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100 Years | Three Generations

The Arthur A. Dugoni School of Dentistry is a family. The community on campus and beyond is tight-knit and cooperative. But did you know that every graduating class is filled with family members of previous graduates? Recently, 10 to 20 students in each class at the dental school have Dugoni School of Dentistry graduates and practicing dentists in their families. “We have several families at the Dugoni School of Dentistry who can boast three generations of graduates—the Dugoni and Hovden families to name a few,” shared Dr. William van Dyk ’73, past president of the Alumni Association, at the 2016 Annual Alumni Recognition Luncheon. Another such three-generation legacy family is the Skelley family of San Francisco.

The Skelley family has a long history in dentistry and in San Francisco. Their dental dynasty started with Dr. Fred Skelley, P&S Class of 1915. He grew up in San Francisco and met his wife of Finnish decent, Ingrid Arvonen, while attending Glen Park Grammar School. He and his family were long-time inhabitants of San Francisco and all survived the 1906 Earthquake.

Fred began his practice in San Francisco when he opened his dental office on Mission Street near 29th Street shortly after graduating from the College of Physicians and Surgeons. Now, 100 years later, the family includes 15 dentists, many of whom are Dugoni School of Dentistry alumni.

While the veracity of the stories is unverified, there are several legends in the Skelley family folklore about how Fred ended up completing a degree in dentistry. One story is that he was encouraged to join the class by a friend but was one unit short in physics to be able to attend the program, so he worked all summer long on the new Geary Street streetcar line in order to make enough money to take the one remaining course needed. Another tall tale is that Fred’s father used all the family’s money to head out to the Gold Rush in Alaska. Left without money for tuition, Fred needed to finish college one year early, so he switched to dentistry and obtained his DDS degree from the College of Physicians and Surgeons. His offspring are glad that he did.

Dr. Eugene Skelley ’54 always wanted to follow in his father Fred’s footsteps. He remembers his father and his father’s classmates as “icons of dentistry.” They were the early adopters of the newest methods. Eugene recalled, that as a child, his family had a large building in San Francisco, the one on Mission Street which they still own today. “My dad’s office was there and it was just always a big part of our lives,” he said.

Dr. Coragene Skelley ’41, Eugene’s Skelley’s older sister, also followed in her father’s footsteps even though she was one of only two women in her graduating class. Coragene married another dentist, Dr. Edward Savio ’39, and all three of their children—Dr. Coragene I. Savio ’70, Dr. Ednaima (a.k.a. Tad) B. Savio ’71 and Dr. Edward F. (Ted) Savio ’91—attended the Dugoni School of Dentistry and became dentists too.

It looked like so much fun, we all wanted to do it. —Dr. Lila Marie Skelley ’74

In upholding the family tradition, Dr. Coragene Savio ’70 married Dr. Barry Kinney ’68, another dentist and Dugoni School of Dentistry alumnus. “When I got out of dental school in 1969, I was ready to start my practice downtown at 450 Sutter,” Kinney told the Noe Valley Voice. “My father in-law (Dr. Edward Savio), who had his offices out at 1712 Church near Day Street, suggested that Coragene and I take a look out in the Noe Valley neighborhood before deciding. We found a house on 24th Street, made an offer, and the bank agreed to loan us $50,000 to buy the house and build our office.” This expanded the family dental legacy in San Francisco. Dr. Edward Savio, Sr. ’39 started his practice in Upper Noe Valley in 1939, where Coragene’s sister, Tad Savio, and brother, Ted Savio, still practice today. Barry and Coragene practice nearby, along with her first cousin, Dr. Jocelyn Yvonne Skelley ’90. Dentistry is truly a family profession for the Savios and their Skelley cousins.

Back on Eugene Skelley’s side of the family tree, of his five children, two are dentists and Dugoni School of Dentistry grads—Drs. Lila Marie Skelley ‘74 and Jocelyn Yvonne Skelley ’90. Two others are in related professions as a registered dental hygienist and dental lab technician. At age 93, Eugene is still licensed and continues to work in the lab. He even has dreams of achieving dental breakthroughs in the area of prosthetics. A culturally aware and creative thinker, he suggested, “One day a month students and professors should only speak Spanish at the dental school since it is our second language in San Francisco.”

In our interview, Eugene expressed fond memories of his dad, Fred. “He was athletic and healthy and inspired everyone.” It seems that with his indomitable spirit and family full of dentists, Eugene has inspired lots of people too. Lila Marie recalls that her dad took her to the dental school when she was a young child. “It looked like so much fun, we all wanted to do it.” Instead of feeling obligated to become a dentist, Lila had wanted to be a dentist since she was four years old. In keeping with tradition, she also married a Dugoni School dentist, Dr. Kjell Ragnar ’96, and she continues to practice in Alameda, California. She remembers that big old family building in San Francisco too; her grandfather used to serenade his patients by playing his grand piano at their Mission Street space.

Fred’s wife Ingrid Arvonen (Lila and Jocelyn’s grandmother) had dental connections of her own, including Ingrid’s brother, Dr. George Arvonen, his son, Dr. Paul Arvonen, and his daughter, Dr. Michelle Arvonen—another three-generation family of dentists. The 15th dentist on the Skelley family tree, Dr. Wallace Bachelder, was Dr. Fred Skelley’s first cousin. As a child, Wallace visited Fred’s dental office and later went to UCSF School of Dentistry. “My grandfather was the inspiration to his dental career too,” Lila Marie Skelley proudly declared.

Dr. Jocelyn Yvonne Skelley grew up in the dental profession. Like her older sister, Lila, her dad took her to the dental school when she was five years old, which sealed the deal for her career. “As soon as I walked in there, I thought this is incredible. I knew that I wanted to do this,” she recalled. As a young woman, she worked in her father’s office taking impressions and pouring models of teeth and later assisted at her sister’s office. Also a jewelry maker, she loves both the art and the science of dentistry. Back in the early days of her career, the whole family practiced in the same building together on Mission Street where they worked, lunched and all had fun together with their family business.

Channeling what her father had done for her and her sister, Jocelyn took her son to the dental lab when he was five years old and taught him how to pour impressions and work with some equipment. For Jocelyn and her family, dentistry has been a way of life. “We enjoy the best of both, the old solid and true hands-on techniques and the modern technology emerging every decade,” says Jocelyn. To this day, Eugene believes dentistry is the best profession and recommends it to all the young people he encounters “who are smart and have good dexterity.” For the Skelleys, dentistry really is the “best and only” profession. The Skelley family connection to the Arthur A. Dugoni School of Dentistry is strong and they have high hopes for a fourth generation of Dugoni School dentists in the family.

The Arthur A. Dugoni School of Dentistry continues to maintain its rich tradition of treating patients, students, faculty and staff like family. No wonder so many dental school alumni families send their offspring to follow in their footsteps.

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

Students Get Out of the Classroom and into the Community

By Christina Boufis

“Community involvement is a huge part of our dental school,” said Dr. Sigmund Abelson ’66, associate dean for clinical affairs. “It’s part of our mission but also part of a student’s education.” To that end, students from the Arthur A. Dugoni School of Dentistry travel to different extramural sites to provide care and serve the needs of a diverse patient population at community clinics, hospitals, senior centers and other locales.

“Not only do we want to do good things and provide dental care to the underserved,” said Abelson, “but also exposing our students to different populations is a tremendous learning opportunity. We hope that after they graduate, many of them will want to work in some of these underserved areas.”

One rotation that is mandatory for students in their second and third clinical years is to spend about a week at Highland Hospital’s Oral Surgery program in Oakland. The students gain needed hospital experience for their degree, explains Dr. A. Thomas Indresano, chair of the Dugoni School’s Department of Oral and Maxillofacial Surgery and the Dr. T. Galt and Lee DeHaven Atwood Endowed Professor, who heads the Oral and Maxillofacial Surgery residency program and student rotations at the hospital. “We let them work in the clinic to perform extractions and some minor surgery, and that adds to their experiences in the surgery clinic at school. Indeed, the patient population whom students encounter at Highland Hospital, a major regional trauma center, consists of many people who are in pain and who most likely do not have a regular dentist.”

The students get to observe how interdisciplinary care functions.

In addition to receiving hands-on clinical training, students get experience seeing patients from the entire medical view. “In school students learn that every patient should complete a medical history and students review all of their medical conditions. But it’s really brought home when students operate on patients and are certain that these things are correct,” he added.

Though the rotation at Highland Hospital is mandatory, not every student is enthusiastic about surgery. But, according to Indresano, “you’d be surprised at how quickly they catch on. You can see a big difference after one week, and then after the second week they’re pretty comfortable. They’re less timid.”

Students also have the opportunity to participate in an extramural rotation at La Clinica de la Raza, in the Fruitvale neighborhood of Oakland, home to the city’s largest Latino population. “We are a community-based health center, so we actually provide medical, dental, optometry and mental health services,” said Dr. Ariane Terlet ’86, chief dental officer at La Clinica. About 50% of the patients are children, about 80% are Hispanic and all are low-income at 200% of the federal poverty level and below. “We have patients who have a lot of needs and a lot of decay, and our students are able to provide quite a bit of service.”

There are different student rotations at La Clinica, including removable prosthodontics and endodontics. “The students observe many different things and receive a lot of experience. And the patients are grateful to have the care.”

Rotations at La Clinica are very popular and, while they require a lot of work, they’re a win-win for everyone, according to Terlet. “I need to provide care to a large group of people, and, if I can supervise others, it gives me more hands. It’s also a great educational experience for the students, and there’s a great deal of satisfaction in watching them learn and having them be excited.” Furthermore, the student rotations serve as a “retention and recruitment tool not just for our own site, but for other community health centers that need qualified staff.”

Students rate their rotations at these different extramural sites quite highly.

Exposing students to a different patient population and having them work at the clinic may even spark one of them to consider a career in public health, as one of Terlet’s endodontic residents is now doing. “I don’t think he ever would have considered it before coming to work for us.”

Students treat another underserved population when they rotate through On Lok Lifeways, an organization that serves seniors throughout the Bay Area. On Lok Lifeways is a Program of All-inclusive Care for the Elderly (PACE) program. Its goal is to keep seniors, who would otherwise meet the criteria to be placed in a skilled nursing facility, in their own homes.Dental students participate in a one-day rotation at either of the On Lok senior centers on Bush Street or 30th Street in San Francisco. “One of the main lessons we hope students get from the rotation is an appreciation for the interdisciplinary care that’s provided there,” said Dr. Elisa Chavez, associate professor in the Department of Dental Practice, who also directs student rotations at On Lok Lifeways.

Students have the opportunity to see multiple patients, many who have six or seven major medical conditions, and are taking several medications or have varying levels of dementia. “It’s kind of eye opening in certain respects, when you see all the complexities that can impact dental care,” explained Chavez. “The seniors are a very different population from what the students would see in the dental school’s Main Clinic. The students observe how interdisciplinary care functions and why it’s very important when you’re dealing with frail elders. And they are able to provide a variety of services.”

Extramural rotations have been part of the dental school’s educational program for the last few decades. Dr. Dennis Kalebjian ’78 was one of the first students to do a rotation in Fresno at the Valley Medical Center, which has now merged into the Community Regional Medical Center, a Level I trauma center in the Central Valley. At this rotation, students are exposed to some of the most challenging cases, particularly very young children and patients with special needs or who have oral and facial trauma.

“The main things students learn from an extramural rotation is the basic concept of hospital dentistry, being on call after hours with the residents, making in-patient hospital visits when a consult is required and actually operating on out-patient hospital cases under general anesthesia, particularly on young patients with special needs,” said Kalebjian.

After Kalebjian’s experience with the Fresno rotation as an undergraduate, he got hooked. “I became a resident, and later an attending faculty member, and remain here to this day. I’m not alone in that. There are a couple of people who have followed the same route.”

Dr. Torrey Rothstein ’05, director at the Sonrisas Community Dental Center in San Mateo, another extramural rotation site, also felt the pull to help an underserved community. “An opportunity arose to work at Sonrisas a year after I graduated. At the time I was working part-time as an associate dentist in a private practice. There was such a contrast working at a safety net clinic compared to the private office, a contrast that pulled me towards helping the underserved in our community and has kept me here for almost 10 years.

The patient population at Sonrisas is low-income, below 250% of the federal poverty level and without private insurance, according to Rothstein who oversees student rotations at Sonrisas, along with Dr. Brian Sheppard ’10. “It’s a smaller clinic, and the students get a lot of very good experience—one-on-one coaching and instruction and the opportunity to receive good feedback,” said Rothstein. “They have new clinical experiences that will benefit them throughout their careers. We’ve heard students enjoy coming here. I’m not sure if it’s because we’re close to the beach or if it’s the clinical experience.”

Joking aside, students rate their rotations at these different extramural sites quite highly. “When we do exit interviews, rotations always come back as one of the best experiences they’ve had in dental school,” said Abelson. “Our students find it valuable. We treat the population that’s in great need of dental care and, at the same time, we’re providing this tremendous educational experience for our students.”

Christina Boufis, PhD, is a health and medical writer from the East Bay.

ASDA: Advocating for Change

Leadership is one of the dental school’s seven core values. Dean Emeritus Arthur A. Dugoni ’48 continues to exemplify what it means to be a leader, espousing the importance of getting involved and giving back to the profession. His message is heard loud and clear by the Dugoni School family. Alumni, faculty and staff have embraced the many opportunities for leadership as shown by their involvement within the dental school, organized dentistry and their communities. Students at the Dugoni School of Dentistry are carrying on the tradition of leadership and service and many are taking an active role in the American Student Dental Association (ASDA).

“I never expected to be standing in front of the president of the American Dental Association speaking about IDS students and advocating for a change I believe in,” said Amro Elkhatieb, IDS Class of 2016 and advanced standing liaison for District 11 of ASDA. “It was an amazing experience to present at the District 11 Meeting in Irvine last October and to have the opportunity to meet Dr. Carol Summerhays.”

Elkhatieb’s presentation focused on the challenges foreign dentists encounter with taking Part One of the National Board Exam in the United States or Canada before being eligible to become an IDS student in this country. Although Summerhays was unaware that prospective IDS students can only take the initial part of the exam in the United States or Canada, she exhibited immense enthusiasm and support of possible changes. She asked Elkhatieb to follow-up on this specific topic and encouraged the students to lobby for change through ASDA.

After the ASDA Annual Meeting in March 2016, the organization formed a new, five-member national committee—the Advanced Standing Advisory Committee. “We are looking forward to making changes for IDS students,” said Elkhatieb. “It will be a win-win situation for everyone—IDS students, DDS students and patients. I believe this committee will also foster a better understanding of people from other cultures.”

Currently, Pacific’s ASDA chapter consists of five executive cabinet members and 25 student leaders involved on the various teams or committees led by the cabinet members, such as the legislative liaison team, the event coordinator team, the treasurer team, etc. “We decided to model our chapter after the national ASDA organization during the year I served as president,” said Steve Truman, Class of 2016, president of Pacific’s ASDA Chapter from 2014-15 and the ASDA District 11 community outreach coordinator for Northern California. “We have seen better results with the new organizational chart. Roles are more clearly defined and we created a document that outlines the roles and responsibilities to help future ASDA leaders at the Dugoni School.”

Four students from the Dugoni School of Dentistry were appointed to positions for ASDA’s District 11 for the 2015-16 year which represents students from all six of the California dental schools.

Four students from the Dugoni School of Dentistry were appointed to positions for ASDA’s District 11 for the 2015-16 year which represents students from all six of the California dental schools. Tiffany Wang, Class of 2017, served as communications chair, Dana Baba, Class of 2016, was a member of the District 11 Planning Committee, Truman served as community outreach coordinator for Northern California and Elkhatieb was the advanced standing liaison. “For me, ASDA opened up networking opportunities with other California dental students and even with peers from all over the nation. To see that we were united under like-minded interests and causes was very empowering,” said Wang. “As a completely student-run organization, ASDA is a great platform to exchange ideas with the mission to advocate for our profession, and I am eternally grateful for the life-long friendships that I have made along the way.”

Pacific’s ASDA chapter improved its already strong participation in district and national ASDA meetings in 2015. Twenty-nine students attended the ASDA Annual Session (14 more students than the previous year), nine students participated in National Lobby Day in Washington, D.C., 22 students attended the National Leadership Conference and 27 students represented the Dugoni School of Dentistry at the District 11 Meeting. The ASDA chapter raised money through fundraisers, lunch and learns and the ASDA Vendor Fair, in addition to obtaining some sponsorships. These funds helped pay for conference registrations and accommodations for the students attending the various ASDA meetings.

“ASDA has shown me that, as a common voice, students can push to make changes in dentistry and in dental education,” said Truman. “At Lobby Day, we represented 20,000+ dental students when we spoke to representatives on Capitol Hill.”

When not attending state or national meetings, members of the dental school’s ASDA chapter are planning various professional development programs, service projects or social events here in San Francisco. “This year, we aimed to create activities and offer opportunities that busy dental students would find beneficial or enjoy doing,” said Laura Tsu, Class of 2016, Ideal ASDA chair and resident historian and graphic designer. “We wanted to optimize every student’s experience here and help them become confident, knowledgeable and well-rounded clinicians in the future.”

This group of committed student leaders coordinated a number of new ASDA activities this past year, including:  the “San Francisco Survival Guide” workshop, Ugly Christmas Sweater Party, First-Year Speed Meeting, “How to Get a Job in 30 Days” workshop, Q4 March Madness, “All About the Boards” collaborative workshop with the CDA representative, Curry Senior Center community outreach program and Kids Enjoying Exercise community service project. In addition, ASDA continued to implement its traditional annual activities, such as the Penny Wars fundraiser, ASDA Vendor Fair, ASDA Pre-Dental Day, “First Year First Aid” workshop, bake sale, ASDA Clinical Transitions meeting and the Bridge Builders cultural diversity showcase.

In May, University of the Pacific honored the dental school’s ASDA chapter at the 2016 Faith Davies All-University Leadership Awards Luncheon on the Stockton campus.

According to Tsu, ASDA cabinet members devised social media campaigns to help spread the word about ASDA events. These campaigns increased attendance at ASDA programs and kept the school informed of the latest happenings. “Our Q4 March Madness, one of the most exciting new events, brought together the school’s student body, faculty and staff, said Tsu. “The collaboration between school administration and ASDA leadership in executing the tournament emphasizes a strong level of communication and trust for one another. We had one of the highest student participation rates at this event, and everyone showed an unbelievable amount of spirit throughout the competition.” The tournament attracted 140 participants and 60 spectators, including alumni, faculty and staff, and raised $1,000. Pacific’s ASDA chapter received an honorable mention for this activity at the ASDA Annual Session.

“Our ASDA chapter is dedicated to creating a strong campus community and leading a variety of events on campus that highlight the different interests of our students,” said Kathy Candito, faculty advisor for ASDA and associate dean for student services. “ASDA students are some of the most amazing young men and women. They are great leaders and the future of the profession.”

“Our student-run ASDA organization is recognized as one of the most outstanding ASDA chapters in the United States,” said Nader Nadershahi ’94, interim dean. “It has become a national model for its organization, leadership, student participation, programs for the dental school and community, collaboration with other professional and community service organizations, student advocacy and involvement on the local, state and national levels.”

In May, University of the Pacific honored the dental school’s ASDA chapter at the 2016 Faith Davies All-University Leadership Awards Luncheon on the Stockton campus. The ASDA chapter received the Student Organization of the Year Award, which recognizes a registered student organization that has made a lasting impact on the Pacific community.

“My involvement with ASDA has provided a more fulfilling and rewarding dental school experience,” said Kyle Hing, Class of 2017, member of the ASDA event coordinator team. “I’ve had the opportunities to give back to the community, further my skills as a leader and strengthen my fellowship with other Dugoni School students.”

“ASDA is just one group at the dental school,” said Truman. “There are so  many activities going on at the school and I am most excited that organizations such as ASDA, ADEA, CDA and SCOPE are coming together to collaborate on programs, whether in the community or at the school.”

Each year, the ASDA chapter increases its presence on campus as student leaders at the Dugoni School of Dentistry continue to give back to the profession and the school. Many of the exemplary individuals involved in student organizations will go on to become the future leaders of organized dentistry and will make an impact on the profession and beyond.

Kara Sanchez, BA, is the editor of Contact Point magazine.

Alex Schmotter ’15 | Entrepreneurial Spirit

Driven–that’s one word to describe Alex Schmotter ’15, who successfully created a business while earning his DDS degree at the Arthur A. Dugoni School of Dentistry. His hydration beverage, pHenOH 7.4, hit the market in July 2014, going against brands like Gatorade and Powerade.

THE BASICS
pHenOH 7.4 is the natural culmination of Alex’s life experiences. Alex’s father, Richard, is a dentist and an associate member of the Alumni Association, his mother, Peggy, is a professional chef who runs a catering company in Marin County, California, and his older sister is an elite triathlete. These influences, combined with Alex’s active lifestyle and passion for teeth, were key ingredients in his career path.

The vision for pHenOH 7.4 began to take shape during a bike ride in college when Alex was brainstorming for his senior biology research project topic. As a pre-dental student at Cal Poly, San Luis Obispo, he already had teeth on his mind, and while he rode his bike, he started to pay attention to the way he was consuming sugary sports drinks as well as their effects on his body.

Alex’s research project developed into much more when he started experimenting with recipes for a better alkaline sports drink, one that would be refreshing and effective without huge amounts of sugar.

The company is now a team of 14 and is growing rapidly. pHenOH 7.4 is already being distributed by several of the most influential distributors to many retailers throughout the Western United States, including San Francisco Bay Area Whole Foods stores. pHenOH 7.4 has now partnered with its first East Coast distributor, and Alex envisions the company growing to include multiple product lines reaching a broader consumer base.

“We want to be a brand — a wellness brand and a lifestyle brand,” said Alex. “We’re trying to develop a culture behind our product. We want to set new standards for operation and product quality in a long-standing and stagnant industry.”

DENTAL STUDENT AS AN ENTREPRENEUR
Alex recalled an advisor asking him, “So do most people, or does everyone, tell you that you’re crazy for trying to do this while in dental school?”

It’s a question he was asked many times during his time at the Dugoni School of Dentistry. Dental school and start-up life are both full-time commitments, but managing multiple priorities was not foreign to Alex. As a college student, he played on the lacrosse team and was constantly juggling practice and travel time with a heavy pre-dental course load. Life as a student entrepreneur gave him a unique perspective into his dental school classes and clinical work.

“I was sitting there in lecture learning again about the science that went into a product,” recalls Alex. “It was a very interesting experience because I would sit there and think, ‘That’s an angle or that’s a fact or that’s an approach we could take that I hadn’t thought of and would not have picked up on had I not been in the mindset of product development.’”

He appreciated that the Dugoni School of Dentistry’s Helix Curriculum is a competency-based curriculum that does not merely focus on completing a checklist of requirements. At the Dugoni School, the faculty’s goal is to develop various strands of knowledge to shape their students into excellent dentists who can care for their patients’ needs.

“During your third year, you’re not just showing up to work on a requirement,” said Alex. “You’re showing up to clinic to help your patients, and you’re enjoying what you’re doing. You step into this building, and you’re a dentist.”

WHAT’S IN HIS FUTURE?
After graduation last year, Alex has been working a few days a week at his father’s dental practice in Marin to keep his dental skills sharp and learn more about the business side of dentistry. On the other days, he commutes to Palo Alto to work with his pHenOH team. He also hopes to incorporate philanthropy into his career as a dentist and entrepreneur. He is a newly appointed member of the Dugoni School’s Alumni Association Board of Directors with plans to serve two, three-year terms.

Travel and philanthropy are passions that run deep in Alex’s family. Alex and his father have gone on dental mission trips to places such as Kenya and Mexico, and Alex has developed a passion for what he describes as a “selfless way of seeing the world.”

Mission trips give him a chance to integrate himself into the community’s daily life. “You see a different side of the world and you learn that people are people,” said Alex. “And, I feel everyone across the globe has the same tendencies and unique characteristics in the way they do things and the way they act with others. Human nature is all the same.”

Alex has several humanitarian dental trips coming up this year. Recently, he visited Myanmar in Asia to provide dental care to the underserved population there. He will then head to Peru in May and Africa in August. “These trips are an amazing way for me to put my dental degree to good use,” says Alex. “The goal is for pHenOH 7.4 to be able to support an expanded effort to set up dental clinics all around the world.”

3D Printing Opens Up New World of Digital Dentistry

A new high-tech printer is ushering in an exciting era of innovation at the Arthur A. Dugoni School of Dentistry.

The purchase of a CubePro Duo 3D printer is the result of collaboration among the Departments of Biomedical Sciences, Orthodontics, Endodontics and Integrated Reconstructive Dental Sciences. Faculty members collaborated to apply for and receive a $9,000 grant from the University’s Technology in Education Committee to cover the cost of the printer, workstation and specialized software.

The printer will provide a new way to use 3D images, now common in dentistry, to enhance the educational experiences of students and residents and the care of patients. 3D printing uses a layer-by-layer manufacturing technique to produce physical objects from 3D digital files.

The printer will provide a new way to use 3D images, now common in dentistry, to enhance the educational experiences of students and residents and the care of patients.

The school has plans to leverage this innovative technology throughout its curriculum. In the area of restorative dentistry, the 3D printer will help create standard teaching and testing models. In a preclinical simulation setting, dental students can operate on standardized teeth with defects generated by the printer, thus removing the element of variability when using extracted teeth. One 3D-printed, single-tooth restoration costs less than $5, much less than the nearly $200 charged for a model produced by an outside commercial vendor.

The school’s Departments of Biomedical Sciences and Orthodontics have proposed a new selective course for DDS students on “the language of 3D modeling and printing” to give them exposure to this technology. The course will include expanded offerings to focus on topics specific to orthodontics at both the DDS and graduate levels.

3D printing has the potential to reduce the school’s clinical costs by opening a new pathway for manufacturing dental appliances.

Also, 3D printing has the potential to reduce the school’s clinical costs by opening a new pathway for manufacturing dental appliances. Currently, it costs $125 to print one cubic centimeter of titanium in any shape at an outside vendor. A root analogue implant would use less than this amount, so the cost would be lower. If the dental school obtains its own Direct Metal Laser Sintering (DMLS) printer, the savings would be even greater.

Biomedical science faculty members are organizing to employ 3D printing to create bioresorbable scaffolds for periodontal implants. This process has broad application in dentistry and would eliminate the method of extracting bone from other parts of the body to obtain the graft material.

“The manipulation and printing of 3D images has high potential in dentistry,” said Dr. Gary Richards, associate professor in the Department of Biomedical Sciences. “It’s important that our students have the tools and experience necessary to participate in this revolution.”

Focusing on People and Programs

Nader A. Nadershahi, Interim Dean

It has been a pleasure to serve as interim dean during the current academic year. Since moving into our new facilities nearly two years ago, the Arthur A. Dugoni School of Dentistry has spent time fine tuning and reflecting on our building to make sure it works best for students, faculty, staff, patients and other members of the school family. After this intensive focus on our “place,” we are eagerly refocusing on the success of our people and programs.

We are looking closely at our educational competencies to make sure our programs provide students with the skills, knowledge and values required for the changing future of health care. We are reevaluating our curriculum to make sure it remains up to date with the dental profession and the changing needs of society, and recently held an off-site faculty, alumni and student retreat to focus on this issue. We relentlessly pursue excellence in our programs.

The dental school is also investing in people, our most valuable asset. By recruiting and developing talented faculty and staff, we will continue to deliver world-class programs. The dedicated individuals who work at the dental school will help us carry on our great legacy of excellence in dental education.

We are also committed to our students by addressing the challenge of the rising cost of higher education as we support our students and programs through philanthropy. Growing our endowments will help us ensure a strong and stable future for our beloved dental school. In the Philanthropy section of this magazine, you’ll learn more about exciting opportunities to double your gifts to students and programs through the power of the Powell Match program.

These are ambitious goals, but together the Dugoni School family will accomplish them and build an even brighter future.

Sincerely,

nader_signature

Nader A. Nadershahi ’94, DDS, MBA, EdD
Interim Dean

The Technology Story

By David W. Chambers

There is a paradox involved with educational technology: its cost can be gauged by looking at the equipment, but its value depends on the context in which it is used.

When the dental school decided to issue laptop computers to all students, there was a debate over whether or not wthey should be allowed in the classrooms. I thought of this a few years ago while teaching a large seminar on research for first-year students. I required everyone to bring their laptop and we looked things up in class, did customized group exercises and actually wrote a paper in class. In a digression, I remarked that the Hippocratic Oath does not say “First, do no harm.” A few minutes later I noticed a lot of students huddled around a computer and suddenly I just caught an expletive and the words, “He’s right.” That is “just-in-time, just-for-me learning.” Had I passed out a copy of the oath and gone down on my knees begging students to read it, the probability of compliance would have been statistically insufficient.

We are coming to realize that learning technology is a paradox. The key is not the equipment; it is everything around it.

We are coming to realize that learning technology is a paradox. The key is not the equipment; it is everything around it. This insight is at least 2,500 years old, and is found in the Taoist writings of Lao Tzu. “The value of a cup is not in its walls, but in the empty space they create.” The value of a 4G device is not its touchscreen text pad, but its giving us something intelligent – seeming to do while waiting for an elevator or cab.

Technology in the Curriculum

The dental school is now on its third generation of course management software systems. Faculty put lecture notes, PowerPoint presentations, readings, video clips and links to other resources online, along with assignments, chat rooms, quizzes and secure grade posting. We even administer final examinations in computer format. We have come a long way from the days when we videotaped lectures so students who were on extramural rotations could keep up with the lock-step curriculum. (I actually reviewed the sign-out slips in the library back then to learn the impact of our early move in technology; we could have saved the effort.)

The purpose of the lecture now is to serve the most important function of motivation. People such as faculty members are uniquely positioned to answer the question “Why should one be interested in a topic?” even when, by comparison with electronic media, they are poorly equipped to present the material in its full richness.

Leading universities such as Harvard, MIT, Cambridge and Oxford now have, by faculty vote, “open access policies” putting all course material on the Internet. The best educations are now virtually free. There are two reasons for this: digital technology has reduced the cost of transmission—an extraw digital copy is quite literally not worth charging for. The other reason is that the value of knowledge is not the packages of content; it is in the creative act of making new content and in the context that makes that content useful. The one who manages the context controls learning, not the one with the new gadget.

Here is an example. The course management software the Dugoni School of Dentistry uses allows faculty members to track who is using it. In the research course mentioned previously, I checked use patterns and found there was a minor blip in “eyes on page” when new content was announced (but not when it was discussed) and a major blip hours before an assignment was due. I also found that students who regularly used material on our course management software scored about a grade and a half above those who neglected it.

Being the first to implement electronic education technology does not guarantee impact. When the dental school occupied its current building in the late 1960s, we had an electronic real-time individualized polling system to promote active learning. You may have wondered what those little dials in the arm rests in Room 411 were for. At one time they were connected to a sophisticated system for measuring and displaying student input. It proved to be useless technology because the faculty of those days did not consider engaging students in discussion to be an authorized part of their jobs, especially in situations where differences of opinion could be made public. Curiously, one of the hot new educational technologies today is “clickers,” essentially the same concept, except now we use cell phone technology to register input.
Where are the disconnects in technology? Electronics has brought down the cost. But that doesn’t explain why we are now scrambling to reintroduce what we tore out decades ago. The driving change has been in the curriculum. We have shifted from a teacher-centered to a student-centered view of learning. In the old model, students were given credit for the amount of content they were able to extract from faculty members, and under such a system the status of both students and faculty members was determined by regulation of such transactions. Effective technology served to control this process and students crowded the front of the lecture hall to get a copy of the handout (quite literally a handout) and squirreled away semi-secret copies of old exams.

The curriculum at the Dugoni School of Dentistry today is designed around the concept of integrating knowledge and practice. And the integration that matters is the students’. Strands of knowledge, skills and values are woven together in a helix pattern that is held together by the Personal Instructional Programs theme. This is a natural extension of the competency-based curriculum that the school pioneered in the 1990s, where the purpose of dental education is focused on developing the capacity to practice rather than accumulating check-offs. In the model that existed before that, the method of instruction was fixed and the outcomes were allowed to vary (how else could we get a bell curve of student performance). Now the outcome is fixed (competency) and the available means of achieving it have blossomed. Technology means alternatives.

We have changed the context and that pulls new technologies into the mix. Perhaps the technology in greatest demand today is not electronic at all: it is seminar rooms needed for active learning where small groups of students and faculty members can explore different approaches, trace out the consequences of information and actions, verify the values that guide patient care and integrate what is known about the profession. That cannot be easily accomplished in lectures, and podcasts and PowerPoint downloads designed to substitute for talking heads don’t get the job done either. We have ample means for electronic communication and assembling support material; the technology bottleneck right now is physical space for interactive learning.

Technology in the Clinic and on the Web

One of the dental school’s competencies is that our graduates will be up-to-date in clinical technology. In the clinic this means digital radiography, implants, use of clinical microscopes, clinical photography, the constantly changing array of restorative materials and even a commitment to “goopless” (electronic) impressions. We have also installed a new clinic computer system: AxiUm. This does everything one could want in a clinic (at least it did when we installed it about a year ago) from electronic charting and records management to integration of digital radiology and remote access. It also structures faculty control of the treatment sequence, provides financial management and even offers a platform for clinical research.

It required about two years of planning to get ready for the conversion, according to Dr. Richard Fredekind, associate dean for clinical services.

It required about two years of planning to get ready for the conversion, according to Dr. Richard Fredekind, associate dean for clinical services. All of the electronic capability existed in AxiUm off the shelf and could have been plugged in on very short notice. The hard part of the technology upgrade was understanding and agreeing on our clinical, educational and business models and processes. Technology is just as powerful for deepening the ruts of traditional ways of doing things as it is for opening up new methods.

Research conducted in the 1970s, as computers were entering the workplace, confirmed an aspect of the technology paradox we have been exploring: technology almost always makes things go faster, but not necessarily better. The faster or easier part is clear enough. What has been discovered is that technology most predictably leads to improvements when it forces a rethinking of the underlying work processes. The shift in word processing has been that those folks we used to call secretaries have become very scarce: professionals now do their own keyboarding (even though we are not as good at it as were our support staff). The problem has been that we have multiplied the number of documents we generate and the number of copies made, the proportion of Americans in the “information” economy (now over 70%) and the length of the average work week.

To date, our new clinic computer system has provided clear advantages in up-to-date imaging and records management, as well as convenience for access and patient management. It offers the potential for research and provides a rich database for clinic management. It also takes students and faculty members more time to enter, check and override the logic of the system. Dentists who have explored and experimented with electronic digital records in their practices confirm that technology that is not in harmony with practice patterns can be a heck of a pain.

Technology has also played a role in the administration of the dental school. Our website not only broadcasts our PR messages, it also interacts with our communities. Students sign up online for selective courses, RSVP and get tickets for graduation and manage enrollment for graduation and licensure testing. Faculty conduct such business as reviewing credentials for promotion and tenure, attending meetings at the Stockton campus via Skype and participating in surveys from their desks or remotely while at home or while traveling.

Resolving the Paradox

For many alumni, their first exposure to computer technology was Atari. This was the first video game company, founded in 1972 and disappearing in 1998. For millions of Americans, the company defined what computers do: they atari. The word describes a move in the game of Go, where one strikes or scores or captures. To atari is to succeed. Unfortunately, many still embrace this metaphor for our relationship with technology. Research with school children learning to access information on the Web has documented the strong tendency for students to Google until they find a match with the teacher’s request (an atari), and then they terminate the search. If we let it happen, learning can become defined as the “first hit.” The only thing sadder than technology becoming an end in itself would be for it to define the standard for the end of learning. This is the deep paradox of technology in an organization devoted to learning.

My guess is that readers will soon forget most of what is in this article. What are most likely to be remembered in the future are the stories about the Google search for the Hippocratic Oath, the arm rest dials in Room 411 and the story about Atari. There is a reason for this. These are examples of narrative rather than opinion or factoids. We remember things that have a structure with a beginning, a middle and an end—especially when we can insert ourselves at the beginning or the end. Electronic technology opens for us the amazing power of taking things apart into elements, stripping off the beginning and the end, of finding them quickly and for reassembling them in marvelous recombinations. But it only counts for learning when it is reassembled. Meaningful material always has a lead-in and a follow-up; it is part of the flow of professional life. Schools that issue computers or Web pages without creating the culture for turning these into the story about becoming a dentist have missed the point of technology.

Pacific Innovators

By Eric K. Curtis, DDS, MA

Philosopher and educational reformer John Dewey believed that every great scientific advance requires “a new audacity of imagination.” But imagination, however bold, is only part of the equation of successful change. Innovation involves not only vision but leadership. Its essence lies both in conceiving an idea and then in applying that idea to make changes that improve lives. Innovation, which includes the willingness to take calculated risks, is one of the seven core values articulated by the Dugoni School of Dentistry. Following are profiles of three Dugoni School dentist-innovators from Northern California.

Building a better toothbrush

The life of Dr. Stephen D. Harada ’77, San Francisco, was changed in 1998 by a Friday afternoon emergency, when he treated a patient who suffered deep caries under an anterior bridge. Dentists often exhort their patients to brush better, but Harada’s reaction on that particular day went one step further. “It occurred to me,” he says, “that if this patient were using a better-shaped brush, he could have avoided all that damage.”

Harada thought about what a better shape might look like. He sketched out a convex head to curve away from the roof of the mouth and avoid triggering a gag response. He reshaped the bristles into a taper on both edges to act as a guide plane, allowing the brush to fit the anterior lingual curve of a dental arch. He insisted on extra-soft bristles of consistent diameter to minimize enamel and cementum abrasion, arranging by mathematical formula a “planar sweet spot” of mid-brush, bristle-tip maximum tooth contact to enhance performance and reduce bristle bending and splaying. He also added a handle with a reverse curve at the neck to allow a further, unhindered reach to posterior teeth. Harada also designed the brush to fit in a cup holder. “It’s a crowded market,” he says. “I didn’t want a ‘me-too’ product. I wanted a brush that would be elegant in its simplicity, where every aspect is pure function.”

Harada went on to design two other toothbrushes. The Curvex II is a multifunction brush meant for children and handicapped or impaired adults, as well as orthodontic and partially edentulous patients. It features a T-shaped handle manipulated by the fingers, instead of wrist action, and held either vertically or horizontally for easy access to lingual surfaces of anterior teeth. The Curvex 1A, also T-shaped, is designed for the delicate surfaces of infant mouths and those of post-surgery, including implant, patients.

Once he had developed and fine-tuned designs that satisfied all his requirements, Harada applied for patents, which were granted internationally beginning in 2001. He formed a company, Ergonomic Dental Technologies (EDT), and in 2000 raised $250,000 with help from dental school classmates—venture capital for dental products, he points out, is nonexistent—to buy a 16-cavity toothbrush mold made to Curvex specifications. He produced 50 commercial-grade prototypes and passed them out to dentists to try. Positive response to the Curvex was unanimous. Dean Emeritus Arthur A. Dugoni himself, impressed with Harada’s innovations, joined the EDT board of directors.

Harada took the Curvex brush to the Dugoni School of Dentistry for testing. “It’s got to be worthy of the school and the profession,” he thought, “or I’m not selling it.”

Harada took the Curvex brush to the Dugoni School of Dentistry for testing. “It’s got to be worthy of the school and the profession,” he thought, “or I’m not selling it.” He credits faculty members Drs. Shannon Wong and Bill Lundergan ’81 for offering strong support during the process. In 2005, a five-week, single-blind crossover study led by Dr. Lisa Harpenau, associate professor of periodontics, found that the Curvex, which has a 25% softer bristle filament than the Oral-B 40 Indicator, the best-selling toothbrush in the world, was as effective as the Oral-B at plaque removal. The Curvex models, manufactured in the United States, also received the ADA Seal of Acceptance.

In the meantime, Harada’s Patterson Dental representative saw the Curvex. Intrigued, the rep sent samples to the Patterson corporate office in Minnesota. Although Patterson fields thousands of product submissions each month, the company proposed exclusive distribution of the Curvex brand. Harada, who had received other offers of interest, accepted. Since 2008, Harada has found himself traveling with Patterson to all the major U.S. dental shows.

“We are all part of the front lines of health care,” Harada says. “If we see a problem, it’s up to us to design a solution.”

Basic research in an acidic world

Practicing in Monterey, California, Dr. Mic Falkel ’87 felt his frustration mounting.
“I had always been irritated with the way dental anesthetic worked in my practice,” he remembers. “It was central to what I did, but it was also the most variable part of my day. I didn’t like waiting while patients ‘marinated,’ and it really bothered me when they didn’t get numb.”

Falkel also remembered his professors at Pacific teaching that dentists can build a practice on painless injections—which is one reason he took extra care in delivering anesthetic. “But there is always someone who will wince at the first drop of anesthetic, no matter how carefully it is delivered,” he says, “And there are those cases, such as pulpitis and infection, where the anesthetic just doesn’t work well.”

As a practice-building routine, Falkel always calls each day’s anesthetized patients in the evening, just as his third-year group administrator, Dr. Ron Borer had advised. What he discovered was that patients often had no pain from the procedure, but reported discomfort at the injection site. Falkel has a bachelor’s degree in chemistry, and he wondered if post-operative pain might be due to the pH of the anesthetic, which he knew was nearly as acidic as lemon juice. He wondered if buffering anesthetic before injection might eliminate the complaints.

Falkel researched the medical literature, accumulating 400 articles on buffered anesthetic. Many of the articles, he discovered, claimed that buffering significantly reduced anesthetic injection pain, and some showed a significantly shorter latency period with buffered anesthetic, which Falkel thought would be a real benefit to his practice. Even so, many other investigators were reporting that they could find no improvement in either injection pain or anesthetic performance using buffered anesthetic. Some commentators called anesthetic buffering “controversial.”

“Where there is controversy in science,” Falkel thought, “there is often opportunity.” Falkel had worked as a chemist in a medical lab during dental school, and he figured that if he could identify—and then find ways to control—the variables that made buffering work, then he might make buffering work to solve problems he had with local anesthetic.

Starting in 2002, he did exactly that, ultimately developing a precision buffering system that carefully manages each of the key variables he was able to identify so that buffering works effectively and reliably. The system Falkel devised, called Onset™, is about the size of a pen and takes under five seconds to buffer an anesthetic cartridge before it is loaded into the syringe. “We think it’s an elegant solution,” he says, “in a simple package, to a complex problem.”

But solving a problem through library and lab work was just the start. “First of all, as a dentist who set out to solve a problem for my own practice,” Falkel says, “I was not really sure if other dentists had the same problems or, even if they did, whether non-dentists would see the value in solving these problems. And although I knew my way around a dental office and the lab, funding and creating a company was a new challenge altogether.”

Falkel turned to friends who had successfully built technology companies and, together, they created Onpharma and took it directly to the experts—other dentists—for funding.

Falkel turned to friends who had successfully built technology companies and, together, they created Onpharma and took it directly to the experts—other dentists—for funding. Onpharma’s group of 95 dentist investors understood the need for improvement in dental anesthetic, and most of them now have had the chance to use the product. Falkel notes that this group, which Onpharma calls its “founders,” brings an understanding of the science, and enthusiasm for the solution that can only come from dentist-to-dentist exchanges.

Onset™ will be available to the general market in fall 2010.

Life in three dimensions

Regardless of how James Cameron may describe it, the blockbuster movie Avatar is not 3-D. “Avatar is really a movie in stereo,” explains Dr. Bruce B. Fogel, associate alumni member and clinical associate professor of endodontics at the Dugoni School of Dentistry. “Stereo means that the images come out of the screen. 3-D, on the other hand, properly refers to images that can be rotated 360 degrees.”

Fogel, CEO and vice president for sales for eHuman, Inc. and senior author of eHuman’s 3-D Tooth Atlas, works regularly in three-dimensional imaging. His Cupertino-based company traces its roots to 1998, when Dr. Paul Brown, a clinical assistant professor of endodontics at the Dugoni School of Dentistry, and a colleague of Fogel’s, participated in a project involving NASA and Stanford University to educate astronauts about how to deal with medical and dental emergencies. The astronaut training included a practice simulator to learn anatomy. “We are passionate about teaching,” Fogel says, “and we realized that we had an opportunity to change a paradigm of teaching and learning, from using illustrations produced in traditional, static two dimensions to interactive 3-D images.”

In 2000, Brown formed a company with Dr. Eric Herbranson, an adjunct assistant professor of endodontics at the dental school, and applied for a multi-year grant from the National Institutes of Health (NIH) to develop a prototype for a library of dental anatomic imaging. “We started with the pulp—what we knew best—and worked our way out, later including occlusion and the temporomandibular joints, using 3-D imaging and animation,” Fogel says of the project. Using the same technology, they also developed an osteology program to facilitate the study of skull anatomy.

The team did its work on Sun workstations at Stanford in 2001 and 2002, where computing power allowed the development of high-resolution images that were then manipulated with proprietary software. But between 2003 and 2006, the power of personal computers jumped to the point of allowing such images to be run on any laptop—a boon for students accustomed to screens full of games and graphics. “Students intuitively understand the advantages of 3-D imaging,” says Fogel, “and they feel comfortable with the technology. One of our jobs nowadays is to educate the educators, who must meet the expectations of the students.” Fogel’s 3-D Tooth Anatomy is currently used in 75% of North American dental schools, as well as for dental education in private practices.

In 2008, the company, boasting a list of partners and collaborators that includes dentists, physicians, surgeons, researchers, educators, artists and technicians, was renamed eHuman. Eleven additional NIH grants, extraordinary in themselves, have funded many of its resources. Most recent products include a 2-D dissection atlas based, Fogel says, on “the finest collection” available of images of human dissection, digitized and made interactive, and quick-reference anatomy capsules downloadable to smart phones. The next step is an online interactive resource. One of eHuman’s recent grants funds an online, interactive dental anatomy course. Future projects include 3-D imaging of all the joints of the human body and an expanding skull atlas to demonstrate variations and aberrations.

The wow factor in 3-D imaging is remarkable, but more important effects include a faster, deeper grasp of anatomy in a non-linear learning environment that can benefit not only students but professors and practitioners as well. “We live in a 3-D—and stereo—environment,” Fogel says. “Seeing anatomy in three dimensions can significantly improve learning.”