “dedicated to his fellow humans, one who connects with others and goes into the community and creates opportunities for service.” Nadershahi adds, “In every role, Gene has always represented the very best of our profession.”

Numerous nominators for the 2019 University of Pacific Distinguished Faculty Award repeat the same accolades when describing LaBarre. Graduates from the Class of 2019, Drs. Michelle Fat and Hannah Fox, testify that he is incredibly skilled at communicating with patients, has an unwavering commitment to excellence and quality, possesses seemingly limitless knowledge and serves as a powerful and thoughtful mentor. As a natural teacher, LaBarre is known for his commitment to mentoring others. Dr. Lola Giusti, adjunct faculty member at the Dugoni School of Dentistry recounts that, “Gene spent many selfless hours mentoring me and other faculty members in his department.” His supporters mention the phrase “head, heart and hands” in describing Dr. LaBarre because he epitomizes an extraordinary educator with vast knowledge, deep care for patients and very skilled artistry.

After 37 years of teaching at the Dugoni School of Dentistry, 21 years as chair of the Department of Removable Prosthodontics and more than 15 years as director of the Faculty Practice, LaBarre still sees patients one full day per week. For fun and leisure, he enjoys the outdoors, especially hiking, backpacking and camping.

Pacific to Launch New Health School and Graduate Programs

University of the Pacific is leveraging its reputation for preparing healthcare professionals by instituting four academic programs and a new School of Health Sciences to meet the demands of a growing healthcare industry. Healthcare jobs are expected to increase by 18% from 2016 to 2026, according to the U.S. Bureau of Labor Statistics, outpacing all other employment sectors. Existing educational programs in Northern California simply cannot meet the demand.

In addition to the successful physician assistant program launched in 2017, the Dugoni School of Dentistry has played a critical role in developing Pacific’s new accelerated master’s degree programs in clinical nutrition, nursing and social work that will begin in fall 2020. A doctorate in occupational therapy program will be offered the following year. These degree programs will join the University’s current popular programs in audiology, physical therapy, athletic training, physician assistant studies and speech-language pathology to form Pacific’s new School of Health Sciences headquartered on the University’s Sacramento campus. The dental and pharmacy programs will remain in their respective schools.

Students in the School of Health Sciences will benefit from interprofessional educational opportunities where they will work alongside and learn from their peers. This collaborative approach will prepare students for clinical settings where integrated teams provide patient care.

Pacific has trained healthcare professionals since 1858 when the University formed the first medical school in California, now the Stanford University School of Medicine. The University’s current portfolio of healthcare programs includes other premier and high-enrollment health schools and programs, such as the Arthur A. Dugoni School of Dentistry, which was founded in 1896 as the College of Physicians and Surgeons. The Department of Speech-Language Pathology dates back to 1936. Music therapy was introduced in 1938 and will remain in the Conservatory of Music. The Thomas J. Long School of Pharmacy and Health Sciences opened in 1955. The Department of Physical Therapy was established in 1985 and the doctor of audiology program was launched in 2015.

For more information about the new School of Health Sciences, visit pacific.edu/admissions/graduateprograms.