new era at temple dental

DIAMONDMaurice H. Kornberg School of Dentistry Magazine | Fall 2013

THE NEXT 150 YEARS

New Era at Temple DentalBeginning a

3223 North Broad StreetPhiladelphia, PA 19140

Non-ProfitOrganizationUS PostagePaidPhiladelphia, PAPermit No. 1044

Copyright © November 2013 Temple University


Contents 1 The Next 150 Years

Dean Amid I. Ismail

3 The Future of Dental Practice“It All Depends on You!”Dr. Michael C. Alfano

6 The Next 150 Years: Where Are We Going in Dentistry?Dr. Howard Bailit

11 New Comprehensive Care Clinics

14 Temple University Kornberg School of DentistryRolls Out Innovative E-Campus Platform

16 Making the Impossible, Possible

20 Making an Impact: Kornberg School of Dentistry Goes Global

24 Faculty Dr. Maobin Yang Bringing New Life to Root Canals

26 Dr. Mustafa A. Badi A Passion for Radiology

28 Dr. Merriam Seyedain, ’11 Her Role in the Future of Dental Care?

29 The Future Depends on Faculty, Faculty, Faculty

30 Faculty News

31 New Course Focuses on Research

Page 11

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Page 46Page 16 Page 24

32 Research Project ENGAGE

34 Research Spotlight Steve Jefferies

35 Thomas Rams

36 Student Spotlight Mark Novasack: Conquering Dental School With a Little Beef Jerky On The Side

39 Student Achievements Dr. Sarah Gray, ’13 Ms. Andrea Frantz, ’16

40 Alumni Alumni Award Recipients

42 Class of 1964 ‘When You Take, You Gotta Give Back’

43 Letter from Dr. Robert Levine

44 Alumni Association Begins “Mentoring for Life” Program

45 Alumni Spotlight More Than Just Dentistry: Judee Hashem-Rapoza, DMD

46 Legacy Families The Shore Family: “Shorely” Proud of Dentistry

50 Remembering Joan Ballots: Dental School and University Supporter

52 In Memoriam

DO YOU HAVE A STORY TO SHARE?

We are looking for alumni to interview for the next Diamond's Alumni Spotlights and we would love to hear

from you. Please contact Editor Ashley LaRosa at215.707.9005 or [email protected].

2014 CONTINUING EDUCATION COURSES

TEMPLE DENTAL ALUMNI DISCOUNT 15% (UNLESS OTHERWISE NOTED)

Wed., Feb. 26, 2014Nitrous Oxide Sedation(HANDS-ON)Dr. Stanton Braid and Dr. Allen F. Fielding

Wed., Mar. 12, 2014Dental Management ofEmergencies and Medically CompromisedPatientsDr. Gary Jones and Dr. Allen F. Fielding

Fri., Mar. 21, 20142nd Annual EngineDriven Instrumentationin Endodontics – PanelDiscussionModerator: Dr. CemilYesilsoySpeakers: Dr. Chris Glass,Dr. Eric Herbranson andDr. Martin Trope

Wed., Apr. 2, 2014Updates in PediatricDentistry: Treating TinyTots to TeensDr. Lance Kisby

Fri., Apr. 18, 2014Feel Good Dentistry – A Sane Approach toEsthetic DentistryDr. Steven Weinberg

Fri., May 16, 2014Limiting Exposure in the21st Century DentalPracticeDr. Michael Ragan

3223 North Broad StreetPhiladelphia, PA 19140http://dentistry.temple.edu

Facebook Link:http://www.facebook.com/TempleDental

Copyright © November 2013, Temple University

DeanAmid I. Ismail

Director, DevelopmentJennifer Jordan

EditorAshley LaRosa

Contributing WritersKyle BagenstoseMeg CaveLeslie FeldmanJessica Lawlor

DesignCynergy IntegratedCynthia BusbeeJanice Ellsworth

PhotographyRyan BrandenbergJoseph Labolito

1

Over the last 150 years, the Philadelphia Dental College, the Temple University School of Dentistry and now the Maurice H. Kornberg School of

Dentistry have experienced, undergone, suffered, and exuberantly witnessedwars, tragedies, triumphs, economic developments, emergence of neweconomies and the disappearance of countries and cultures. In all of theseevents, our dental school has continued to educate dentists (and for severaldecades, dental hygienists) every year. The school thrived in perhaps the best150 years in human history, especially for the United States. I can only con-template what we see today, for predicting what will happen in the future isbeyond the bandwidth of any human. We cannot envision that far but wecan plant seeds that will help those who follow us.

In this issue of Diamond, two prominent dental leaders share their predictionsfor our profession from the perspectives of academia, private practice, andpolicy. They are well known nationally and to our alumni. One shares his cautious pessimism about the future of the profession, while the other is excited about the future. I can attest to you without hesitation that in theyear 2280 their predictions will be proven wrong because the future cannotbe predicted with the limited information we currently have.

Today we face major challenges in dental education. Institutions face a highlevel of competition for faculty who are clinically proficient in all aspects ofgeneral dentistry. This situation was not caused by recent decisions, but bydecades of shifts in funding for higher education to students, growth in theincome of dentists (which is wonderful), and misguided funding strategiesthat shifted research, and hence training funds, awayfrom dental schools to medical and other schools in universities. Our current system of dental and highereducation in the U.S. operates in individual islands thataddress local markets or segments of markets. Theopening of for-profit dental schools in osteopathic medical schools which, like the majority of other dentalschools, are focused on clinical education and on meet-ing the basic standards for accreditation, are threatsthat will haunt the status of our profession, and here-after, our dental school over the next decade.

We have prepared, and are preparing, ourselves for this new world. Afterfive years of planning and execution of critical decisions to increase the fund-ing base for the school and renovating our facilities, we are now competingfor the best students who are choosing our dental school even when they are

“Today we face major challenges indental education. Institutions face ahigh level of competition for facultywho are clinically proficient in allaspects of general dentistry.”

— Dean Amid I. Ismail

MESSAGE FROM DEAN AMID I. ISMAIL

Amid I. IsmailDean and Laura H. Carnell Professor

BDS, MPH, MBA, DrPH, Diplomate ABDPH

150 yearsThe Next

2 Diamond | Fall 2013

given the choice to attend various otherschools. Our averagegrade point average(GPA) and Dental Aptitude Test (DAT)scores are now abovethe national average.Our clinics are evolvingto become care centerswhere more and morepatients will seek careand, hence, provide ourstudents with opportunities to graduate with excellent

clinical skills. We are building and will continue to build our research capacity in areas thathave direct impact on oral health and future management of dental and oral diseases.These changes did not happen because of administrative fiat but rather through the carefulstrategic positioning of the school built on the support of students, staff, faculty andalumni.

Positive change does not just happen, it is created by individuals, groups, other leaders or nature. Finding those leaders who will build the future to become better than today is themain challenge for our country, states, cities and school. The future will not be shaped bymanagers who do excellent daily tasks but by those who can envision the future, select theright targets at the precise time, and convince others to lead the way to reach these targets. Selecting the right target is the core competence of leadership.

Temple University dental school is at that precise moment in its long history to move on apath to reach its destiny. We will remain a center for excellence in clinical care and educa-tion of dentists for the 22nd century that is not only based on developing advanced clinicalskills but on science and, most importantly, professional ethical standards. Please join me inhelping us achieve this target; become a leader and steward of the future of this boundlessdental school.

“We are building and will continue tobuild our research capacity in areas thathave direct impact on oral health and future management of dental and oraldiseases. These changes did not happenbecause of administrative fiat but ratherthrough the careful strategic positioningof the school built on the support of students, staff, faculty and alumni.”


3Diamond | Fall 2013

Michael C. Alfano, DMD, PhDProfessor & Senior Presidential FellowExecutive Vice President EmeritusNew York University

In the joyful spirit of the 150th Anniversary

of the founding of the Kornberg School of

Dentistry at Temple University, this article

should strike an appropriately high-minded,

upbeat tone to match the occasion. Indeed,

on several past occasions I have had the

wonderful opportunity to speculate about

the amazing advances that science and

engineering will bring to an ever brighter

future for the dental profession. However,

on this occasion, Dean Ismail asked for a

“pull-no-punches” assessment of where the

profession seems likely to be headed, so

here is my take on what the dental profes-

sion may look like in a couple of decades,

especially if dentistry in the United States

continues to be dominated by the bastions

of the status quo such as the ADA House of

Delegates, among others. That said, let me

quickly point out that these are my views,

not those of Dean Ismail.

“It All Depends on You!”

THE FUTURE OF DENTAL PRACTICE


My pessimism about the future of dentistry isdriven by the profession’s continuing resist-

ance to changes in the delivery model for dentalservices. Such resistance is certainly not a new phe-nomenon. In 1910, the dentists in Ohio successfullycampaigned to close the very first school of dentalhygiene on the basis that the graduates would notbe as well qualified to perform hygiene services asdentists. Yet, if we fast-forward to the beginning ofthe 21st century, there are now hundreds of dentalhygiene educational programs and ALL parties arewell served by the birth of the dental hygiene profession. The public can receive important servicesfrom hygienists at fees that are lower than whatthey would be if provided by a dentist; the dentist iswell served by being able to focus his/her time onmore complex procedures with associated increasedfulfillment and enhanced practice revenue; and den-tal hygienists themselves are well served by the opportunities for meaningful careers in healthcare.Thus, the reader should be wary that repression ofnew ideas in support of the status quo with its established dental practice revenue models oftenmasquerades as a genuine concern for the well-being of the public. Indeed, not every new idea forchange in healthcare delivery is worthy of imple-mentation. Yet, any thoughtful layperson can seethrough a thinly veneered rhetoric about quality of care to recognize that the perceived economic interests of the dental profession are also driving recalcitrance to change.

History repeats itself. In my 40-plus-year career, Ihave seen substantial initial resistance by the profes-sion to such reforms as expanded-functiondental assistants, routine glove wearing,Medicare, and mercury hygiene, amongmany others. The newest wave of resistancehas been launched in opposition to the efforts in several states to approve a type oforal healthcare practitioner commonlyknown as either a mid-level practitioner ora dental therapist. Two states now allowsuch practitioners—Alaska and Minnesota—and several others are considering the ap-proval of such practitioners, but ‘organized

dentistry’ always mounts strong opposition. The cur-rent position on mid-levels is particularly worrisomebecause organized dentistry is not only opposed tothe licensure of such practitioners, it is opposed evento the study of how such professionals might servethe public and enhance dental practice. I thereforesubmit that this extreme position of not wanting toknow if such mid-level providers can be helpful ornot is no longer simply supporting the status quo, itis an anti-intellectual position unworthy of a science-based profession that rose to university status morethan a century ago. Moreover, unlike the past exam-ples listed above wherein the profession eventuallyreversed itself, today’s ‘status quotians’ could beplacing the profession on the precipice of a declinethat may not be reversible, as I will explain later.

By now you must be thinking that I am firmly ensconced in the belief that the creation of a mid-level practitioner in oral health will be both the answer to the access-to-oral-care problem and a successful vector in mitigating the rise in oral health-care costs in the country. Not true. While I believethe large database from other countries, and theearly results from both Alaska and Minnesota,demonstrates clearly that mid-levels can safely deliver high quality oral health services, I do notknow if the trilevel U.S. payment system—a combi-nation of self-pay, private insurance and public programs—will support such a provider model adequately. Also, I do not know if the creation ofsuch a new type of practitioner will result in the deployment of these practitioners in a manner thatwill increase access to care. Moreover, neither Alaska

“Thus, the reader should be wary thatrepression of new ideas in support ofthe status quo with its established dental practice revenue models oftenmasquerades as a genuine concern forthe well-being of the public.”

— Michael C. Alfano


nor Minnesota constitutes an ideal place to studythese unknowns. In the case of Alaska, the dentaltherapists are deployed primarily in remote villageswith the partial economic support of Native Ameri-can tribes. In contrast, while the Minnesota modelcan be evaluated in the more traditional tri-payersystem, the level of training for a mid-level dentalpractitioner in that state can be as long as six years,thereby creating a health practitioner with the num-ber of years in training, and presumably compensa-tion, approaching that of a dentist. As more stateswrestle this matter to a conclusion, we are at risk ofcreating an oral care delivery model that will vary bystate, type of mid-level training required, disparatescopes of practice, and variable to no supervision, including the establishment of mid-level oral careoffices with absolutely no linkages to a dentist, themost dangerous outcome of all.

I submit to you that this is the course we are on overthe next 20 years. I predict that the anti-intellectualforces will prevail in some states, not others. I fore-see a future whereby no one is well served. The pub-lic will become confused about what services areavailable from a dental therapist vs. a dentist vs. adental hygienist. Dental therapists will practice withthe moral hazard that they might be inclined to fit apatient who is best treated by four implants and anoverdenture, with a full non-implant supported den-ture simply because they might be licensed to makea denture but not to place an implant. Amidst thisconfusion, the esteem of the dental profession willsurely decline as many patients in need of ‘routine’care will migrate to the dental therapist who willlikely charge lower fees for comparable services.Such patients may never avail themselves of the diagnostic acumen or complete range of services offered by a dentist because they habitually seekcare from a dental therapist. Ultimately, this scatter-shot ‘system’ of dental care will create biases andbroken trusts from which there can be no recovery.

Instead of fighting every effort to explore the po-tential of adding a new type of dental practitioner

to the oralhealth team, thedental profes-sion should beallowing thisevaluation tooccur, and if itturns out thatmid-levels canmake valuablecontributions inthe UnitedStates, the pro-fession should embrace their licensure and work to ensure that the professionals are linked to the restof the oral care team and deployed in ways whichenhance the access to care and oral health of thepublic. In this manner, much like the lesson learnedfrom dental hygiene more than 100 years ago, thepublic will be well served with more access at lowercosts and the profession will continue to grow in esteem and to prosper economically.

To paraphrase a former dean of the Harvard Schoolof Dental Medicine:

“Dentists are the most over-educated professionalsfor what they do, and they are the most under-trained for what they should be doing.”

Perhaps the dental alumni of the distinguishedschool of dentistry at Temple University can committo begin to change this. Perhaps they can begin toacknowledge that their best value to society is in ac-curately diagnosing the many oral diseases and oralmanifestations of systemic disease, treatment plan-ning complex patient needs with the most appropri-ate services available, performing complex surgicalservices, managing collapsed occlusions, using phar-macotherapy prudently, and supervising a first-rateteam of colleagues, each with high skills in morenarrow aspects of oral care. Perhaps the future ofthe profession can be bright, but it all depends onyou!

“The public will bewell served with moreaccess at lower costsand the profession willcontinue to grow inesteem and to prospereconomically.”



Howard Bailit, DMD, PhDProfessor EmeritusUniversity of Connecticut

This paper examines trends that are likely to drive changes in dentaleducation and practice and determine the future of the profession. Themajor drivers of change are the prevalence of oral diseases, innovationsin science and technology, and market forces. The paper focuses onshorter-term issues (e.g., 10 to 20 years). The long-term future of theprofession depends on how these issues are resolved.

Oral Disease The United States and many otherdeveloped countries are experi-encing major improvements inoral health. As a result of commu-nity water fluoridation, preven-tive services provided by dentists(e.g., sealants), and better per-sonal preventive behaviors, therehas been a dramatic decline in theincidence of caries and the preva-lence of untreated dental decay.This trend has affected all incomeand education groups and is cer-tain to continue. Older cohorts(e.g., above 65 years of age) whodid not have the full benefits offluoride are declining in numbers.Younger cohorts have much lessdisease.

Not only is the population gettinghealthier, but most untreated dis-ease is concentrated in lower in-come groups. This is not becausethe incidence of caries is thatmuch higher in this segment of

the population. Rather, it is theresult of large disparities in finan-cial access to care. The fact is thatthe lower income population (ca.100 million people) has the high-est prevalence of untreated toothdecay but accounts for less than20 percent of dental expendi-tures. In contrast, people in theupper third of the income distri-bution have relatively little un-treated disease but account for 53percent of expenditures. In otherwords, the population that hasthe resources to pay for dentalservices is in excellent oral health.The population that has most un-treated disease cannot afford topay for private sector dental serv-ices, and public programs for thepoor have significant limitations(i.e., Medicaid, safety net clinics). These trends have major implica-tions for private dental practice.Namely, the effective demand forrestorative care, the financialmainstay of most general prac-tices, is declining. In 1959, 42 per-cent of general practitioner (GP)services were restorations and in

2005, 12 percent. In the future,restorations are likely to accountfor an even smaller percentage ofGP dental services.

While there are other oral dis-eases that require treatment, andmore elderly are dentate and vis-iting dentists, these are not sub-stitutes for fewer restorations. Asrestorative care declines, dentistsare becoming more dependent fi-nancially on diagnostic and pre-ventive services. Prosthetics andspecialty services remain a rela-tively small and declining compo-nent of the average generaldental practice.

It is important to recognize thatthe current dental education anddelivery systems were organizedto provide care to a populationwhere tooth decay was rampant.This is no longer the case, and thetrends are clear—less tooth decayand especially among upper in-come groups. This raises a basicquestion: How many dentists areneeded in the future to meet the

THE NEXT 150 YEARS

WHERE ARE WE GOING IN DENTISTRY?

Trends


effective demand (in contrast toneed) for dental care?

Science and Technology No one person can predict the sci-entific developments in eachmajor area of biomedical researchthat will impact the future prac-tice of dentistry. It is possible tomake some general predictions.First, the billions of dollars spenteach year on biomedical and tech-nology research by governmentsand private industry in developedcountries will lead to more effec-tive diagnostic, preventive andtreatment methods. This will re-sult in new and improved commu-nity and practice level preventivemethods that will further reducethe incidence of caries and peri-odontal disease. More treatmentswill be available that do not re-quire doctoral level training and

can be delegated to auxiliary per-sonnel (e.g., Atraumatic Restora-tive Treatment). At the same time,some new treatments will requireadvanced scientific training (e.g.,stem cell-derived tooth trans-plants).

Second, research on basic diseaseprocesses will result in the closerintegration of dental and medicalcare. The relationship betweenperiodontal disease and a host ofsystemic medical conditions hasreceived a great deal of attention(e.g., type II diabetes). Less wellknown is the impact of medicaltreatments on oral physiology(e.g., salivary flow) and diseases(e.g., xerostomia and caries). Thisis a growing problem as the pop-ulation ages and takes more med-ications. Finally, it is likely thatsome new therapies to prevent

and treat oral diseases will involvethe use of medications that havesystemic side effects. Thus, bothdentists and physicians will needto have a greater appreciationand understanding of the basicpathophysiology and treatmentof conditions that have both oraland systemic manifestations.Overall, advances in biomedicaland technology research will leadto significant further improve-ments in oral health. Dentists willneed a greater understanding ofhuman biology and the clinical(dental and medical) sciences touse these advanced therapies andto interact effectively with otherhealth professionals.

Delivery SystemThe dental care delivery systemevolved over the past 200 years inresponse to local market forces.


While these market forces arenever static, they are now in a pe-riod of relatively rapid change.This review examines one impor-tant area of change, the forma-tion of group practices.

Until recently, the dominant prac-tice model was independent solodentists. Ten years ago, they rep-resented almost 85 percent of pri-vate practicing dentists. Solopractices dominated, becausethey were able to deliver care justas efficiently as group practices.Over the past 20 years, solo prac-tices did increase in size (i.e., op-eratories, staff and equipment). Inpart, this resulted from healthierpatients who primarily needed di-agnostic and preventive serviceswhich, in large part, were dele-gated to dental hygienists. Den-tists also employed more dental

assistants and administrative staffto increase practice efficiency. Now, the number of group prac-tices is increasing and solo prac-tices decreasing. The reasons forthis change are not fully under-stood but are probably related topractice efficiencies related tolarger size. Examples include in-creases in the size and complexityof practice staff, greater use ofexpensive technology, and betteraccess to the capital needed toconstruct, equip and operate dental offices. Another grouppractice advantage is the avail-ability of more dental graduateswho have substantial educationaldebt and are unable to purchasetheir own practices.

Many groups are made up ofabout five offices with two to fivedentists per office. At this time,

there are not many practices with20 or more dentists in the samelocation. Likewise, most grouppractices are not part of larger in-tegrated medical care systems. Itis still unclear who owns thesenew group practices: dentists, cor-porations or others.

In 10 years, group practices willbecome a significant componentof the dental delivery system inmany markets, and they will em-ploy thousands of dentists. This isa major change from the currentdental care system, but it is essen-tially the same delivery modelthat now exists in medicine.

As these groups begin to exerttheir influence at the local marketlevel, they are likely to come intoconflict with solo practitioners.This is because of different finan-


cial incentives. For example,group practices are much betterpositioned to gain from the em-ployment of dental therapiststhan solo dentists. Likewise,group practice companies willwant larger organizations to buythem and may advocate forchanges in dental practice acts topermit non-dentist ownership ofdental practices.

It is also reasonable to predictthat some group practices will tryto contract directly with employ-ers to deliver care to employeesand dependents. This will putthem in competition with insur-ers. A major unresolved issue isthe interest of large medical caresystems (e.g., Accountable CareOrganizations) in owning and op-erating dental practices. To date,this does not appear to be thecase, but it is too early to predicthow medical care systems will de-velop vis-à-vis dentistry.

ImplicationsSo, what impact will the changesjust described in oral health, thebiomedical sciences, and marketforces have on dental educationand practice? It is perilous tomake predictions, because manychanges will take place over thenext 25 or more years that cannotbe predicted. With this in mind,here are few cautious remarks:

Dental EducationDental schools are facing majorchallenges because public supportis declining and educational debtmay soon reach unsustainable lev-els. At the same time, the number

of schools and graduates is in-creasing rapidly, but the demandfor dental care is decreasing.Other professions, such as lawand veterinary medicine have re-cently faced similar challenges,and they experienced dramaticdeclines in applicants. This maywell occur in dentistry, as dentalgraduates find it increasingly dif-ficult to pay back hundreds ofthousands of dollars in educa-tional debt.

If this does happen, will mostdental schools survive by downsiz-ing and operating more effi-ciently or will many be forced toclose? Unfortunately, based on asimilar supply and demand imbal-ance in the 1980s, the latter out-come is most likely. This will be adifficult period for the dental education community, and it willlead to some basic questionsbeing asked: • How many dentists are neededto provide care to an increas-ingly healthy population?While it is true that a large per-centage of the American peopledo not have adequate access todental care, this is not becausethere are too few dentists. Theaccess problem will not besolved until American taxpayersdecide to provide the poor ade-quate public dental insurance.

• What is the appropriate level ofdental school training in thebiomedical and clinical dentaland medical sciences? Researchin the biomedical sciences willproduce new therapies that require a strong science back-ground, and more patients will

have related oral and systemicdiseases.

• Should graduates be required tospend another two or threeyears in residency training, sothey are well trained to providemost dental services and towork efficiently with a full arrayof clinical and administrativestaff and advanced technology?

• Should the education of dentistsand physicians be more closelyintegrated? Clearly, it is goingto be very difficult to operatesmall dental schools efficientlyand still provide students ahigh-quality education. Closerintegration with medical schoolsmay offer major operating effi-ciencies.

• Is dentistry a learned profession(e.g., law, medicine) or a doc-toral level technical occupation(e.g., optometry)? If the former,the education of dentists must bebased in research-intensive uni-versities, and dental schools haveto provide faculty the time andresources necessary to competesuccessfully for research grantsand generate new knowledge.

PracticeDentists also face serious chal-lenges. At the national level dental utilization rates and perperson expenditures began to de-cline five years before the 2007/08economic recession, and these declines are reflected in lowerpractitioner incomes. At the sametime, dentists are faced with arapid increase in the supply ofdental services, resulting frommore graduates and the greateruse of auxiliaries.


How will the majority of dentistswho are still in solo practices respond to these challenges? • Similar to physicians in the1990s, will they form Independ-ent Practice Associations to com-pete with large dental grouppractices and to increase theirnegotiating leverage with pur-chasers?

• Will many solo dentists decideto form or join group practices?The past 20 years have seen thevirtual collapse of solo medicalpractice; the majority of physi-cians are now in some form ofgroup practice.

• Will some dentists see advan-tages in becoming part of largemedical care organizations? Ofcourse, this depends on hospi-tals and medical group practicesmaking a decision to offer den-tal services.

In all likelihood, all these optionswill be pursued, as dentists re-spond to different local marketsupply and demand challenges.

Long TermIt is too early to judge how thechallenges faced by the profes-sion will be resolved. If the rightdecisions are made in the nextseveral years, the long-term fu-ture (e.g., 20 or more years) isbright. This is because most Amer-icans value and want more dentalservices. National norms of gooddental health are high, and allpeople want a functional and es-thetic dentition. Americans alsohave empathy for the less fortu-nate, so in time public resourceswill be available to provide theunderserved financial access to

basic dental services. What all thismeans is that there is a strong un-derlying demand for dental care,if it is affordable.

At the same time the practice ofdentistry has the opportunity toevolve into a medical disciplinewith a firm foundation in the bio-medical and clinical sciences. Re-search is providing dentists inpublic health and clinical practicemore evidenced-based methodsto improve oral health by commu-nity prevention programs andpersonnel preventive and curativeservices, respectively. These advances will make dentistry aneven more satisfying and reward-ing career.

ConclusionsThis review suggests that the den-tal education community andpractitioners face some difficultyears ahead, but the long-termfuture is very promising. Yet, thechallenges now facing the profes-sion are real and must be ad-dressed. Indeed, the real danger isto assume that there are no prob-lems, and that the status quo willcontinue into the foreseeable future. This is clearly not the case.

What dentistry needs are leaderswho will come together and ad-dress these problems, realizingthat they are contentious andlikely to lead to conflict amongpeople of “good will.” They needto take a long-range perspectiveof what is best for the Americanpeople and the profession. Theyneed to convince a disparategroup of dental educators andpractitioners to come togetherand pull in the same direction.They need to convince the profes-sion and the public that this is thetime to make fundamental im-provements in the current systemfor educating the dental work-force and delivering care to thepopulation.

While the times are challenging,this is also a period of opportu-nity and optimism. This idea iscaptured in the famous quotefrom President John F. Kennedy.

“When written in Chinese, theword 'crisis' is composed of twocharacters. One represents dangerand the other represents opportu-nity.”

“When written in Chinese, the word'crisis' is composed of two characters.One represents danger and the otherrepresents opportunity.”

— President John F. Kennedy

危機


New comprehensive care clinics

A lexander Fuller, a fourth-year dental student atthe Kornberg School of Dentistry, had hadenough walking. Every day he’d hustle from

appointment to appointment, up and down flights ofstairs and through the school's long corridors and backagain, to earn his requirements for graduation. Oneday, his curiosity got the better of him.

“I actually wore a pedometer to see how much runningaround I did,” Fuller says. “It came to be almost fivemiles, and that wasn't even a full day.”

But things have changed for Fuller and his fellow stu-dents, after the school transitioned from a department-based model to comprehensive clinics last spring. Itwas a fundamental reorganization of Kornberg’s clinics—pegged by ranking faculty members as a mod-ernization of the school—that grouped all of the juniorand senior graduate students into one of four “clusters”during their final two years.

Now, Fuller reports to not only the same clinic eachday he’s at the school, but the same exact chair. He canperform most procedures on the spot, including thosethat incorporate fixed prosthodontics, removable pros-thetics and limited endodontics, instead of runningfrom department to department. His patients knowwhere to find him, and he works closely with the fac-ulty assigned to his cluster, as well as administratorswho help with scheduling and paperwork.

“It’s much more efficient,” Fuller says. “All the materi-als I need are somewhat close; I don’t have to run upand down floors, between different faculties, and all ofthat. Those were big time wasters.”

That’s an encouraging review for Kornberg faculty, whoforged ahead with the change in May after approxi-mately five years of planning. The transition comes atthe tail end of a trend across the academic world,which saw most universities adopt a comprehensive


model sometime over the past several decades. How-ever, Kornberg’s hesitancy to switch has turned out tobe an advantage.

“We were able to learn from other schools, and othermodels, and take the best of them all to put together inour model,” says Hana Hasson, DDS, MS, an associateprofessor and director of cluster 2B. “For example,other schools have organized their models in such away that a faculty member stays with their studentsthrough two years of clinical practice. So that limitsstudent exposure to different practices and abilities.”

In Kornberg’s model, students are assigned to eithercluster 1, 2A, 2B, or 3, named for the floor on whichthey reside. Each cluster is overseen by a cluster direc-tor, or leader, who is responsible for the progress ofabout 40 students and directly interacts with the cluster’s senior students. The directors are assisted by a faculty mentor, who oversees all of the third-year students in the cluster, and also a team of five or sixfaculty row instructors, an administrator known as aclinical coordinator, and a secretary.

“It’s one big group practice, and very realistic,” saysJohn Friel, DDS, assistant professor and director ofcluster 3. “We have a receptionist that makes and confirms appointments, and a businessperson thattakes credit cards and payments and deals with pre-

authorizations. I think that it’s a big plus for the stu-dents, and they’re learning real-world dentistry, wherethey’re not just focused on one department but thetotal patient care package.”

For their part, students seem to agree that the clustermodel cuts down on headaches. Many fourth-year stu-dents, who saw both models during their clinical careexperience, say the new system reduces the limitationsof quirky computer systems and paperwork while im-proving the patient experience.

“In the old system, it was a battle to get chairs everymorning at 8 a.m.,” says Mary Grace Rizzo, a fourth-year student in cluster 1. “I’d log into a computer system and try and find an opening in the section Ineeded, and it wasn’t necessarily fair because it was justwhoever clicked the fastest. Now I don’t worry aboutthat, I know I have a chair on certain days.”

Michael Saba, a student in cluster 3, says this sometimeschaotic system would often affect patient relationships.

“If you couldn’t get a chair to see a patient, they oftenwouldn't believe that there wasn’t room for them in adental facility,” Saba says. “Then they’d walk in thatday and see half the chairs not being used, because astudent would book a chair just to have it.”

Now, each chair is shared between two students, withseniors taking Monday, Wednesday and Friday morn-ings, and juniors taking Tuesday, Thursday and Fridayafternoons. In addition to resolving the fight for chairs,students also say the cluster’s coordinators and otheradministrators help to cut back on how much paper-work they handle.

“We’re a bit like a den mother,” says Rosalind Neal,who oversees the daily ins and outs as coordinator ofcluster 2A. “Basically, we make sure that operations arerunning smoothly, and act as liaison between the patients, students and faculty.”

For all the positives of the new system, there are a fewpoints of concern for students and faculty. Chiefamong them is the fact that students will see fewer faculty members, and therefore schools of thought,over their two years of providing clinical care.

“The cluster system streamlines things a lot more, but Ialso don’t mind seeing other faculty perspectives onhow to do things,” says Colin Rice, a fourth-year student in cluster 1. “Since the cluster is a set facultygroup, we don’t always get to experience the otherphilosophies or certain faculty members who know[procedures] to do things more quickly.”

However, while some students no longer have the option to pursue chairs with professors of their choice,faculty members say the more personal relationshipsthat result from the cluster system can also have posi-tive effects.

“From a mentorship standpoint, you may only get toknow a small group of students well, but then theyopen up to you,” says Gene Whitaker, DMD, PhD, associate professor and mentor. “If they get to trustingyou, they may share what their problems and weak-nesses are, and that’s what we want them to do. If theyhave an issue, they’re now comfortable discussing it.”

Mentor and associate professor Mark Meraner, DDS,says that more interpersonal advising is a goal theschool has had for years.

“I’ve been here 33 years, and in that period of time[the school] has tried to develop some sort of advisingsystem where full-time faculty would be assigned a certain number of students and do the kinds of thingsmentors are supposed to do now,” Meraner says. “But itwould come and go and never really became consis-tent. There was always a perceived need to do this.”

Another positive of more closely monitoring studentsis ensuring that some don’t get lost in the shuffle ormiss requirements. Mandatory attendance was also instituted—something that caused groans among somestudents but will benefit their experience in the longrun, faculty members say.

“When we started, some students were trying to avoidthe front desk or just go around the corner becausethey’d always done it that way,” Hassan says. “Really,it’s about the change of looking at a patient not as a requirement, but in the sense of providing total care.”

At the end of the day, students and faculty know thatthe most important thing isn’t the number of footstepsthey take, or the amount of papers they fill out, or thebattling over chairs. Instead, it’s two primary questions:Did the patient get the best quality care, and did thestudent get the best possible education?

Time will tell just how much positive impact theswitch to a cluster system will have, but faculty andstudents alike are optimistic that it will only furtherimprove the quality reputation of Kornberg’s servicesand graduates.

“There’s always resistance to change, especially whenyou already have large group practice associations com-ing in and hiring Temple students because they havegreat experience right off the block,” Friel says. “Butwe just felt we could make it better, and I think wehave.”

Despite the fact that Fuller’s clinical rounds no longerdouble as his daily exercise, the soon-to-be graduateagrees that the experience is better for students and patients alike.

“We don’t have to reintroduce a patient to differentfaculty in different rooms and waste time explainingwhat’s going on over and over. Instead, we get right toit,” Fuller says. “We can do more and focus on care instead of paperwork. It’s interacting with a humanbeing instead of a paper trail.”



InnovativeE-Campus Platform

Rolls Out

Online education for the dentalcommunity is about to become awhole lot simpler and more acces-

sible thanks to an innovative new onlineplatform Temple University KornbergSchool of Dentistry is introducing duringthe fall 2013 semester.

The “E-Campus” initiative offers dentistsand dental students an online academicplatform to take continuing educationcourses. The platform features live andrecorded webinars to allow practicingdentists to receive continuing educationcredits and certificates from behind theircomputers, rather than in the classroom.Students and professionals will be able toaccess the new platform via any portabledevice, including laptops, tablets andsmartphones.

The idea for the E-Campus platformcame from Dean Ismail, who taskedMustafa Badi, DDS, MS, assistant profes-sor in the Department of Oral Maxillofa-cial Radiology, with the responsibility ofchairing an advisory committee to bringthe platform to Temple.

Dr. Badi pulled together some of Korn-berg Dental’s best and brightest to makethe idea a reality. A committee of abouteight people, including the dean of aca-demic affairs, the chair of restorativedentistry and the director of the ortho-dontic graduate program, was formed

TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY

This new undertaking will elevateKornberg Dental to new heights in

the dental world.


during the spring 2013 semester tobegin planning.

The E-Campus platform utilizestechnology powered by healthcare -learning.com. This UK-based company specializes in providinginteractive teaching and onlinecourses for healthcare professionals.The advisory committee workedclosely with the company to pre-pare the platform for the Templedental community.

This new undertaking will elevateKornberg Dental to new heights inthe dental world. While onlinecourses are fairly standard acrossmuch of academia, few dentalschools offer online CE courses be-cause of the hands-on nature ofdentistry.

The first course to be offered on theE-Campus platform will be the“Dental Implantology” certificatecourse. Offered completely online,the course will feature material fromseven Kornberg Dental professors.

“The reason we chose to offer thisspecific course first is because it’sKornberg Dental’s largest and mostpopular certificate course,” explainsDr. Badi.

One feature that will certainly dif-ferentiate Temple’s E-Campus ini-tiative from anything that has beendone in online dental education be-fore is the platform’s E-Portfoliofeature. In addition to serving as a

resource for professionals, the E-Portfolio feature will support whatstudents are learning in the class-room by allowing them the chanceto collect case studies interactivelyat a learn-as-they-progress pace.

“We’re considering requiring stu-dents to have at least one E-Portfo-lio throughout their time atKornberg Dental,” says Dr. Badi.“Creating an E-Portfolio will helpstudents with critical thinking andinterdisciplinary skills.” Dr. Badisaid he is unaware of any other den-tal school offering an E-Portfolio tostudents.

Perhaps the most exciting partabout the E-Campus initiative isthat it will not just benefit Templestudents and alumni, but will beopen to students and professionalsnationally, and in the future, inter-nationally.

For years, Kornberg Dental has of-fered successful continuing educa-tion courses on campus, oftenrequiring professionals to commit totraveling to Philadelphia for two tothree days to earn credits. Now, Kornberg Dental alumni, alongwith other dental professionals, including dentists, specialists, assis-tants and hygienists, will have theopportunity to learn from Temple’sfirst-class faculty at their own pace,from the comfort of their ownhomes and offices.

In the future, Dr. Badi hopes theonline platform will utilize moreonline tools, including blogs, tomake learning more interactive andfun. Students will be able to learnat their own pace, take breaks andutilize all kinds of online tools.

“Apart from the E-Campus plat-form being convenient and flexible,it enables Temple to share its dentalknowledge and expertise with theworld,” says Dr. Badi.

Other future plans involve openingup the E-Campus platform to theworld—including translating thematerials to prevent language bar-rier issues. Dr. Badi suspects the firstlanguage the platform would likelybe translated to is Chinese.

As the platform begins to grow andbecome a fixture at Kornberg Den-tal, Dr. Badi expects that the Uni-versity will allow outside dentalexperts to share their knowledgethrough the platform. Temple aimsto be the thought leader behindthis new technology that will bene-fit dental professionals for years tocome.

“Dentistry is such a hands-on pro-fession,” explains Dr. Badi. “Whilewe understand the importance ofkeeping our program hands-on, wealso want to adapt to the world welive in by helping future dental pro-fessionals learn in the ways that suitthem best.”

MAKING THE IMPOSSIBLE, POSSIBLE

It’s May 24, 2013, and the entire preclinical lab forgeneral dentistry has been fully demolished. Thetimeline was just two weeks, but an even tighterdeadline lies ahead. In three months, an entirelynew lab must be ready for incoming students.

To accomplish this feat, two shifts of 18 men eachwill essentially work around the clock for the firstmonth. Then as certain plateaus are reached, theteam of tradesmen will be scaled back accordingly.

All utilities will be relocated the only way thatmakes sense: in the ceiling of the clinic below.Plumbers alone will put in 1,000 feet of piping—without impacting operations.

Monumental Constraints“That was the goal,” says Theo DeSanto, Temple’ssenior project manager, facilities management, as hereflects on the undertaking. “That was why weworked at night.”

The constraints were obviously monumental: use ofan existing space, a short time period and a tightbudget. “It was more difficult than building a housewith three levels,” says Dean Ismail, who admits hewas prepared for construction to be completed oneto two weeks late. “But Theo is the person whomade it happen,” he emphasizes, with a nod ofagreement from Dr. Dan Boston, associate dean forclinical comprehensive care who helped coordinatethe project.

A centerpiece of the renovation is certainly the sim-ulator. No longer a head on a stick as in the previouslab, the simulator is a patient torso and “exactly likeseeing a real patient,” says Dr. Boston. “It’s the lat-est model from a manufacturer who makes dentaloperating equipment. You can develop ways ofworking, get the proper approach and not learn badhabits.” Helping also with the true-to-life environ-ment are the instruments. They’re legitimate ones,identical to what’s in the school’s general sterilizedsystem.


Before (left) and after: Nothing is the same in this largest simulation labin the country.


Such thoughtful planning marks each element ofthe design. Nothing is the same as it was. Aisles arewider for ease of movement. Benches are lowerwith no cabinets above to impede sightlines and student interaction. Internet and intranet capability,monitors that can show live video and documentsfrom the instructor station and hookups for guestlecturers’ laptops enable use of the most currenttechnology. Portable and standing microphonesallow instructors to move around and engage stu-dents. Electric, suction, natural, water, compressedair, an active filtering system for fumes and an AVsystem are all squeezed into customized stationsthat make use of every square inch.

Overall, the look is inviting and comfortable. Ratherthan one large room, two smaller ones, mirror im-ages with 71 stations each, create a friendlier space.In the middle is a lab enclosed with lots of glass. Atthe entrance is a display case with large replicas ofdental instruments and a skylight that captures lightfor the instructor station. Graphic blocks of color, actually doors on locked instrument cabinets, filltwo ends of the room. Still to come is artwork thatwill add interest to the walls.

Also to come is a digital lab with milling stations forcrowns, prostheses and other restorations. With allthe infrastructure in place, work will begin in aboutsix months. It will be the last step in a renovationthat features the largest simulation lab in the coun-try.

Blazing Some TrailsFinancing for the project came, in part, from theuniversity. “The Dental School is paying off a five-year, $4 million loan from Temple,” says Dean Ismail.Ken Kaiser, Temple’s interim chief financial officerand treasurer, describes his reaction to the request.“We were happy to partner with the dental schooland the dean. It’s a worthwhile project, and it’s theright thing to do for the students. The dean hadgreat ideas and was creative. He didn’t just ask for ahandout. He’s using his own resources, too. It’s been

Week of June 3, 2013

Workstations looking south, July 26, 2013

Row A close-up, August 7, 2013


used as a model, jump-starting deals with otherdeans for new programs or renovations. He’s blazingsome trails.”

At a time when Temple is changing its budgetmodel, Kaiser is particularly pleased that Dean Ismailis thinking entrepreneurially. “Our new budget isbased on revenues rather than expenses, and thedean is generating new revenues. So the more rev-enue he brings in, the more he can spend.” Com-ments the dean: “Things do not just happen. Theyhave to be made to happen.”

Asked why he wanted to renovate now, Dean Ismailexplains, “The lab was built in 1990. It was 23 yearsold and deteriorating. We couldn’t get parts. Tech-nology has advanced, and our students could see thedifference. We’re now providing students with theenvironment they deserve for excellence in clinicaleducation and practice.”

To reach that goal, planning began with input froma faculty committee. “We developed requirementsbefore construction,” says Dr. Boston. “Then we sawfour designs before the dean and the faculty choseone.” Providing coordination from the school side in


the initial stages through to completion, Dr. Bostonmet regularly with the architect, contractor and sup-pliers. “We were lucky that general contractor J.J.White stayed with us. He had worked on our otherclinic renovations and knew the school and had thesame workers. We also appreciate the quality workof architect Brian Ychyshen from Bohlin CywinskiJackson.” But it’s DeSanto who gets the highestpraise. “I’m sad to see Theo leave,” Dr. Boston re-marks, recognizing that DeSanto needs to move onto other Temple projects. With a smile, DeSanto re-sponds, “I’m very proud of this particular renova-tion. The level of detail and design in a shortamount of time was quite a task.”


MAKING AN IMPACT: KORNBERG SCHOOL OF DENTISTRY

Goes Global

The school’s students and faculty members gain first-hand knowledge ofthe global challenges in accessing oral health care as they provide treat-ment and education to adults and children. In addition, faculty travel internationally to teach, provide academic or professional consultation orconduct research with international colleagues.

The school recognizes that its graduates are entering a truly global profes-sion. The school’s vision encompasses both local and global perspectivesand aims to contribute educational, research and service outreach that willmake a positive difference right here in the community and beyond.

The Advanced Education in General Dentistry/Master of Sciencein Oral Biology (AEGD/MS)Kornberg School of Dentistry offers Kuwaiti residents a certificate programfor both AEGD-1 and AEGD-2, a two-year overall AEGD program com-bined with either a Master’s of Science or a Master's of Public Health de-gree. Additionally, the Kuwaiti residents are eligible to challenge theAmerican Board of General Dentistry written and verbal examinations.This program, which began in the 2011-2012 academic year, was started toprovide Kuwaiti dentists with training in more advanced dental proceduresso they can be more versatile and provide outstanding quality care to theirpatients in Kuwait.

“Through this program, the students,faculty and staff learn about Kuwaiticulture and lifestyle,” explainedAlessandro Bartoletti, DMD, director,AEGD Program. “Similarly, theKuwaiti residents gain the invaluableexperience of learning about our cul-ture and lifestyle in addition to theadvanced clinical training they re-ceive.”

Following completion of the program,residents return to Kuwait to practice

within the Ministry of Health system for three years. Once that time iscomplete, they will be able to either remain with the Ministry of Healthor, should they so desire, enter private practice in Kuwait.

THE KORNBERG SCHOOL OF DENTISTRY EXTENDSITS MISSION INTERNATIONALLY

Kuwaiti students gather for dinner for a night outwith the dean and several faculty members.


The Global Collaboratory forCaries ManagementThe purpose of the Global Collabo-ratory for Caries Management heldin June in London was to completeprotocols for the Practice and Edu-cation domains of ICDAS andICCMS. ICDAS is a caries classifi-cation system that was started incollaboration with various coun-tries across the globe to define anddevelop consensus on how best topreserve tooth structure throughprevention of the initiation oftooth decay and the minimal re-moval of cavitated hard dental tis-sues. Dean Amid Ismail was one ofthe team leaders in the project.This conference was a follow-up on

the previous global caries manage-ment workshop which was held atKornberg in 2011. A new protocolfor caries management will help theschool to implement a contempo-rary cariology and restorative careprogram.

“The conference helped promoteoral health across the world as theprotocols for caries classificationand management will be standard-ized across the globe,” said GayatriMalik, BDS, PhD, assistant profes-sor, Pediatric Dentistry and Com-munity Oral Health Sciences, whowas selected to attend the confer-ence. “The meeting was very bene-ficial as I got to interact with

renowned leading researchers anddental practitioners and share theirthoughts on the current dentalpractice. We also got an opportu-nity to be a part of a group which isputting together various protocolsin preventive dentistry, which isgoing to be the future of dentalpractice.”

He added that during the fewmonths he has been at Kornberg,he has realized that the dean’s pro-gressive ideas and collaborationwith various countries on differentaspects of clinical and research dentistry will help Kornberg toshare and integrate ideas from allover the world. “This will help us in

Participants from numerous countries traveled to London for the Global Collaboratory for Caries Management this past June.


providing our patients with state-of-the-art dental care.”

Matthew Palermo, DDS, interimchair, Department of RestorativeDentistry, who also attended theconference, said “the various inter-national programs provide Korn-berg with an opportunity to shareits knowledge with other countries,and also give us a perspective on is-sues they are facing. Education isneeded in many regions of theworld, and Kornberg is helping toclose the knowledge gaps in theseregions.”

The Alliance for Oral HealthAcross Borders The Alliance for Oral HealthAcross Borders is an organizationthat currently includes over 40 den-tal schools, companies, foundationsand individuals. The organization,of which Dean Ismail is chairmanof the board, is focused on develop-ing ambassadors to promote peaceand understanding among dentalstudents and faculty from diverseregions of the world that are inconflict. A major online and face-

to-face training program will belaunched in December in NewYork. Program sites where memberscan collaborate and work togetherare being identified.

TopchoiceKornberg is negotiating with privatedental groups in China to providecontinuing dental education fordentists from that country workingin private practice. It is expectedthat the first course will be offeredin Philadelphia this December.

Bridge to PeaceOn July 10, Dean Ismail was akeynote speaker at an American, Israeli and Palestinian gathering ofdentists and dental leaders inJerusalem to celebrate the unveilingof the Tree of Peace at Al-QudsUniversity. This new tree representsthe fourth tree unveiled in theworld. Allen Finkelstein, DDS,Class of 1969, is the primary spon-sor and donor for this initiative.

On May 4, 2012, a Tree of Peacewas dedicated to the KornbergSchool of Dentistry by Dr. Finkel-stein, in honor of his children andgrandchildren. Designed by Parisiansculptor Hedva Ser, a UNESCOArtist of Peace, it is a reminder ofthe strides being made to create alegacy of global peace through

Bridge to Peace students attended a “white-out” Temple Men’s basketball game during theirstay. From left, Orit Markman, Batoul Abuassba, Areen Saleh Abdo, and Liat BenMoyal-Segal.

Visitors from Topchoice toured the dental school this past semester and discussed future collaborations with Temple. From left: Yi Hong, PhD, general manager of Eyar at Topchoice;Dean Ismail; Qihong Fu, DDS, PhD, CEO of Topchoice Medical; Maobin Yang, DDS, MDS, PhD,assistant professor, Kornberg School of Dentistry; and Matthew Palermo, DMD, interim chair ofrestorative dentistry.


dentistry. Ser has been recognizedfor her contribution to the defenseof tolerance and the meeting of cultures through art and for her creation of the Tree of Peace.

“People have more in commonthan they differ,” commented DeanIsmail at the Kornberg unveiling.“All humans need peace, but not alllive in peace. The Tree of Peace is atrue reminder to all of us that peaceis a simple word that has tremen-dous meaning. It is the foundationfor life and prosperity and some-thing we all need to strive for in ourlives.”

“Attendance at international programsand involvement with the Alliancestrengthens Kornberg's position in theglobal dental school arena,” concludedDean Ismail. “The reputation of Kornberg as a global school will createopportunities to bring together students,faculty and staff from around theworld together with Kornberg studentsand faculty to learn about the U.S.and dental education in our country.”

The “Tree of Peace” stands in front of the Kornberg School of Dentistry and is a reminder to allof the strides being made to create global peace through dentistry.


If all goes according to plan, Maobin Yang, DDS,MDS, PhD, is going to bring new life to rootcanals—literally. Dr. Yang, an assistant professor at

the Kornberg School of Dentistry, is focusing his re-search at Temple on the new field of pulpal regenera-tion, which aims to create methods to replace decayed pulpal tissue with healthy, living tissue.

“This is a new direction, especially for endodontics,”says Dr. Yang. “Traditional root canal treatments havebeen [relatively unchanged] for about 50 or 60 years,and even went back further with the use of inert mate-rials like mercury before that.”

Dr. Yang says there are two main methods for pulpal regeneration. The first, revascularization, is alreadyused in clinics and involves inducing bleeding into theroot canal in the hopes that it will encourage new, natural tissue development.

“This is not a very predictable method; some cases failand some succeed, and we don’t have a lot of controlover that,” Dr. Yang says, adding that it is difficult todetermine why the procedure succeeds when it does,since it requires pulling healthy, regenerated teeth.

Instead Dr. Yang, in a novel collaboration with the TempleCollege of Engineering’s Bioengi-neering and Biomaterials Center,is much more interested in a second method: tissue engineer-ing. This method involves using acombination of stem cells, growthfactors and biomaterials to pre-dictably create new pulpal tissue inside the root canal.

The three factors work a bit like abowl of soup. The stem cells act as the ingredients, thebiomaterials serve as the pot in which to hold them,and the growth factors work like a secret recipe: whattemperature to use and how long to boil to achieve thebest result.

“The growth factors are usually small molecules, like aprotein, that guide cell proliferation to form the tissueyou want,” Dr. Yang explains. “But the key question ishow to control their release. You need them to work ata certain time, in a certain location. That’s the focus[of our research] right now.”

Although the growth factors might be the most puz-zling of the three components oftissue engineering, the biomaterialspart of the equation needs answersas well. These materials work asthe scaffolding for regenerating tissue, and must have just the rightqualities to be effective. That’swhere the experts at the College ofEngineering come in.

“There are all kinds of biomateri-als. You need one that is not toostiff, won’t be rejected by the bodyand can provide a reservoir for

gross factors,” says Dr. Yang. “I arrived at Temple lastyear, right when the [Center for Bioengineering] wascreated, and we realized what a great opportunity itwas. They’re the experts in biomaterial.”

Dr. Maobin YangBringing New Life to Root Canals

FACULTY

“I arrived at Temple last year, right when the

[Center for Bioengineering]was created, and we realized what a great opportunity it was.

They’re the experts in biomaterial.”

Dr. Yang preforms his clinical research at the College of Engineering’sBioengeneering and Biomaterials Center located on Temple's MainCampus.


Dr. Yang works closely with College of Engineeringfaculty and students, often in the center’s 20,000-square-foot, state-of-the-art lab, to develop appropriatematerials. One key factor is the material’s degradation,which Dr. Yang compares to dissolvable stitches.

“You don’t want materials to stay in the human body,”says Dr. Yang. “You have the rate of tissue regenera-tion, so you have to inversely match that rate with thedegradation of the scaffolding.”

None of this would be possible without recent ad-vances in the study of dental stem cells, which lags behind similar fields. While many of the first stem cellswere discovered by researchers in the 1960s and ‘70s,Dr. Yang says the first dental stem cells weren’t discov-ered until the new millennium.

“The first [dental] stem cell was discovered by a Chinese scholar, who was looking at the inside of hisdaughter’s baby tooth and thinking about what cellsare in there,” Dr. Yang says. “Now we know of fivekinds. And it turns out these cells are obviously moreaccessible than from cord blood or bone marrow.”

The possibilities of dental blood cells have fascinatedDr. Yang throughout his studies and career. Born inChina, Dr. Yang earned his bachelor’s and master’s degrees there and began clinical work. However, he developed a natural curiosityabout how new research mighttranslate into clinical proceduresand decided to pursue a PhD in biomedical science at the University of Connecticut.

“I completed my PhD in 2009but kept thinking about how toapply research to the clinic andcontinued my residency for another three years,” Dr. Yangsays. “I was doing root canaltreatments on a daily basis, andevery day I’m thinking abouthow I take out pulp and put innew material, why not come upwith a different way?”

Now, using the resources at Temple, Dr. Yang is trying todo exactly that. And the possibilities are promising.“Every year in the U.S., 22 million endodontic proce-dures are performed, costing about $30 billion,” Dr.Yang says. “And for kids [who have root canals] theroot is not formed and will not continue to grow, soconventional treatments leave a very fragile tooth.”

While Dr. Yang’s research is currently fully funded bythe university, he says that more money is being setaside by organizations like the American Associationof Endodontics, which earmarked $2.5 million for regenerative endodontics in its budget for next year,and the National Institutes of Health.

“This field is going to become more and more competi-tive because a lot of people think this is the future andwill benefit a lot of patients,” Dr. Yang says.

And although he won’t say just how close the researchis to being ready for bench and animal studies, Dr.Yang seems to think he has a jump on the field.

“This is a hot territory now, but so far we haven’t found another group doing the same thing,” Dr. Yangsays. “We believe the things we’re working on are very innovative.”

Dr. Maobin Yang works alongside his graduate reasearch assistant, Riddhi Ajit Gangolli, who iscurrently pursuing her PhD in Bioengineering at Temple University’s College of Engineering.


Dr. Mustafa A. BadiA Passion for Radiology

Mustafa A. Badi, DDS, MS,assistant professor, Department of Oral Max-

illofacial Pathology, Medicine, andSurgery Division of Oral and Max-illofacial Radiology, has a passionfor technology and was always look-ing for a career that would blendhis dental background with tech-nology. Both the availability of dig-ital dental radiography in the early2000s, and the introduction ofcone-beam CT (CBCT) technol-ogy in the dental field, attractedhim to specialize in oral and max-illofacial radiology.

“I am particularly attracted to thefield of oral and maxillofacial radi-ology because it is the basic study ofdental diagnostic science,” ex-plained Dr. Badi. “Comprehensive

and effective treatment of any dental problem relies on good andsound diagnosis. Also, currentlythere is a shortage of oral and maxillofacial radiologists trained in reading and interpreting the advanced imaging modalities avail-able in dentistry today.”

Dr. Badi joined Kornberg School ofDentistry in January 2013. A gradu-ate of Istanbul University Faculty ofDentistry, Istanbul, Turkey, he at-tended the University of TexasHealth Science Center, San Anto-nio, for his residency and postgrad-uate training. He had been in thedental field for 11 years prior togoing back to graduate school tospecialize. His previous experiencein the field of dentistry includesgeneral dentistry, CAD/CAM den-

tistry, radiology and dental infor-matics.

Oral and maxillofacial radiology isthe ninth specialty of dentistry recognized by the American DentalAssociation. An oral and maxillo-facial radiologist (OMR) is a den-tist specialized in the acquisitionand interpretation of radiographicimaging studies performed for diag-nosis and treatment guidance forconditions affecting the maxillo-facial region. Specialization inOMR requires the completion ofresidency in an American Dental Association CODA-accredited pro-gram. Training includes a thoroughknowledge on techniques and inter-pretation for maxillofacial CT,CBCT, MRI, ultrasound and otherpertinent modalities. OMRs may befurther qualified by passing theAmerican Board of Oral and Maxillo-facial Radiology (ABOMR) exam.

The radiology clinic at KornbergSchool of Dentistry is equippedwith digital intraoral sensors, digitalpanoramic radiography machines,state-of-the-art cone-beam CT ma-chines (CBCT) for both small andlarge fields of view. It has a state-of-the-art radiographic interpretationroom with dual monitors and fineviewing software and a central stor-age of images in a PACS systemthat makes it accessible throughoutthe school.

“Conventional 2D dental imagingtechnology sometimes has limita-


tions in dental diagnosis,” said Dr.Badi. “Two-dimensional radiographsare a representation of a 3D subject.The true third dimension in den-tistry had been missing until the in-troduction of CBCT technology inthe late 1990s and early 2000s.”

CBCT technology utilizes a cone-shaped beam of x-rays to producecomputed tomography images ofthe craniofacial structures at a frac-tion of the dose usually used inmedical imaging. During a CBCTscan, the scanner rotates aroundthe patient’s head, obtaining manybase images. The software collectsthe data and reconstructs it, pro-ducing a digital volume composedof three-dimensional voxels ofanatomical data that can then bemanipulated and visualized withspecialized software. CBCT has become increasingly important intreatment planning and diagnosisin implant dentistry, orthodonticsand endodontics.

“At Kornberg, we are lucky to havea good team of faculty with years ofexperience who specialize in differ-ent aspects of dental diagnostic sci-ences, including oral medicine, oralpathology and oral radiology,” saidDr. Badi. “Since we are in an edu-cational institution, we want ourstudents to learn the best patientcare practices.”

A goal for Dr. Badi, and all of thefaculty and staff, is to provide anoverall positive experience to en-

courage more patients to seek den-tal care. “There are a number of pa-tients that avoid dental care due todental phobia. The more positivethe experience patients have withtheir dentists, the more they’ll bewilling to seek dental care. Thegoal is to encourage and improveoverall oral healthcare in as manypatients as we can and to provideinformation and directions onwhere they need to go next.”

Dr. Badi explained that Kornberghas focused on reorganizing theclinical training structure to reflecta more realistic general practicemodality that will equip the stu-dents with the knowledge and ex-perience they expect to face intheir real-life dental careers. “Thesegeneral practices also have the ad-vantage of providing a permanentlocation for the new patients get-ting admitted in the dental school.This makes it easier for patient’sdental problems to be addressed in a vast dentalschool setting.” He addedthat Kornberg has alwaysbeen known to provideexcellent clinical trainingto dental students andwonderful dental servicesto the community at an affordablecost. “I am hopeful that we willgrow to provide services to evenmore communities. The overallgoal is to train dentists that have astrong background of ethics com-bined with evidence-based diagnos-tic and clinical skills that can

improve the overall oral healthcareof the community. At the same time,I see the school providing excellentaffordable dental care that is focusedmore in comprehensive treatmentand thereby influences dental behav-ioral changes to improve the overalloral health care standards.”

In the future, Dr. Badi plans to develop and provide training thatenables the new dental graduates todeliver quality dental care to thepublic. “Students need to be trainedand educated in the importance oflearning good dental diagnosticskills, understanding the limitationsof dental radiography, radiationprotection and safety, modern conventional and advanced imag-ing modalities, indications and lim-itations of emerging technologies. I will also focus on mentoring students about the importance ofproviding patient-centered overalloral healthcare.”


The question promptedthoughtful and concise answers. That’s because

Merriam Seyedain, who has alwayswanted to teach, knows what shewants to impart to her students asthey begin thinking about their future dental practices.

A periodontist who is also assistantprofessor in Kornberg Dental’s pre-doctoral clinic, Dr. Seyedain saysher goals are twofold: to teach students to see the big picture forbetter comprehensive care and todevelop confident students who canhave positive relationships with patients.

“Comprehensive care is how wewere trained here in residency,” shepoints out. “But when I comparenow to what I was taught as a resi-dent, over time I’ve realized thatthe patient relationship is also veryimportant. I talk to the studentsabout it.They shouldtake time tolisten to pa-tients, seewhat theywant and what they’re interestedin. Then they will be more open totreatment because they know theyhave a part in the treatment plan.”

Asked how the Dental School sup-ports her goals, she responds posi-tively. “Our students get a lot oftreatment planning. The faculty Iwork with are all on the same page.We all practice and teach in a com-

prehensive way. Faculty with differ-ent specialties work together, givingstudents the information they need.”

What also helps, she notes, are thenew clinics. “It’s much easier toteach now. In the past every spe-cialty was separated. Now we worklike in an outside practice, with allfaculty available in every clinic.”

Dr. Seyedaingraduatedfrom theUniversity ofPittsburgh’s

biology program and also from itsdental school, where her brother ison the periodontal faculty. Butwhen looking for a residency, sheremembers how Kornberg Dentalcaught her attention. “I felt reallycomfortable and connected withthe faculty from the first day. Wehave a lot of great names in research in our department and Ibelieve all faculty are clinically out-

standing. I feel really good aboutbeing here and am so glad I choseTemple. It’s a second home for meand has been for five years now.”

Raised in Iran with a father whostill practices as a periodontistthere, she credits him with teachingher what still influences her profes-sionally every day. “I used to assisthim, and he would emphasize, ‘Always live your day so you’re atpeace with yourself when you go tosleep at night.’ ” She recalls that italways came up with both parents,but he thought it was also impor-tant in the field of periodontics. “Infact, it’s a big thing I think about allthe time,” she says. “That’s how Itry to make sure I do what’s best forthe patients. I basically imagine thatthey are my own parents or evenmyself sitting in the dental chair.”

It’s just one more indication of howpatient relations are always on hermind.

Dr. Merriam Seyedain, ’11 Her Role in the Future of Dental Care?

“Over time I’ve realized thatthe patient relationship is also

very important.”

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In just these few words, Dean Ismail sums up theimportance of investing in faculty recruitment anddevelopment. In response, the Dental School plansto establish a new fund that will incrementally raise$5 million over the next 10 years.

“This new fund will enable us to recruit new faculty,significantly strengthening our capacity to maintainexcellence in clinical education and patient care,”explains Jennifer Jordan, director of development.“In the past we haven’t had the capacity to conductsponsored research. Yet the ability to maintain astrong dual mission in clinicaleducation and research is nec-essary in the future.”

Always thinking ahead, thedean envisions a team ofhighly qualified, academicallyoriented clinical and biologicalscience educators and re-searchers, so the school can expand on the predoc-toral and postdoctoral levels. “Temple Dental Schoolwill be one of the top-ranked schools in the U.S. andthe world in its reliance on research and science forbuilding strong health-oriented clinical programs,”says Dean Ismail. “The opportunities are boundless.”

To get there, he is asking two questions. What docurrent faculty need for their development? Whattype of additional faculty do we need to fulfill ourmission?

With plans already underway to hire new faculty,the dean notes, “We expect to be in a pivotal posi-

tion to achieve what many thought was impossiblejust a few years ago.” That’s due to the school’s in-novation in financially managing its resources and increating new financial streams—which has the sup-port of Temple’s president and provost and is in linewith the university’s new budget model that will beintroduced in 2014.

This new phase for Temple Dental fits with the uni-versity’s current direction of building significantscholarship and research capacity. “We are alreadypart of this new emphasis at Temple,” says the dean.

“For our students, the benefitwill be an engaging and scien-tifically based education.”

To prepare the school for thisnew path, Dean Ismail will di-rect a new course, “Science inDental Practice.” It will offerbackground knowledge on the

scientific method and its applications in clinical, bio-medical, epidemiological healthcare and behavioralresearch. For alumni, the course is noteworthy be-cause its annual Science in Dental Practice day willbe an opportunity to earn continuing educationcredits. The day’s presentations of research projectsand critical appraisals of clinical questions will en-gage all students and faculty in considering the ap-plications of science in dental practice.

Be sure to read more in this issue about what’splanned for “Science in Dental Practice”: NewCourse Focuses on Research, page 31.

The Future Depends on Faculty, Faculty, Faculty

“We expect to be in a pivotalposition to achieve what

many thought was impossiblejust a few years ago.”


NewsDr. Daniel Boston, associate dean for comprehensiveclinical care, presented an abstract as a poster presen-tation at the national American Dental Educationmeeting in Seattle in March 2013 on “New programfor online capstone comprehensive case presenta-tions.” Dr. Boston was also appointed to the editorialboard of the online journal, “Case Reports in Den-tistry,” and was issued the following patent as an inventor: Selective Dentin Caries Excavator, Italian Patent 1 143 873, November 28, 2012.

Dr. Susan Chialastri, associate professor in the department of periodontology and oral implantologyand graduate of the class of ’87, received the 2013Faculty Award from the Class of 2013. This was pre-sented to Dr. Chialastri at the Senior Banquet dinnerat the Water Works Restaurant on May 9, 2013. Dr.Chialastri was also named the Faculty Speaker at Commencement for the Class of 2013 on May 17,2013, at the Academy of Music.

Dr. Chialastri is the 2013 recipient of the College ofHealth Professions Gallery of Success Award and the2012 Herbert G. Frankel Award as Outstanding Xi PsiPhi Alumni, which was presented to Dr. Chialastri bythe Supreme Chapter representatives on September 4,2013.

Dr. Chialastri also completed the Teaching in HigherEducation Certificate Program in July 2013 throughthe Education Department at Temple University.

In January 2013, Dr. Lisa Deem, ’87, associate deanfor Admissions, Diversity and Student Services, waselected chairperson of the Pennsylvania State Boardof Dentistry. Dr. Deem will serve for at least a year.

On Saturday, September 14, 2013, Dr. ThomasDeem, ‘85, was honored as“faculty member of thegame” at Lincoln FinancialField as the Temple OwlsFootball Team faced theFordham Rams.

Dr. Deem is an adjunctfaculty member in theDepartment of Restora-tive Dentistry. He is an

outstanding faculty member at the Dental School andalso volunteers his services for Temple Athletics.

Dr. Thomas Rams, professor in the Department of Periodontology and Oral Implantology, was awardedhis PhD in Medical Sciences on September 9, 2013,after presenting his thesis on “Antibiotic resistance inhuman periodontitis and peri-implant microbiota” tothe University of Groningen in the Netherlands.

Dr. Matthew Palermo, interim chair of the Depart-ment of Restorative Dentistry, lectured at two nationalmeetings over the past year: the American Academy ofPeriodontology Annual Meeting in November 2012and the American College of Prosthodontics EducatorsMeeting in April 2013. Dr. Palermo was also elected asthe Chair of Predoctoral Prosthodontic Educators Committee in the American College of Prosthodonticsand the Executive Counsel of the American Prostho-dontic Society.

Dr. Jie Yang, professor in the Department of OralMaxillofacial Pathology, Medicine and Surgery, hostedthree international visiting research scholars over thepast two years; Dr. Ling Zhu from Shanghai Jiao TongUniversity School of Stomatology; Dr. Zuyan Zhangfrom Peking University School of Stomatology, and Dr Fangfang Xie from Guangxi Medical UniversitySchool of Stomatology.

Dr. Yang was also invited to be either the keynote orguest speaker at the following international schools orcongresses: 53rd Dental Information Education Scien-tific Forum, Faculty of Dentistry in Padjadjaran Univer-sity; Faculty of Dentistry at Mahasaraswati DenpasarUniversity; 9th Asian Congress of Oral and MaxillofacialRadiology; and the Chinese Stomatological Associa-tion’s Annual Meeting in 2012.

Dr. Yang was recently electedto serve as the secretary to theBoard of the International Asso-ciation of Dento-Maxillo-FacialRadiology (IADMFR) and electedto serve on the Executive Councilof the American Academy ofOral and Maxillofacial Radiologyand serve as the Councilor for Educational Affairs.

FACULTY


New Course Focuses on

RESEARCH How can Kornberg more fully engage the dental

school community in research activities? That’sthe question a new course, “Science in Dental Prac-tice,” is designed to answer.

For instance, suppose students are grappling withthe issue of whether to consider dental implants fora patient taking bisphosphonates. In this course, stu-dents will do a structured assessment of current lit-erature, looking for all available evidence. Thenthey’ll appraise the evidence and make some conclu-sions about how to apply it to professional practice,while also considering patient values and prefer-ences. The idea is twofold: to involve students andfaculty in the process of scientific inquiry and to pro-vide feedback into the curriculum and patient carefrom evidence-based findings.

Noting the benefits for students, Dr. Maria Forna-tora, associate dean for Academic Affairs, is enthusi-astic. “This unique, innovative educational andprofessional experience will give all students an op-portunity to be involved in research and learn howto critically appraise and apply the literature to pa-tient care. It will also sharpen their ability to thinkcritically about patient care by asking the right ques-tions and seeking evidence to support what we doand how we practice now and in the future.”

She adds, “Being involved in school-wide researchand scholarship as a predoctoral student is a terrificopportunity in and of itself. But the course also pro-vides our students with the skills they need afterthey graduate, so they can fulfill their professionalresponsibility to be lifelong learners who incorpo-rate emerging information and best evidence intotheir daily practices.”

The vision of Dean Ismail, the course isscheduled to begin a phased-in imple-mentation within the next 18 months.

Two components will be included: an online seminarseries through Temple E-Campus and a practicumthat requires each student to attend four annualScholarly Activity and Research (SAR) Days held inthe spring and to actively participate in at least oneSAR Day by presenting a scientific poster. The onlineinstruction will focus on such topics as philosophy ofscience and the scientific method, ethics in humanand animal research, how to do a literature search,methods in molecular biology, and evidence-baseddentistry. To develop a poster, each faculty-men-tored team of 4-5 classmates will answer a questionrelevant to oral healthcare or dental education.They’ll reach their conclusion by appraising biomed-ical, clinical, translational, educational or epidemio-logic literature and research. Initially, posters will beprinted and displayed in Mitten Hall, and studentswill present orally to their peers, browsing facultyand the judges. “Eventually,” says Dr. Fornatora, “itwould be ideal to have large monitors instead ofboards, so the posters are displayed digitally. Itwould be much greener!”

Currently, predoctoral students seek out faculty andprojects if they’re interested in research. Since theydo research only in their limited spare time, just asmall minority participate now in research days, saysDr. Fornatora.

Although the dean developed the course, he soughtinput from three faculty groups: the Research Com-mittee, the Management Committee and the Cur-riculum Committee. The result is one that Dr.Fornatora is “delighted to be able to include in ourDMS curriculum.”

Two components will be included: anonline seminar series and a practicum.


RESEARCH

At first glance,the KornbergSchool of Den-

tistry’s Project ENGAGEmay appear to be a $1.75million philanthropic en-deavor. Funded by a $1 million grant from the UnitedHealth Foundation and a $750,000 grant from UnitedHealthcare, program workers will ring phones andknock on doors in North Philadelphia neighborhoodsin an effort to help a vastly underserved youth demo-graphic access dental care.

Currently, only 30 percent of children under the age of6 in the zip codes near Temple University have accessto proper dental care. Project ENGAGE hopes to doublethat number to 60 percent by providing education, assisting in scheduling appointments at local care clinicsand even by applying varnishes or sealants in livingrooms.

However, there’s something bigger at work. KornbergDean Amid Ismail, the primary architect of ProjectENGAGE, hopes that in several years healthcare in-dustry experts will look back and see the project as theoriginal blueprint for a new way of providing, and pay-ing for, dental care.

“The current dental care system relies on people tocome to us, and the reality is that people will oftenonly come when they have a problem, even when resources are available to them,” Dean Ismail says. “Butby placing more emphasis on prevention and manage-ment of disease, we may be able to shift very high-costhospital treatments to lower-cost clinical treatments.”

Dean Ismail has been a believer in this approach evenbefore legislation like the Patient Protection and Af-fordable Care Act altered the national conversationaround healthcare. He had shopped the idea to differ-ent funding sources for more than half a decade beforefinally receiving the UnitedHealth grants last winter.

Dean Ismail says it’sjust a matter of timing.

“We were ahead of our timeproposing this [five years ago], before people

started talking about systems and integrated care,”Dean Ismail says. “And in this case, a health insurancecompany became interested in testing a new model,because everyone is tracking the realities of high-costcare. And we believe we can provide a solution.”

Dean Ismail is a major proponent of providers’ takingthe first step toward improving an individual’s health-care, something he views as the opposite of the currentsystem and came to realize while working with innercity neighborhoods in Detroit. “It’s not just about hos-pitals and treatments, but what happens in the com-munity and the home,” Dean Ismail says. “How do youencourage people to take care of their own decisionmaking, and change their lifestyle?”

However, there was one major hurdle to the dean’sidea to visit families in their own homes. In order tofind these at-risk individuals, he would need to accesslarge swaths of patient medical histories and home ad-dresses. Not only that, he would then need to sharethis data with community workers hired and trainedfrom the very neighborhoods that the program targets.Not an easy sell for a healthcare provider’s legal team.

“We went into unchartered ground, with a health in-surer giving data on their patients to a dental school,for use in a large registry, which will then be accessedby people in the community,” Dean Ismail says. “Whenwe first presented that, they said ‘Are you really seriousabout doing this?’”

However, after a lengthy legal review that involvedUnited Healthcare, Temple University and state agen-cies, the project was green-lighted. The majority of thepatient data will be provided by United Healthcare,with records added from the state Medicaid program,

P R O J E C T

Engage

Kornberg and partnering clinics. The school brought ina third-party vendor to build a registry over the fall,and community workers will be making their first callsthis winter.

But then the big question will need to be answered:Will the program become financially sustainable? DeanIsmail says initial funds will last less than two years.Anything beyond that will require new capital.

“We’re going to rely on income generated from servicesto sustain the program,” Dean Ismail says. “So that’sanother novel aspect: If we’re successful, other partnerswill come into the program with funding. You can con-sider this the startup fund, and then we’ll start gainingoperational funds.”

But Dean Ismail is thinking bigger still.Given what he sees as a currentlyunsustainable, high-cost system, hebelieves the model could be ex-panded to other Philadelphianeighborhoods and regionsof Pennsylvania, and evenbe replicated across the coun-try.

“Depending on how it’s done, it’s finan-cially beneficial to bring more peopleto the provider,” Dean Ismailsays. “We’re at the point intime where more re-sources need to be in-vested to expand the baseand expand access to care.High costs are really shiftingthe way dentists practice and areimpacting their income, and weneed a different approach.”

Because of this dynamic, DeanIsmail believes that

the $1.75 million in grant money is not so much aphilanthropic donation for United Healthcare as it isan investment in the future.

“We can’t afford a system anymore where we providecare to a community and then leave,” Dean Ismail says.“This is to be a sustainable model, and insurance com-panies agree we need to increase the base. We can’tkeep pouring in money trying to make the current piework. We need to make a new pie.”

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RESEARCH SPOTLIGHT

The Kornberg School of Dentistry has many faculty members currently working onresearch that will significantly impact the future of the field of dentistry. As welook to see how the next 150 years of dentistry come to life, there is no doubt thatour researchers will play a role in this. In this section, we take a look at two of ourresearchers and find out what motivated them in their fields, what projects theyare working on, and what their future plans are.

STEVE JEFFERIES

1. What projects are you currently working on?My major research project is translational researchconcerning bioactive dental cements as well as theexamination of some of their unique properties. Iam also in collaboration with a researcher in Europeon a unique technology for remineralization andfluoride/drug delivery.

2. Who will this benefit and how?These materials and their bioactive/remineralizationproperties may aid in the remineralization of earlycarious lesions and may reduce the risk of secondaryor recurrent dental decay in restored teeth.

3. Are you collaborating with anyone?Professor Håkan Engqvist at the Angstrom Institutein the University of Uppsala, Uppsala, Sweden.

4. What has been your most significantachievement (scientific or not)?Scientifically/technologically: the invention of En-hance Finishing Device/Enhance Finishing-PolishingSystem; and my translational research on bioactivecements.

5. Favorite scientist/researcher and why?May I list two: Benjamin Franklin: He was truly a multitalented, politically savvy scientist.Ignaz Philipp Semmelweis: An early pioneer of anti-septic procedures whose highly important scientificobservations, which challenged the prevailingdogma, were accepted only many years after histragic death.

6. Tell us about your first science project/experiment:I built a wind tunnel for a 7th grade science project.

7. What do you hope to accomplish in the future?Continue my research on the novel and uniqueproperties of bioactive dental cements.


1. What projects are you currently working on?I am evaluating the extent of antibiotic resistanceamong subgingival and submucosal bacterialpathogens in human chronic periodontitis and peri-implantitis. Additionally, I am assessing the anti-bacterial effects of dental lasers on periodontal bacterial pathogens.

2. Who will this benefit and how?Patients with chronic periodontitis and peri-implan-titis may receive better optimized antimicrobialtreatment regimens that are selected based onknowledge of antibiotic-resistance patterns of theirtargeted pathogenic bacterial species. Additionally,study of the antibacterial effects of dental lasers onsubgingival bacterial pathogens may help explainclinical outcomes associated with certain dental lasertreatment protocols.

3. Are you collaborating with anyone?I collaborate with Dr. Jon B. Suzuki within the dentalschool, and outside the dental school with Dr. Arie J.van Winkelhoff, a periodontal microbiologist at theUniversity of Groningen in the Netherlands, and Dr. Jorgen Slots, a periodontist and oral microbiolo-gist at the University of Southern California in LosAngeles.

4. What has been your most significantachievement (scientific or not)?Co-authoring with Dr. Paul Keyes at the National Institutes of Health a series of clinical research stud-ies in the 1980s on microbiologically modulatednon-surgical periodontal therapy.

5. Favorite scientist/researcher and why?Dr. Paul Keyes was my first periodontal disease men-tor during my dental staff fellowship at the NationalInstitutes of Health in the 1980s. Dr. Keyes, a leg-endary figure in dental research, is the most decentand intellectually honest individual I have ever met,and an excellent role model, from whom I learnedfar more than merely how to better treat periodon-tal diseases with non-surgical anti-infective treat-ment regimens.

6. Tell us about your first science project/experiment:Study of mutagenic compounds in chlorinated wastewater effluent during my master’s degree programin environmental health sciences at Johns HopkinsUniversity School of Public Health prior to my dentaldegree studies.

7. What do you hope to accomplish in the future?Further research studies and journal publications focused on application of diagnostic microbiology,antimicrobial agents, dental lasers, and probiotics inperiodontal disease therapy.

THOMAS RAMS


Think you’re busy? Think again.Mark Novasack is a 32-year-old hus-band, father of two, former engineer,entrepreneur and full-time, third-yeardental student at Temple University Kornberg School of Dentistry.

FROM ENGINEERING TO DENTISTRYAfter graduating from Lehigh Univer-sity in 2003 with a Bachelor of Sciencein mechanical engineering, the Lin-wood, N.J., native took a job as a de-sign engineer for a consulting firm inNew York City. After years in the BigApple, he switched jobs to a firm inKing of Prussia and relocated to Chest-nut Hill, Pa., where he lives now withhis family.

Novasack was on the fast track to suc-cess as an engineer—he had recentlyearned his professional engineering li-

cense, which is often compared to asrigorous a process as a lawyer preparingfor the bar exam.

After seven years working as an engi-neer, Novasack had a change of heartand decided to pursue a career in dentistry.

A COMPLETE 180During their honeymoon in 2008, Nova-sack and his wife, Kathleen, talked atlength about their dreams and futuretogether. There was a poignant mo-ment when Novasack admitted that hewasn’t sure engineering was what hewanted to do for the rest of his life,and he and Kathleen mulled over theidea of his going back to school.

“I looked at the people above me at myjob and just realized that I wanted todo something different,” he says. It wasthen that dentistry popped into Nova-sack’s head, and he began to seriouslyconsider returning to school to beginhis career for the second time.

No stranger to the dental world, Nova-sack grew up around the field. His father,George F. Novasack, has run a successfulpractice in Somers Point, N.J. for years.

“My dad never pushed me into thefield, but I always had a feeling in theback of my mind that I might end upbecoming a dentist,” Novasack remem-bers. “I wanted to do more—to directlyhelp people and take them out of pain.In my career as an engineer, I wasn’table to do that.”

MARK NOVASACKConquering Dental School With a Little Beef Jerky On The Side

STUDENT SPOTLIGHT


His friends thought he was nutsto give up all he had accom-plished as an engineer, but Nova-sack trusted his gut. He also hadthe support of the most impor-tant person in his life—his wife,who agreed to take on the re-sponsibility of taking care of thefamily while Novasack pursued hisdream.

“Sometimes, you have to makedecisions that aren’t popular. Iknew this decision was right forme, and I had to follow thepath,“ he explains.

PURSUING HIS DENTAL SCHOOL DREAMSNovasack quit his job as an engi-neer and began to research hisoptions.

Four days after his daughter Juli-ette was born, Novasack started apost-baccalaureate program atPenn State Abington in May of2010 to complete course require-ments in biology, chemistry andanatomy before he could apply todental school.

There, he joined a predental club,where he met Brian Hahn, recruit-ment coordinator for KornbergDental. It was Hahn who solidified Novasack’s desire anddrive to go to dental school—specifically at Temple University.

BECOMING TEMPLE MADEWith the help of Hahn, Novasackenrolled at Temple and neverlooked back.

One of the factors that drew Novasack to Temple was Korn-berg Dental’s focus on clinical ex-perience. “The people we serve atTemple need our help. That’s all I

really needed to know.” he says,speaking of Temple’s patientpool, consisting of a mostly un-derserved population.

Another reason Novasack choseTemple is because of its strong rep-utation, not only in the Philadel-phia dental world, but nationallyand internationally, as well.

“When I tell people I go to Tem-ple, they say, ‘Oh my goodness,Temple makes the best dentists!’”Novasack explains. “Temple gradsjust know what they’re doing.”

Novasack has nothing but positivethings to say about his experienceat Kornberg Dental.

“The instructors at Temple arejust spectacular. Having gonethrough four years of engineeringschool, the teachers I’ve had atTemple are infinitely better thanany teachers I’ve ever had in mylife,” he says gratefully. “I owe alot to them.”

BEEF JERKYIn addition to his full-time studiesat Kornberg Dental, Novasack isan entrepreneur, running a busi-ness on the side focused on themost unlikely of products: high-end beef jerky.

Every year, Novasack’s parentshave a big Christmas party, whereevery attendee is responsible for


bringing a signature item. Afterlearning how to make beef jerkyfrom a colleague at his old engi-neering job, Novasack decided, almost as a joke, to make his ownbeef jerky to contribute to theparty. Surprisingly, the jerky was ahit.

For fun, Novasack experimentedwith different flavors of jerky andeventually looped in his friendand neighbor, Marcos Espinoza.Over drinks in the spring of 2012,they talked about starting a busi-ness, with the goal of makingbeef jerky Philadelphia’s next bigthing.

After bringing on a third partner,the business got off the ground,officially launching with the nameSide Project Jerky, keeping ingre-dients and production local, work-ing with a butcher in Chestnut Hilland a kitchen in Manayunk.

Buzz began to build—Men’s Jour-nalmagazine included the productin a holiday gift guide and TheWall Street Journalmentioned thejerky in a Super Bowl eats roundup.The business is still growing and

the jerky can be purchased fromlocal retailers in Northern Liberties,South Philadelphia and Center City,as well as nationally in New York,Oklahoma and Georgia.

Novasack enjoys melding togetherhis jerky business with his passionfor dentistry by using his class-mates as a focus group for newflavors. (And yes, in case you werewondering, his classmates DOpoke fun at him for the odd mixof beef jerky and healthy smiles.)

A BALANCING ACT“It’s not all rainbows and uni-corns. There’s a lot of family sacri-fice,” Novasack says, when askedhow he balances it all.

Novasack treats his studies at Kornberg Dentistry like he did hiscareer as an engineer. He wakesup early, arrives on Temple’s cam-pus long before other students,attends classes and is often thelast one to leave at night, after anevening of studying. He prideshimself on never doing school-work in his home. He works hardto separate his school life andfamily life.

However, that balance can’t al-ways be achieved. Novasack re-calls a recent Father’s Day spentstudying for finals from 9 a.m. to9 p.m. when he would muchrather have been spending timewith his wife, 3-year-old daugh-ter, Juliette and 1-year-old son,Bennett.

“It’s been a hectic three years,” headmits. “But I know it’s all goingto be worth it in the end.”

LIFE AFTER DENTAL SCHOOLNovasack is looking forward tothe day in May 2015 when hecompletes dental school and canfinally become a practicing den-tist.

He plans to move his family to At-lantic County, N.J. to join his fa-ther’s dental practice in SomersPoint. In the meantime, Novasackenjoys shadowing his dad whenhe visits and looks forward to get-ting to know the patients thereand continuing the successfulpractice his father built.

“After all my family and I havegone through, I’m going to be sowell equipped to handle myself asa professional dentist. I’ll be ableto juggle a full-time job whilehaving freedom and flexibility inmy schedule to provide a betterlife for my family,” he says. “Thatis what I see at the finish line.That’s what pushes me throughthe tough times.”

Photography by Michael Persico.


AchievementsStudent

DR. SARAH GRAY, ’13, was selected by the American Association of Women Dentists to receive the 2013 Colgate Research Award for her efforts in showing academic distinctionand demonstration of excellence in research.

Hometown: I’m from the suburbs of Philadelphia.

Undergraduate School and Major:Wake Forest University,Major: BS Biology, Minors in Spanish and Chemistry Kornberg School of Dentistry: DMD

Why did you decide to study dentistry: I chose to studydentistry because I enjoy working with people and believethat dentistry is a unique combination of science and art. Iam currently in the orthodontic residency program becauseI love that, in orthodontics especially, you can positively affect patients' confidence and self-esteem with your treatment.

Future Plans: I plan on practicing orthodontics near Philadelphiaand want to teach in the orthodontics clinic at Temple.

MS. ANDREA FRANTZ, ’16, received a glowing letter ofrecommendation from Columbia University’s Professor BurtonL. Edelstein for her outstanding work during her summer internship at the Children’s Dental Health Project. During herinternship, Ms. Frantz worked to develop a conceptualmodel that incorporated multiple constructs from recog-nized behavioral theories to explain a pediatrician’s election(or failure of election) to provide oral health services toyoung children in conformance with AAP and AAPD policy.

Hometown: Scranton, Pennsylvania

Undergraduate School and Major: University of Pennsylvania Major: Health and Societies

Why did you decide to study dentistry: For a studentinterested in clinical care, public health and the arts,

dentistry is an ideal career. An ever-changing and always challengingfield, dentistry will allow me to treat oral disease in individual patientswhile pursuing research directed at lowering the burden of disease inthe entire population.

Future Plans: I am currently looking forward to beginning my time in clinic! Although I hope to combine both a clinical and research-oriented career with an eye toward public health, I am excited to experience the multiple disciplines that dentistry has to offer.


The alumni awards program began in 2011 to pay tribute to Kornberg alumniwho have made major contributions to society and dentistry in general. Alumniare asked to submit nominations and the Board of Directors of Kornberg voteson the honorees. The awards are presented at Alumni Day each spring.

“These are alumni who have made outstanding achievements in the field ofdentistry and are true humanitarians,” said Alan Simkins, DMD, chairman of theAwards Committee. “There are over 7,000 Kornberg alumni who are payingtribute to these individuals. It is truly a great honor for the recipients.”

Business Award: Neil R. Patel, DMD, ‘09Dr. Patel was recognized for his business accomplish-ments and passion for innovation. He is the founderand CEO of Molar Geek, a social platform estab-lished to create a venue for students, residents anddoctors to collaborate in the field of dentistry.

Humanitarian Award: Jeremiah J. Lowney, DDS, ‘61Dr. Lowney was recognized for his vision and workwith the Haitian Health Foundation (HHF), of whichhe is founding president. The organization does out-reach work in southwestern Haiti, providing fullhealthcare and disease prevention programs. He wasawarded the White House Champion of ChangeAward in 2013, one of 12 awards given nationally inrecognition of humanitarian service.

Leadership Award: Arnold S. Weisgold, DDS, ‘61Dr. Weisgold was recognized for his leadership rolein the areas of periodontal prosthesis, restorativedentistry, esthetics, implant prosthodontics and oc-clusion. He is a consulting editor for several journalsand received the Saul Schluger Memorial Award forClinical Excellence from the Seattle Study Club.

Service Award: John V. Esposito, DDS, ‘61Dr. Esposito, associate professor emeritus, was rec-ognized for his knowledge, time and effort as abeloved faculty member of the Kornberg School ofDentistry. He was awarded the Xi Psi Phi FraternityInstructor of the Year eight times and the StudentCouncil Faculty of the Year award at Temple Dental.

In 2006, he established the John V. Esposito, Jr.Scholarship Fund and the endowment was com-pleted in 2013 by the class of 1983 in honor of hisservice and commitment to the school.

Education Award: Edwin L. Granite, DMD, ’57Dr. Granite was recognized posthumously for hiscontributions toward the advancement of educationin dentistry. He traveled to third-world countries torebuild faces of needy children in indigent commu-nities. He was honored at the Delaware Academy ofMedicine’s Annual Meeting and was proud to havethe clinic where he practiced at Christiana Care, theEdwin L. Granite, DMD, Oral and Maxillofacial Sur-gery & Hospital Dentistry Clinic, named in his honor.

Distinguished Achievement Award: Beatriz Mirabal-Garces, DMD, ‘02Dr. Mirabal-Garces was recognized, as a colleague ofher describes, “for being a gentle soul who repre-sents real understanding and empathy and the abil-ity to reach down and help somebody up.” Dr.Mirabal-Garces owns her own practice, The GarcesDental Group. In 2012, Dr. Mirabal-Garces and herhusband founded the Garces Family Foundation, anorganization committed to helping improve thehealth and education of the underprivileged immi-grant population in Philadelphia and surroundingneighborhoods. The Foundation will also supportthe Farm to Families program established by the St.Christopher’s Foundation for Children.

ALUMNIAward RECIPIENTS

The 2013 Awardees are:

ALUMNI


The Kornberg School of Dentistry has much to look forward to following its

150th anniversary celebration.

With shared commitment, the

ABRAMSON FAMILY FOUNDATION

encourages alumni and friends tocontinue their support of

the Kornberg School of Dentistryas we serve our students and patients

over the next 150 years.

�

�


CLASS OF 1964‘WHEN YOU TAKE, YOU GOTTA GIVE BACK’

Class of 1964’s Living LegacyTheir class already had set oneprecedent: They’re the school’sbiggest supporters relative totheir size. So why not set another? “Exactly,” thought AlanSimkins.

His idea, which is getting enthusi-astic response from classmates, isa $50,000 endowment for studentscholarships. “It honors our classand the school and gives to thestudents,” he explains, “and itcould be the first of many endow-ments as other classes say, ‘Wedon’t want to be left behind.’”

The concept hit Dr. Simkins not allat once, but over time. The seedwas planted when his father, alsoa dentist, always talked about giving back. Then the thoughtcontinued to grow through Dr.Simkins’ years on the Alumni Association, including a term aspresident and chair of the AwardsCommittee. Encouragement froma close friend and Alumni Boardmember, Dr. Leonard Abrams, andfrom his dental practice partnerto serve the school nourished theidea, as did regular contact withhis close-knit class.

“We’ve kept in touch,” he says.They’ve also stayed involved withthe school. Five of his classmateshave been on the Alumni Board.

Asked what binds the Class of1964 together so tightly, hepoints to their backgrounds. “Wewere from middle-class and work-ing-class families. We knew Tem-ple gave us the opportunity to dothings, to raise our children andhave a better life.”

Pausing for a moment, he remem-bers a comment of then-dean, Dr.Timmons. “We were sitting inclass, and he said, ‘Turn to theman on your left and on yourright. One of you won’t be herefor graduation.’ But Timmons waswrong about our class. We weremotivated and out of 120, mostof us graduated.”

The handful of vets in the classprovided great role models. “Theywere men in their 30s who hadserved their country, were seriousabout school and married withchildren,” he recalls. “We wereboys. They made a big impressionon us.”

He continues, “Many in my classworked two to three jobs while inschool. One of us, Irv Snyder, gotup at four in the morning to de-liver papers before going to class,then worked as a waiter at nightand would go back and study.Others were painters in the sum-mer and came back to school inthe winter. School prepared us forwhat life was going to be like.”

With that kind of work ethic, Dr.Snyder became successful, as theyall did. “Coming from New Yorkand Pennsylvania mainly, we’veall done well professionally,” hesays. However, he points out that“if aid had been available, lifewould have been easier.”

Noting the changes at the schoolnow, Dr. Simkins says his class-mates are seeing the “180-degreeturnaround,” and that’s anotherreason for their support. “Wewant to be sure that studentswho need help aren’t in the samesituation we were. We’ll have acommittee who will pick the students warranting the scholar-ships.”

Dr. Alan Simkins, ’64


Letter from Dr. Robert Levine

It has been an honor and privilege to serve as Presi-dent of your Alumni Association for the past year. Sincerest thanks to all for the tremendous support ofour 150th Anniversary commemoration. Our Alumniof KSOD are truly exceptional professionals; they arefirst-rate clinicians, teachers and leaders in local andnational dental organizations and a positive forcewithin their communities.

Equally rewarding to me has been the opportunity towork with an extremely dedicated and hard-workingboard. Together, we composed a Mission and Action Statement declaring to all our vigilance and dedication to ensuring the betterment of our students, alumni and school. Additionally, the AlumniAssociation board launched a bold, new “Mentoringfor Life” Program for our students to establish withalumni mentors lifelong relationships, beginning withthe students’ first day of school and continuingthrough their transition to professional life and beyond. The main goal being to inspire personalgrowth, encouraging volunteerism, vision for the future, cultural sensitivity and philanthropic aware-ness, all values reflected in the core of the dental profession. On a professional level, mentors will provide guidance to the mentee on residency/specialty programs, job searches, and networking opportunities. To date, over 200 students have signedup with over 80 mentors.

As your Alumni Association President, I have beenasked to help organize Temple’s first annual GlobalDay of Service on Saturday, November 9, 2013.Global Day of Service is designed to unite Templealumni and friends worldwide in community serviceon a single day. On November 9th, a dental phone-a-thon will be held at the KSOD, reaching out to fellowalumni, with the goal of raising funds for needy pa-tients unable to pay for advanced services at theschool (e.g., periodontal and dental implant therapyand prosthetic reconstruction).

The Alumni Association serves as a liaison to improvecommunication between the dental school and its

alumni and to fosterpositive relationshipsamong administra-tion, faculty, alumniand students. Alumnireconnect with theschool and each otherat programs and so-cial events organizedby the Alumni Associ-ation. Additionally,the Dental AlumniAssociation supportsand provides socialand professional opportunities for today’s dental stu-dents through a number of worthwhile student activi-ties such as the freshmen bbq, white coat ceremony,mentoring programs, international outreach pro-grams, alumni golf outings, and hospitality suites forstudent examinations. This is only made possible withyour financial support.

Our Dean, Dr. Amid Ismail, is transforming ourschool, moving forward with a strategic visionand unwavering commitment to create a truepatient-centered and comprehensive dentistrymodel, one that honors the experience of ouralumni and creates the most advanced andcomprehensive learning experience to educatedentists for the next century.With your help, wecan preserve the great traditions of Temple Univer-sity’s Kornberg School of Dentistry and ensure its future development and growth.

Remember, all alumni receive a discount on ContinuingEducation classes. Visit http://dentistry.temple.edu/alumnito view upcoming CE programs and alumni events.

With sincere best wishes,

Robert A. Levine, DDS, FCPP, Class of 1981President, KSOD Alumni AssociationClinical Professor in the Department of Periodontology and Oral Implantology Temple University Kornberg School of Dentistry

Dear Kornberg Alum,

ALUMNI


ALUMNI ASSOCIATION BEGINS “Mentoring for Life” PROGRAMThe Kornberg School of Den-tistry’s Alumni Association re-cently partnered with the schoolto begin the new “Mentoring forLife” Program, in which studentswould be paired with alumnimentors in the surroundingPhiladelphia area. The idea, firstoriginated by Alumni AssociationPresident Dr. Bob Levine, was tohave each freshman studentpaired with an alumnus who hadbeen through the same experi-ence the student had gonethrough. The mentor’s responsi-bility would be to guide the stu-dent from year to year, helpingthem transition from those toughdidactic basic science courses, en-couraging them along the way,and into the rigorous clinical as-signments. Eventually, the studentwould come to the mentor for ad-vice on GPRs, job interviews andpostgraduate work. The wholeidea is for the mentor and stu-dent to share a bond throughouttheir professional careers.

In the beginning, the “Mentoringfor Life” program’s goals weresomewhat limited; the goal wasto match freshmen with willingalumni mentors in the area. How-ever, after members from theAlumni Association spoke withstudents about the program, theassociation soon came to noticethat there was a need for mentorsnot only in the freshmen class,but for all classes. A registrationweb page for mentors and stu-dents was created and over 200

students signed up with around80 mentors in the area participat-ing. Because of the overwhelmingparticipation of students, theAlumni Association decided topair various students with eachmentor so the students could alsomentor each other, much like alearning community. For example,a senior and junior might bepaired with the same mentor al-lowing the junior to benefit fromhaving a senior mentor and analumni mentor. The registrationpage also allowed students tomake specific requests for men-tors, based on specialty practice,geographic area and whetherthey practiced dentistry as an active duty officer in the military.

During the course of the mentor-ing program, students and men-tors will be asked to meet at theschool at the beginning of the

year to go over the details andbenefits of the program while in-troducing the students to theirmentors, and also at the end ofthe year to wrap up the year andshare experiences. Throughoutthe year, the mentors and stu-dents will meet at their own mu-tually agreed-upon times.

If you are interested in becomingan alumni mentor for the 2014-2015 school year, please visithttp://dentistry.temple.edu/mentoring for more information.

ALUMNI


The patient-centric approachJudee Hashem-Rapoza, DMD, Class of 1990, whosegeneral dentistry practice in Plymouth Meeting, Pa,promotes overall health and wellness, thrives on thisvery simple notion.

“It is my practice to treat the patients as human beings first, through caring and listening,” she says.

The guiding philosophy of Dr. Judee’s alternativedentistry is that the health of the mouth and thebody are one and the same. According to Dr. Judee,as she is called by her patients, oral health is a vitalcomponent of the “whole body” and optimumhealth. Dr. Judee’s practice takes into considerationthe cause-and-effect relationship between a pa-tient’s oral health and the health of the rest of thepatient's body—for example, the well-documentedlink between periodontal disease and heart disease.

Dr. Judee achieves her mission by employing a patient-centric practice that fosters trust and opendialogue. “People are anxious about going to thedentist for different reasons, including worryingabout the effectiveness of localized anesthetic andfeeling that the dentist is rushed or is neglectingtheir concerns,” she says. “Other factors include anticipation of pain, negative past experiences andeven the sterile smell of the dental office. Interrupt-ing the normal day's routine to visit the dentist alsois a factor in general anxiety.

Together as a teamDr. Judee opened her practice in 1992 with one chairand 10 patients. Today, her practice is a tremendoussuccess with over 6,000 patients and a staff of fourthat shares her whole-patient philosophy.

“We work together as a team,” she says. “It is ourgoal to make sure every patient has a positive expe-rience. My staff and I are down to earth and reallyfocus on our patients and their lives. We need tomake sure they feel comfortable, so we tend to theirphysical and emotional needs.”

Indeed, studies have shown that the most importantfactor in overcoming dental anxiety is good dentist-patient communication.

“If I had the opportunity to convey one message tothe new students entering the profession of den-tistry, I would tell them that they are caring forhuman beings who have emotions and fears,” shesays. “Our job is to find out what they fear and talkto them about it and ease their anxieties.”

Dr. Judee also emphasizes patient trust at her prac-tice. She places value in the word, making sure thatevery patient feels confident that she always hastheir best interest at heart. “Patient trust is of utmost importance to me and ultimately results inpatient satisfaction. Trust is the foundation of a successful patient-dentist relationship, as with allother relationships.”

More than anything, Dr. Judee sees herself as ahealthcare professional who takes pride in her profession. “I am not a salesperson,” she notes. “My mission is to provide outstanding care to each patient as it pertains to their individual health, age,chief complaints, and diagnosed pathologies allwhile considering their budget.”

Dr. Judee adds, “I love what I do. Caring for humanbeings is very natural to me. It’s simple, I LOVE PEOPLE. I enjoy going to work every day.”

ALUMNI SPOTLIGHT

MORE THAN JUST DENTISTRYJUDEE HASHEM-RAPOZA, DMD

Dr. Judee Hashem-Rapoza (center) with her daughters Madeline (left)and Liza (right).


The Shore Family“ S H O R E LY ” P R O U D O F D E N T I S T R Y

LEGACY FAMILIES

The Shore legacy at KornbergSchool of Dentistry began

with a cousin graduating fromthe school in 1930. The traditioncontinued year after year, capti-vating generation after genera-tion of the family, with nearly 20relatives who have been Temple-trained dentists and hygienists.Dr. Joseph Shore, the founder ofthe Shore-Snyder Dental Center inNorwood, Pa., grew up in theStrawberry Mansion section ofPhiladelphia and ultimately set-tled in Haverford with his wife,Bette Mandel Shore.

The Shore-Snyder Dental Centertruly is a family affair. Betteserved as the practice’s book-keeper from when Joseph firstopened in 1952 until last year.Joseph was joined by his brother,Leon, who passed away in 1983,and eventually by his son, Jeffrey,in 1979. Joseph’s grandson, An-drew, now works with his fatherand grandfather, and the practicerecently welcomed Robin,Joseph’s granddaughter, after herKornberg graduation this pastMay.

The PatriarchJoseph practiced dentistry forover 62 years and retired only oneyear ago. While he has many fondmemories and reasons to thankTemple School of Dentistry (it wasrenamed Kornberg School of Den-tistry years after Joseph earnedhis degree), he was not always onthe path to becoming a dentist.Originally, Joseph planned to become an accountant. However,he received a letter from his

cousin during WWII whichconvinced him otherwise.Joseph hasn’t looked backsince, and recently pub-lished his autobiography.

Joseph credits Temple withpreparing him to diveheadfirst into opening hisown private dental practiceimmediately after graduat-ing. He felt completelycomfortable performing allof the dental procedures he

learned during his time as a stu-dent. Joseph believes Temple issuch a wonderful place becauseof its faculty. He remembers hisinstructors taking the time to as-sist and invest in him and his class-mates, truly making sure theyunderstood the material. He ac-knowledges that “they weretough on us…I went to bat for myfellow students because I was wayahead of them in my require-ments and they respected me.Many of the instructors wouldhang around my area, and theywould talk to me.” While Josephrecognizes how helpful he was tohis peers, he identifies them asone of his favorite aspects of histime in dental school.

Joseph points out that much haschanged in dentistry since he firstentered the field. He explains thatwhile most of today’s dentistspractice in group settings, thiswas not the case years ago. He

In 2010, Andrew received his diploma from his fatherand grandfather.

Three generations: Andrew, Robin, Joseph, and Jeffrey at Robin’s 2013 graduation ceremony.


feels that “it makes a big differ-ence starting in a group practice,learning various techniques fromeach other, giving you more confi-dence.” Joseph also shares thechanges that have evolved in pa-tients themselves. “Patients areno longer afraid of dentistry. Theyknow that dentistry is not goingto kill them. Many want to comein to have their teeth cleanedmore often than every sixmonths.” He goes on to explainthat the Shore dentists try to helpparents teach their children thatdentistry can be fun and is notpainful; they even let young patients squirt the water hoseinto their parents’ mouths.

As can be expected based onJoseph’s generosity toward hisclassmates, he was equally gener-ous, if not more so, to futureTemple students; he volunteeredand taught in the school for 10years. Joseph was extremely in-volved in the dental fraternitySigma Epsilon Delta (SED). Heserved as president as a student,went on to become president ofthe Philadelphia chapter and waseventually elected president ofthe national brotherhood. SEDbegan a Cleft Palate Clinic in Is-rael which services Israeli andArab children.

It was Joseph’s happiness practic-ing and teaching that became apparent to Jeff and showed himwhat a wonderful career dentistrycould be. Joseph feels extremelyfortunate to have his progenyworking with him and admits he

becomes teary thinking abouthaving his son and grandchildrenin the practice.

The Middle GenerationDr. Jeffrey Shore followed in hisfather’s footsteps not only in be-coming a passionate dentist, butalso by returning to Kornberg toteach future dentists. He shares:“Besides being able to watch bothmy children progress through fouryears each at Kornberg, teachinghas been one of the most reward-ing experiences of my life. Show-ing students ways to approachproblems they might encounter inpractice and seeing their interestin learning is truly rewarding.”

It is instructors like Jeff who helpmake a Kornberg dental educa-tion so outstanding. “With bothfull-time and adjunct professorsemployed, the students can seeand learn methods used both inschool and in real environmentsoutside the classroom.”

Jeff identifies both his social andclinical experiences as two high-

lights of his time at Kornberg. Byliving on campus, he formedbonds with classmates, many ofwhom he still sees at reunionsand is in touch with today. In ex-plaining the excellence of theTemple program, Jeff elaborates:“With a wide range of patients todraw from and being a clinicallyoriented school, the opportunityof experiencing patients who required simple to complex needswas afforded to me.”

In addition to practicing andteaching dentistry, Jeff leads adental mission to the DominicanRepublic. Through this program,six or seven fourth-year Kornbergdental students travel to the Do-minican Republic for a week andprovide free surgical and restora-tive dental care. Both Andy andRobin participated in the missionduring their fourth years. Jeff alsoserves on the dental assisting ad-visory board at Marple NewtownHigh School.

When asked what he would impart to future dentists, Jeff

The 2012 Temple dental mission group in Samana, Dominican Republic.


shares: “Dentistry is an occupa-tion that they will enjoy forever,whether they have their ownpractice or work for someone. It isa rewarding career.” This is clearlysomething that Joseph hasdemonstrated and that Andy andRobin have recognized.

The Young DentistDr. Andrew Shore can’t choosejust one highlight from his yearsat Kornberg. First and foremost,he identifies learning under hisfather during the first year ofclinic as one of his greatest mem-ories. He also recalls how amazingit felt the first time he completeddifficult procedures (such as a full-mouth extraction with immediatedenture placement), placing multiple three-unit bridges, andfinishing a molar root canal. Lastbut not least, graduation, the culmination of his years and lessons, stands out among themany treasured times.

Andy shares that Kornberg is sucha special, strong program becauseof the way it prepares students todiagnose and treat cases effec-tively. He was highly impressedwith how ready and confident hefelt working with patients so soon

after graduating. He furtherstates, “It’s the students’ clinicalexperience and ability to usethose methods that make theschool so well respected.” Andy’seducation was so stellar that hecredits the actual learning of his“forever craft” as the most enjoy-able part of his four years.

While Andy did not originally intend to become a dentist (hewas a business major as an under-graduate and changed his coursewhen the economy declined), heis clearly happy with his careerchoice and subscribes to his fa-ther’s earlier message as heshares: “According to many newsoutlets, being a dentist is thenumber one profession, and I’dagree with that. I’m grateful forthe knowledge I received at Kornberg—it was invaluable.”

The Newest DentistUnlike her grandfather andbrother, Dr. Robin Shore knewearly on that she wanted to workin the medical field. Her exposureto dentistry from so many familymembers gave her the confidencethat she would enjoy practicing.The closeness of her family wasalso appealing as she explains: “I

loved that my dad and grandfa-ther worked alongside each otherand built a stronger relationshipbecause of it. I wanted to be ableto experience that with my dadand brother.” She was excited tojoin the family’s practice so shecould make her grandfatherproud.

Like her grandfather, father andbrother, Robin recognizes howwonderful the faculty and stu-dents at Kornberg are. She ex-plains that her instructors werealways available to help and fullyunderstand the hardships ofbeing a dental student. She de-scribes her classmates as beingdown-to-earth but enjoying lifeoutside the classroom. “Overall,everyone at Kornberg truly caresabout one another.”

Robin’s classmates enter the pic-ture again when she describes thehighlights of her years at Korn-

Adjunct professor Dr. Jeffrey Shore, with father, Joseph, and graduating son, Andrew.

When not practicing, the Shores are diehardEagles fans.


berg. She recalls celebrating fin-ishing boards, participating insports leagues and taking part inthe Dominican Republic mission.

Similar to Andy’s praise of theschool’s education, Robin feelsprepared to act quickly and ap-propriately in difficult dental situ-ations. “Besides the spectacular,supportive faculty, I credit thequality of my experience to theschool’s requirements and popula-tion of Temple patients. Kornbergproduces the best general dentistsin the area, possibly even thecountry.”

As indicated when she sharedmemories of her dental school ex-perience, Robin was highly in-volved in student life. She waselected secretary of her class dur-ing her fourth year, was presidentof the Dominican Republic Out-reach Club, served as social chairand president of the American As-sociation of Women Dentists andwas an honor board member fortwo years. Most recently, Robinwas selected as a member of Omi-cron Kappa Upsilon, the nationaldental honor society. Only 10members are chosen from eachclass; this is considered by some asthe highest honor for a student.

It is clear that Robin is a peopleperson, so it comes as no surprisethat she has decided to pursuegeneral dentistry because of “theability to build relationships withpatients over a long period oftime.”

Family PrideIf it isn’t apparent from the prac-tice’s composition, the Shore fam-ily likes spending time together.They are an athletic bunch of avidPhiladelphia sports fans (primarilyEagles and Flyers) and have heldEagles season tickets for decades.When the family isn’t practicingdentistry, giving back to the com-munity or cheering on Philadel-phia teams, they turn theirattention to animals. In the last23 years, they have rescued sixgreyhounds and currently care forChloe and Casey.

Similar themes arise when Joseph,Jeff, Andy and Robin talk abouttheir dental school memories andviews of why a Temple dental ed-ucation is so superior. They haveeach made the most of their timein the program, both as studentsand as faculty, gleaning excellentexperiences. It is no wonder they

all take so much pride in being apart of the school and the Shoredental legacy.

The Shore family is proud to haveso many Temple-educated den-tists in its ranks, and they areequally proud to have createdsuch a strong family practice.They are truly bonded.

Andrew, Jeffrey, Bette, and Joseph at Andrew’s White Coat Ceremony.

Joseph and Robin at Robin’s White Coat Ceremony.


Tilghman Moyer, Temple’s interim senior vice presi-dent for institutional advancement, reflects on thefirst occasion that he spent time with Joan Ballots.

Passionate about any team that wore the Owls uniform, especially on the basketball court, Ballots had traveled toSouth Carolina for the first-ever Charleston Classic. Theyear was 2008, and the men lost to Clemson. But whatMoyer fondly remembers is being part of a golf foursomewith Ballots. They played two rounds on one of Kiawah Island’s championship courses, enough time to get to knoweach other. Although Ballots’ reputation as a legendaryTemple supporter and alumna had preceded her, Moyer was drawn to her “incredible passion and belief in the university.”

Last December, Temple lost this trustee, donor and enthusi-astic sports fan when Ballots died after a long illness. “She’smissed by lots of people,” emphasizes Moyer.

Her affection for the school was in her family’s blood, sheonce said in an interview. In the 1890s, her grandfather tookclasses from Russell Conwell, Temple’s founder and firstpresident. Then her father attended Temple before enteringmedical school. Even her late husband, John, ’57, whom shemet while both were counselors at a summer basketball program of the university’s coach, Harry Litwack, went toTemple, graduating from the Dental School.

Ballots’ student days were marked with achievements: in-volvement with student government, playing on four varsityteams and recognition as an outstanding senior. After gradu-ation, she took her degree in education and moved to NewCanaan, Conn., where she became a middle school teacherand coach while John started a dental practice. “His practicewas a significant part of their lives,” points out Moyer. “Itwas in their home, and she was involved with the business asrecord keeper and business manager.”

Remembering Joan BallotsDental School and University Supporter

Generous philanthropist, university trustee and out-standing alumna Joan Ballots died last December aftera long illness.


However, she remained involved with the university.She and her husband quietly provided scholarship dol-lars for students of the Dental School, because they be-lieved in the vital importance of making financial aidavailable. In recognition, a dental preclinical lab wasnamed after them in 2006.

After her husband’s death in 1990, Ballots expandedher leadership. “I’ve seen what good schools can do,”she’s reported as saying. So she helped underwrite ef-forts to build part-nerships withschools in the Tem-ple community. Shealso served on theDental School’sBoard of Visitors, arole she highly val-ued because ofJohn’s great appreci-ation for his dentaleducation. She be-came a member ofthe university’sBoard of Trustees,serving on many committees, including searches fortwo former presidents. For the Urology Department,which treated her husband, she offered additional sup-port.

Athletic programs, always close to her heart, benefitedtoo from her philanthropy. The woman who main-tained a Philadelphia residence just so she could attendevery basketball (and football) home game supportedcoaching positions for men’s and women’s basketball.Then she stepped forward for many capital projects,

such as construction of the Liacouras Center and thewomen’s basketball court.

But it’s her presence at the games that will be missed asmuch as her advocacy. “You always knew she’d bethere,” says Moyer, “truly bleeding cherry and white,touching generations of student athletes.”

As serious about making a difference in the classroomas on the court, Ballots was “a fixture at the university

for decades,” notedActing PresidentRichard Englertupon her death.“Joan has alwaysbeen concernedabout our tremen-dous students andwas never happierthan when she wasin their company.”

Board of TrusteesChair PatrickO’Connor added:

“I’ve worked with Joan for many years and will miss herpassionate participation at our board meetings and herlove of Temple.”

“It was always about the students, the programs, theathletes and the university,” remembers Moyer, “notabout Joan. She was selfless in her dedication.”

For that loyalty, in 1989 she received the F. EugeneDixon, Jr. Inspiration Award. It was an honor of whichshe was especially proud.

“In my mind, she was a pioneering woman. For years, she was one of only a few female

leaders the university had. She spoke her mind,and for someone who came from a generationthat didn’t fully value the contributions ofwomen outside the home, that was unusual.

But she never wore it on her sleeve.”

Tilghman Moyer, interim senior vice president for institutional advancement


In MemoriamMrs. Joan Ballots

Dr. Sidney R. Bridges ’48

Dr. Leonard Cohen ‘54

Dr. Philip Corn ’48

Dr. Raymond L. Detz ’54

Dr. C. Douglas Ebing ’55

Dr. Edward Flood ‘51

Dr. Joseph Gaudel ‘46

Dr. Roy A. Himelfarb ’73

Dr. Clinton Hoffman ’53

Dr. John L. Kallaway ’55

Dr. Edmand H. Lange ’49

Dr. James R. Lynch ’81

Dr. Heather M. Raymond ‘00

Dr. Michael C. Ritter ’70

Dr. John L. Salines ’47

Dr. Ernest Schwartz ‘64

Dr. David Wagner ’48

1944 1949 1954 1959 19641969 1974 1979 1984 19891994 1999 2004 2009

SAVEDATE!TH

E

2014

CLASSES OF

APRIL 11APRIL 12

THROUGH

TEMPLE

DENTALREUNIONS

CELEBRATINGGRADUATING

ALUMNI

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Over the last 150 years, the Philadelphia Dental College, the Temple University School of Dentistry and now the Maurice H. Kornberg School of

Dentistry have experienced, undergone, suffered, and exuberantly witnessedwars, tragedies, triumphs, economic developments, emergence of neweconomies and the disappearance of countries and cultures. In all of theseevents, our dental school has continued to educate dentists (and for severaldecades, dental hygienists) every year. The school thrived in perhaps the best150 years in human history, especially for the United States. I can only con-template what we see today, for predicting what will happen in the future isbeyond the bandwidth of any human. We cannot envision that far but wecan plant seeds that will help those who follow us.

In this issue of Diamond, two prominent dental leaders share their predictionsfor our profession from the perspectives of academia, private practice, andpolicy. They are well known nationally and to our alumni. One shares his cautious pessimism about the future of the profession, while the other is excited about the future. I can attest to you without hesitation that in theyear 2280 their predictions will be proven wrong because the future cannotbe predicted with the limited information we currently have.

Today we face major challenges in dental education. Institutions face a highlevel of competition for faculty who are clinically proficient in all aspects ofgeneral dentistry. This situation was not caused by recent decisions, but bydecades of shifts in funding for higher education to students, growth in theincome of dentists (which is wonderful), and misguided funding strategiesthat shifted research, and hence training funds, awayfrom dental schools to medical and other schools in universities. Our current system of dental and highereducation in the U.S. operates in individual islands thataddress local markets or segments of markets. Theopening of for-profit dental schools in osteopathic medical schools which, like the majority of other dentalschools, are focused on clinical education and on meet-ing the basic standards for accreditation, are threatsthat will haunt the status of our profession, and here-after, our dental school over the next decade.

We have prepared, and are preparing, ourselves for this new world. Afterfive years of planning and execution of critical decisions to increase the fund-ing base for the school and renovating our facilities, we are now competingfor the best students who are choosing our dental school even when they are

“Today we face major challenges indental education. Institutions face ahigh level of competition for facultywho are clinically proficient in allaspects of general dentistry.”


MESSAGE FROM DEAN AMID I. ISMAIL

Amid I. IsmailDean and Laura H.Carnell Professor

BDS, MPH, MBA, DrPH,Diplomate ABDPH

150 yearsThe Next


given the choice to attend various otherschools. Our averagegrade point average(GPA) and Dental Aptitude Test (DAT)scores are now abovethe national average.Our clinics are evolvingto become care centerswhere more and morepatients will seek careand, hence, provide ourstudents with opportunities to graduate with excellent

clinical skills. We are building and will continue to build our research capacity in areas thathave direct impact on oral health and future management of dental and oral diseases.These changes did not happen because of administrative fiat but rather through the carefulstrategic positioning of the school built on the support of students, staff, faculty andalumni.

Positive change does not just happen, it is created by individuals, groups, other leaders or nature. Finding those leaders who will build the future to become better than today is themain challenge for our country, states, cities and school. The future will not be shaped bymanagers who do excellent daily tasks but by those who can envision the future, select theright targets at the precise time, and convince others to lead the way to reach these targets. Selecting the right target is the core competence of leadership.

Temple University dental school is at that precise moment in its long history to move on apath to reach its destiny. We will remain a center for excellence in clinical care and educa-tion of dentists for the 22nd century that is not only based on developing advanced clinicalskills but on science and, most importantly, professional ethical standards. Please join me inhelping us achieve this target; become a leader and steward of the future of this boundlessdental school.

“We are building and will continue tobuild our research capacity in areas thathave direct impact on oral health and future management of dental and oraldiseases. These changes did not happenbecause of administrative fiat but ratherthrough the careful strategic positioningof the school built on the support of students, staff, faculty and alumni.”



Michael C. Alfano, DMD, PhDProfessor & Senior Presidential FellowExecutive Vice President EmeritusNew York University

In the joyful spirit of the 150th Anniversary

of the founding of the Kornberg School of

Dentistry at Temple University, this article

should strike an appropriately high-minded,

upbeat tone to match the occasion. Indeed,

on several past occasions I have had the

wonderful opportunity to speculate about

the amazing advances that science and

engineering will bring to an ever brighter

future for the dental profession. However,

on this occasion, Dean Ismail asked for a

“pull-no-punches” assessment of where the

profession seems likely to be headed, so

here is my take on what the dental profes-

sion may look like in a couple of decades,

especially if dentistry in the United States

continues to be dominated by the bastions

of the status quo such as the ADA House of

Delegates, among others. That said, let me

quickly point out that these are my views,

not those of Dean Ismail.

“It All Depends on You!”

THE FUTURE OF DENTAL PRACTICE


My pessimism about the future of dentistry isdriven by the profession’s continuing resist-

ance to changes in the delivery model for dentalservices. Such resistance is certainly not a new phe-nomenon. In 1910, the dentists in Ohio successfullycampaigned to close the very first school of dentalhygiene on the basis that the graduates would notbe as well qualified to perform hygiene services asdentists. Yet, if we fast-forward to the beginning ofthe 21st century, there are now hundreds of dentalhygiene educational programs and ALL parties arewell served by the birth of the dental hygiene profession. The public can receive important servicesfrom hygienists at fees that are lower than whatthey would be if provided by a dentist; the dentist iswell served by being able to focus his/her time onmore complex procedures with associated increasedfulfillment and enhanced practice revenue; and den-tal hygienists themselves are well served by the opportunities for meaningful careers in healthcare.Thus, the reader should be wary that repression ofnew ideas in support of the status quo with its established dental practice revenue models oftenmasquerades as a genuine concern for the well-being of the public. Indeed, not every new idea forchange in healthcare delivery is worthy of imple-mentation. Yet, any thoughtful layperson can seethrough a thinly veneered rhetoric about quality of care to recognize that the perceived economic interests of the dental profession are also driving recalcitrance to change.

History repeats itself. In my 40-plus-year career, Ihave seen substantial initial resistance by the profes-sion to such reforms as expanded-functiondental assistants, routine glove wearing,Medicare, and mercury hygiene, amongmany others. The newest wave of resistancehas been launched in opposition to the efforts in several states to approve a type oforal healthcare practitioner commonlyknown as either a mid-level practitioner ora dental therapist. Two states now allowsuch practitioners—Alaska and Minnesota—and several others are considering the ap-proval of such practitioners, but ‘organized

dentistry’ always mounts strong opposition. The cur-rent position on mid-levels is particularly worrisomebecause organized dentistry is not only opposed tothe licensure of such practitioners, it is opposed evento the study of how such professionals might servethe public and enhance dental practice. I thereforesubmit that this extreme position of not wanting toknow if such mid-level providers can be helpful ornot is no longer simply supporting the status quo, itis an anti-intellectual position unworthy of a science-based profession that rose to university status morethan a century ago. Moreover, unlike the past exam-ples listed above wherein the profession eventuallyreversed itself, today’s ‘status quotians’ could beplacing the profession on the precipice of a declinethat may not be reversible, as I will explain later.

By now you must be thinking that I am firmly ensconced in the belief that the creation of a mid-level practitioner in oral health will be both the answer to the access-to-oral-care problem and a successful vector in mitigating the rise in oral health-care costs in the country. Not true. While I believethe large database from other countries, and theearly results from both Alaska and Minnesota,demonstrates clearly that mid-levels can safely deliver high quality oral health services, I do notknow if the trilevel U.S. payment system—a combi-nation of self-pay, private insurance and public programs—will support such a provider model adequately. Also, I do not know if the creation ofsuch a new type of practitioner will result in the deployment of these practitioners in a manner thatwill increase access to care. Moreover, neither Alaska

“Thus, the reader should be wary thatrepression of new ideas in support ofthe status quo with its established dental practice revenue models oftenmasquerades as a genuine concern forthe well-being of the public.”



nor Minnesota constitutes an ideal place to studythese unknowns. In the case of Alaska, the dentaltherapists are deployed primarily in remote villageswith the partial economic support of Native Ameri-can tribes. In contrast, while the Minnesota modelcan be evaluated in the more traditional tri-payersystem, the level of training for a mid-level dentalpractitioner in that state can be as long as six years,thereby creating a health practitioner with the num-ber of years in training, and presumably compensa-tion, approaching that of a dentist. As more stateswrestle this matter to a conclusion, we are at risk ofcreating an oral care delivery model that will vary bystate, type of mid-level training required, disparatescopes of practice, and variable to no supervision, including the establishment of mid-level oral careoffices with absolutely no linkages to a dentist, themost dangerous outcome of all.

I submit to you that this is the course we are on overthe next 20 years. I predict that the anti-intellectualforces will prevail in some states, not others. I fore-see a future whereby no one is well served. The pub-lic will become confused about what services areavailable from a dental therapist vs. a dentist vs. adental hygienist. Dental therapists will practice withthe moral hazard that they might be inclined to fit apatient who is best treated by four implants and anoverdenture, with a full non-implant supported den-ture simply because they might be licensed to makea denture but not to place an implant. Amidst thisconfusion, the esteem of the dental profession willsurely decline as many patients in need of ‘routine’care will migrate to the dental therapist who willlikely charge lower fees for comparable services.Such patients may never avail themselves of the diagnostic acumen or complete range of services offered by a dentist because they habitually seekcare from a dental therapist. Ultimately, this scatter-shot ‘system’ of dental care will create biases andbroken trusts from which there can be no recovery.

Instead of fighting every effort to explore the po-tential of adding a new type of dental practitioner

to the oralhealth team, thedental profes-sion should beallowing thisevaluation tooccur, and if itturns out thatmid-levels canmake valuablecontributions inthe UnitedStates, the pro-fession should embrace their licensure and work to ensure that the professionals are linked to the restof the oral care team and deployed in ways whichenhance the access to care and oral health of thepublic. In this manner, much like the lesson learnedfrom dental hygiene more than 100 years ago, thepublic will be well served with more access at lowercosts and the profession will continue to grow in esteem and to prosper economically.

To paraphrase a former dean of the Harvard Schoolof Dental Medicine:

“Dentists are the most over-educated professionalsfor what they do, and they are the most under-trained for what they should be doing.”

Perhaps the dental alumni of the distinguishedschool of dentistry at Temple University can committo begin to change this. Perhaps they can begin toacknowledge that their best value to society is in ac-curately diagnosing the many oral diseases and oralmanifestations of systemic disease, treatment plan-ning complex patient needs with the most appropri-ate services available, performing complex surgicalservices, managing collapsed occlusions, using phar-macotherapy prudently, and supervising a first-rateteam of colleagues, each with high skills in morenarrow aspects of oral care. Perhaps the future ofthe profession can be bright, but it all depends onyou!

“The public will bewell served with moreaccess at lower costsand the profession willcontinue to grow inesteem and to prospereconomically.”



Howard Bailit, DMD, PhDProfessor EmeritusUniversity of Connecticut

This paper examines trends that are likely to drive changes in dentaleducation and practice and determine the future of the profession. Themajor drivers of change are the prevalence of oral diseases, innovationsin science and technology, and market forces. The paper focuses onshorter-term issues (e.g., 10 to 20 years). The long-term future of theprofession depends on how these issues are resolved.

Oral DiseaseThe United States and many otherdeveloped countries are experi-encing major improvements inoral health. As a result of commu-nity water fluoridation, preven-tive services provided by dentists(e.g., sealants), and better per-sonal preventive behaviors, therehas been a dramatic decline in theincidence of caries and the preva-lence of untreated dental decay.This trend has affected all incomeand education groups and is cer-tain to continue. Older cohorts(e.g., above 65 years of age) whodid not have the full benefits offluoride are declining in numbers.Younger cohorts have much lessdisease.

Not only is the population gettinghealthier, but most untreated dis-ease is concentrated in lower in-come groups. This is not becausethe incidence of caries is thatmuch higher in this segment of

the population. Rather, it is theresult of large disparities in finan-cial access to care. The fact is thatthe lower income population (ca.100 million people) has the high-est prevalence of untreated toothdecay but accounts for less than20 percent of dental expendi-tures. In contrast, people in theupper third of the income distri-bution have relatively little un-treated disease but account for 53percent of expenditures. In otherwords, the population that hasthe resources to pay for dentalservices is in excellent oral health.The population that has most un-treated disease cannot afford topay for private sector dental serv-ices, and public programs for thepoor have significant limitations(i.e., Medicaid, safety net clinics).These trends have major implica-tions for private dental practice.Namely, the effective demand forrestorative care, the financialmainstay of most general prac-tices, is declining. In 1959, 42 per-cent of general practitioner (GP)services were restorations and in

2005, 12 percent. In the future,restorations are likely to accountfor an even smaller percentage ofGP dental services.

While there are other oral dis-eases that require treatment, andmore elderly are dentate and vis-iting dentists, these are not sub-stitutes for fewer restorations. Asrestorative care declines, dentistsare becoming more dependent fi-nancially on diagnostic and pre-ventive services. Prosthetics andspecialty services remain a rela-tively small and declining compo-nent of the average generaldental practice.

It is important to recognize thatthe current dental education anddelivery systems were organizedto provide care to a populationwhere tooth decay was rampant.This is no longer the case, and thetrends are clear—less tooth decayand especially among upper in-come groups. This raises a basicquestion: How many dentists areneeded in the future to meet the

THE NEXT 150 YEARS

WHERE ARE WE GOING IN DENTISTRY?

Trends


effective demand (in contrast toneed) for dental care?

Science and Technology No one person can predict the sci-entific developments in eachmajor area of biomedical researchthat will impact the future prac-tice of dentistry. It is possible tomake some general predictions.First, the billions of dollars spenteach year on biomedical and tech-nology research by governmentsand private industry in developedcountries will lead to more effec-tive diagnostic, preventive andtreatment methods. This will re-sult in new and improved commu-nity and practice level preventivemethods that will further reducethe incidence of caries and peri-odontal disease. More treatmentswill be available that do not re-quire doctoral level training and

can be delegated to auxiliary per-sonnel (e.g., Atraumatic Restora-tive Treatment). At the same time,some new treatments will requireadvanced scientific training (e.g.,stem cell-derived tooth trans-plants).

Second, research on basic diseaseprocesses will result in the closerintegration of dental and medicalcare. The relationship betweenperiodontal disease and a host ofsystemic medical conditions hasreceived a great deal of attention(e.g., type II diabetes). Less wellknown is the impact of medicaltreatments on oral physiology(e.g., salivary flow) and diseases(e.g., xerostomia and caries). Thisis a growing problem as the pop-ulation ages and takes more med-ications. Finally, it is likely thatsome new therapies to prevent

and treat oral diseases will involvethe use of medications that havesystemic side effects. Thus, bothdentists and physicians will needto have a greater appreciationand understanding of the basicpathophysiology and treatmentof conditions that have both oraland systemic manifestations.Overall, advances in biomedicaland technology research will leadto significant further improve-ments in oral health. Dentists willneed a greater understanding ofhuman biology and the clinical(dental and medical) sciences touse these advanced therapies andto interact effectively with otherhealth professionals.

Delivery SystemThe dental care delivery systemevolved over the past 200 years inresponse to local market forces.


While these market forces arenever static, they are now in a pe-riod of relatively rapid change.This review examines one impor-tant area of change, the forma-tion of group practices.

Until recently, the dominant prac-tice model was independent solodentists. Ten years ago, they rep-resented almost 85 percent of pri-vate practicing dentists. Solopractices dominated, becausethey were able to deliver care justas efficiently as group practices.Over the past 20 years, solo prac-tices did increase in size (i.e., op-eratories, staff and equipment). Inpart, this resulted from healthierpatients who primarily needed di-agnostic and preventive serviceswhich, in large part, were dele-gated to dental hygienists. Den-tists also employed more dental

assistants and administrative staffto increase practice efficiency. Now, the number of group prac-tices is increasing and solo prac-tices decreasing. The reasons forthis change are not fully under-stood but are probably related topractice efficiencies related tolarger size. Examples include in-creases in the size and complexityof practice staff, greater use ofexpensive technology, and betteraccess to the capital needed toconstruct, equip and operate dental offices. Another grouppractice advantage is the avail-ability of more dental graduateswho have substantial educationaldebt and are unable to purchasetheir own practices.

Many groups are made up ofabout five offices with two to fivedentists per office. At this time,

there are not many practices with20 or more dentists in the samelocation. Likewise, most grouppractices are not part of larger in-tegrated medical care systems. Itis still unclear who owns thesenew group practices: dentists, cor-porations or others.

In 10 years, group practices willbecome a significant componentof the dental delivery system inmany markets, and they will em-ploy thousands of dentists. This isa major change from the currentdental care system, but it is essen-tially the same delivery modelthat now exists in medicine.

As these groups begin to exerttheir influence at the local marketlevel, they are likely to come intoconflict with solo practitioners.This is because of different finan-


cial incentives. For example,group practices are much betterpositioned to gain from the em-ployment of dental therapiststhan solo dentists. Likewise,group practice companies willwant larger organizations to buythem and may advocate forchanges in dental practice acts topermit non-dentist ownership ofdental practices.

It is also reasonable to predictthat some group practices will tryto contract directly with employ-ers to deliver care to employeesand dependents. This will putthem in competition with insur-ers. A major unresolved issue isthe interest of large medical caresystems (e.g., Accountable CareOrganizations) in owning and op-erating dental practices. To date,this does not appear to be thecase, but it is too early to predicthow medical care systems will de-velop vis-à-vis dentistry.

ImplicationsSo, what impact will the changesjust described in oral health, thebiomedical sciences, and marketforces have on dental educationand practice? It is perilous tomake predictions, because manychanges will take place over thenext 25 or more years that cannotbe predicted. With this in mind,here are few cautious remarks:

Dental EducationDental schools are facing majorchallenges because public supportis declining and educational debtmay soon reach unsustainable lev-els. At the same time, the number

of schools and graduates is in-creasing rapidly, but the demandfor dental care is decreasing.Other professions, such as lawand veterinary medicine have re-cently faced similar challenges,and they experienced dramaticdeclines in applicants. This maywell occur in dentistry, as dentalgraduates find it increasingly dif-ficult to pay back hundreds ofthousands of dollars in educa-tional debt.

If this does happen, will mostdental schools survive by downsiz-ing and operating more effi-ciently or will many be forced toclose? Unfortunately, based on asimilar supply and demand imbal-ance in the 1980s, the latter out-come is most likely. This will be adifficult period for the dental education community, and it willlead to some basic questionsbeing asked: • How many dentists are neededto provide care to an increas-ingly healthy population?While it is true that a large per-centage of the American peopledo not have adequate access todental care, this is not becausethere are too few dentists. Theaccess problem will not besolved until American taxpayersdecide to provide the poor ade-quate public dental insurance.

• What is the appropriate level ofdental school training in thebiomedical and clinical dentaland medical sciences? Researchin the biomedical sciences willproduce new therapies that require a strong science back-ground, and more patients will

have related oral and systemicdiseases.

• Should graduates be required tospend another two or threeyears in residency training, sothey are well trained to providemost dental services and towork efficiently with a full arrayof clinical and administrativestaff and advanced technology?

• Should the education of dentistsand physicians be more closelyintegrated? Clearly, it is goingto be very difficult to operatesmall dental schools efficientlyand still provide students ahigh-quality education. Closerintegration with medical schoolsmay offer major operating effi-ciencies.

• Is dentistry a learned profession(e.g., law, medicine) or a doc-toral level technical occupation(e.g., optometry)? If the former,the education of dentists must bebased in research-intensive uni-versities, and dental schools haveto provide faculty the time andresources necessary to competesuccessfully for research grantsand generate new knowledge.

PracticeDentists also face serious chal-lenges. At the national level dental utilization rates and perperson expenditures began to de-cline five years before the 2007/08economic recession, and these declines are reflected in lowerpractitioner incomes. At the sametime, dentists are faced with arapid increase in the supply ofdental services, resulting frommore graduates and the greateruse of auxiliaries.


How will the majority of dentistswho are still in solo practices respond to these challenges? • Similar to physicians in the1990s, will they form Independ-ent Practice Associations to com-pete with large dental grouppractices and to increase theirnegotiating leverage with pur-chasers?

• Will many solo dentists decideto form or join group practices?The past 20 years have seen thevirtual collapse of solo medicalpractice; the majority of physi-cians are now in some form ofgroup practice.

• Will some dentists see advan-tages in becoming part of largemedical care organizations? Ofcourse, this depends on hospi-tals and medical group practicesmaking a decision to offer den-tal services.

In all likelihood, all these optionswill be pursued, as dentists re-spond to different local marketsupply and demand challenges.

Long TermIt is too early to judge how thechallenges faced by the profes-sion will be resolved. If the rightdecisions are made in the nextseveral years, the long-term fu-ture (e.g., 20 or more years) isbright. This is because most Amer-icans value and want more dentalservices. National norms of gooddental health are high, and allpeople want a functional and es-thetic dentition. Americans alsohave empathy for the less fortu-nate, so in time public resourceswill be available to provide theunderserved financial access to

basic dental services. What all thismeans is that there is a strong un-derlying demand for dental care,if it is affordable.

At the same time the practice ofdentistry has the opportunity toevolve into a medical disciplinewith a firm foundation in the bio-medical and clinical sciences. Re-search is providing dentists inpublic health and clinical practicemore evidenced-based methodsto improve oral health by commu-nity prevention programs andpersonnel preventive and curativeservices, respectively. These advances will make dentistry aneven more satisfying and reward-ing career.

ConclusionsThis review suggests that the den-tal education community andpractitioners face some difficultyears ahead, but the long-termfuture is very promising. Yet, thechallenges now facing the profes-sion are real and must be ad-dressed. Indeed, the real danger isto assume that there are no prob-lems, and that the status quo willcontinue into the foreseeable future. This is clearly not the case.

What dentistry needs are leaderswho will come together and ad-dress these problems, realizingthat they are contentious andlikely to lead to conflict amongpeople of “good will.” They needto take a long-range perspectiveof what is best for the Americanpeople and the profession. Theyneed to convince a disparategroup of dental educators andpractitioners to come togetherand pull in the same direction.They need to convince the profes-sion and the public that this is thetime to make fundamental im-provements in the current systemfor educating the dental work-force and delivering care to thepopulation.

While the times are challenging,this is also a period of opportu-nity and optimism. This idea iscaptured in the famous quotefrom President John F. Kennedy.

“When written in Chinese, theword 'crisis' is composed of twocharacters. One represents dangerand the other represents opportu-nity.”

“When written in Chinese, the word'crisis' is composed of two characters.One represents danger and the otherrepresents opportunity.”

— President John F. Kennedy